Sunday, April 22, 2012

Bringing Market Forces to Medicine: Exporting Patients, Importing Doctors

 From the article "Club Med" by James Surowiecki in the New Yorker:

"If more Americans sought care abroad, it wouldn’t just save them money; it could also help control medical costs at home. Medical tourism can be considered a kind of import: instead of the product coming to the consumer, as it does with cars or sneakers, the consumer is going to the product. More medical tourism would increase free trade in medical services, something there has not been much of in the past. The U.S. has been religious about breaking down barriers to free trade, especially in manufacturing and service industries, exposing ordinary workers to foreign competition. But health care has been insulated from the forces of globalization. This has been great for hospitals and doctors, but less good for consumers. It’s one reason that the cost of health care has risen so much faster than that of almost everything else.

There are other ways to bring free trade to medicine, too. As the economist Dean Baker has argued, making it easier for foreign doctors who met standardized requirements to practice in the U.S. would hold down costs and improve service. In addition to exporting patients, we could import doctors. Politically speaking, of course, this all seems improbable, because the medical industry is a powerful lobby and uninterested in competition. But the reality is that, unless we find some other way to rein in health-care costs, the logic of free trade in medicine is going to become harder to resist."

42 Comments:

At 4/22/2012 5:02 PM, Blogger hal said...

More private, for profit med schools are needed as well.

 
At 4/22/2012 5:11 PM, Blogger Hydra said...

Yup. Not sure about for profit Med schools.
Other for profit schools have a bad Rep.

 
At 4/22/2012 5:16 PM, Blogger hal said...

Hydra, profit = growth

growth in enrollment lowers tuition prices.

 
At 4/22/2012 5:22 PM, Blogger VangelV said...

Yup. Not sure about for profit Med schools.
Other for profit schools have a bad Rep.


Really?

 
At 4/22/2012 5:43 PM, Blogger Larry G said...

what countries do we expect to sell market-based health care?

Not the G20 countries, right?

so we're talking about 3rd world and developing countries?

when we say that health care costs are high - do we also say that they are twice as much in this country than the G20 countries?

so we're talking about health care from countries whose own citizens ... do not have access to universal health care, right?

 
At 4/22/2012 5:49 PM, Blogger Ken said...

Hydra,

Other for profit schools have a bad Rep.

They have a bad rep till you compare them to the non-profit government run schools.

 
At 4/22/2012 5:56 PM, Blogger Larry G said...

how would a foreign doctor get your complete medical history?

the article mentioned "standards".

Are we talking about US board-certified physicians?

Is there an international certification body for doctors/medical care providers?

When US News & World Report ranks the hospitals do they include the foreign ones?

 
At 4/22/2012 8:24 PM, Blogger Doom said...

It has been proven that competition is the answer. The case study I use in debates with colleagues is Lasik surgery. Generally elective surgery and not covered by insurance. Started out at $5000, and over time has migrated down below $1000.

Get them to release the medical billing codes and allow us to shop.

 
At 4/23/2012 8:19 AM, Blogger VangelV said...

how would a foreign doctor get your complete medical history?


I would give it to him. Why wouldn't you?

Are we talking about US board-certified physicians?

I think that we are talking about competence. I would feel a lot better if that were certified by a private standards organization rather than a government monopoly.

When US News & World Report ranks the hospitals do they include the foreign ones?

I do not think that the rankings matter as much as you might. What matters is the competence of the individual doctors to handle a particular treatement.

 
At 4/23/2012 8:45 AM, Blogger Larry G said...

how would a foreign doctor get your complete medical history?


I would give it to him. Why wouldn't you?

sure.. how would you actually get it - for multiple doctors and since you're not getting permanent care, routine care how would you "copy" your regular American docs?



Are we talking about US board-certified physicians?

I think that we are talking about competence. I would feel a lot better if that were certified by a private standards organization rather than a government monopoly.

I believe there is a world certification authority but I wonder if it is as rigorous as the US standards.

When US News & World Report ranks the hospitals do they include the foreign ones?

I do not think that the rankings matter as much as you might. What matters is the competence of the individual doctors to handle a particular treatement.

the hospital matters guy - when it comes to specific things like cancer or kidney or liver disease.

Are you only talking about "elective" surgery or life-threatening kinds also?

do you think 3rd world/developing nations have things like trauma centers to fly you to if your operation encounters "complications"?

 
At 4/23/2012 1:02 PM, Blogger james said...

This is a very interesting trend in healthcare. The outsourcing of health services to places somewhere in the world where prices are much lower. Quality is my biggest concern here. Although in the end this trend may help moderate the severe inflation occurring in the price of healthcare services. Healthcare providers will be forced to become more Efficient in order to retain their customers. The biggest beneficiary will be those using the healthcare system. This trend if it continues and really expands will most certainly mean lower prices and better services for consumers of healthcare services. In addition to this money that would have been increasing going into the healthcare system will now be flowing into other sectors of the economy. A positive economic development. This is also one of the few cases in healthcare where the consumer is benefiting.

 
At 4/23/2012 2:05 PM, Blogger VangelV said...

sure.. how would you actually get it - for multiple doctors and since you're not getting permanent care, routine care how would you "copy" your regular American docs?

I have a copy of my own records in case they are needed. I have recorded every trip that my kids have taken to the doctor and any problems that they may have had so there is no issue on that front. And I get copies of all relevant tests that produce any result that is more than one standard deviation off. This does not take up much time or space. And it certainly helps me double check the opinion of my doctors if there is any issue that needs to be resolved.

I do not see how any of this is a problem for anyone seeking treatment.


I believe there is a world certification authority but I wonder if it is as rigorous as the US standards.


Frankly I don't care. For 99% of needs an experienced and competent nurse would be even better than the average doctor. When it comes to specialists you want to go with the best if you can afford it because that increases your odds of success. would take the best heart specialist in Singapore, Bangkok, or Hong Kong over your typical American heart specialist.

the hospital matters guy - when it comes to specific things like cancer or kidney or liver disease.

Are you only talking about "elective" surgery or life-threatening kinds also?

do you think 3rd world/developing nations have things like trauma centers to fly you to if your operation encounters "complications"?


You would be amazed what you find in many hospitals in developing nations. The best hospitals are cleaner, better equipped, and better staffed than your finest hospitals in the US. Even the crappy EU systems have some amazing private clinics that offer fabulous care if you can afford it.

 
At 4/23/2012 4:04 PM, Blogger Larry G said...

are you saying that if your kid had a serious, life-threatening issue that may well involved weeks/months of follow-up care that you'd cart him/her to Thailand or wherever with a packet of copies of their records?

seriously?

 
At 4/23/2012 8:40 PM, Blogger VangelV said...

are you saying that if your kid had a serious, life-threatening issue that may well involved weeks/months of follow-up care that you'd cart him/her to Thailand or wherever with a packet of copies of their records?

seriously?


I would trust some of the Thai hospitals to provide the care that he needs in a timely fashion much more than the Canadian hospitals. Seriously.

 
At 4/23/2012 8:51 PM, Blogger Larry G said...

you'd trust 3rd world hospitals over American hospitals?

I doubt seriously that you'd fly a kid with life-threatening problems to a 3rd world country for care.

 
At 4/23/2012 9:22 PM, Blogger VangelV said...

you'd trust 3rd world hospitals over American hospitals?

I doubt seriously that you'd fly a kid with life-threatening problems to a 3rd world country for care.


Your ignorance is showing Larry. The world is much bigger than the US and some of the best services around can be found outside of the US.

In 1996 or 1997 my wife and I took a little trip to the Seychelles. While on an excursion to Moyenne I sat around and had a few beers with Brendon Grimshaw, an eccentric fellow who owned the island. Some time in the conversation I asked about the local health care. He said that it was fine but what he and a lot of other people did was travel to Singapore or Bangkok for their annual checkups.

Even at that time, it is a lot better now, one could get an appointment set up early in the morning and have a nurse take you to all of the testing facilities for a few hours. Some time after lunch you would be done and free to go sightseeing. Later in the evening a doctor would call you at your hotel with all of the results. The information would be provided to you and mailed to your local doctor. If you needed serious attention you could get any procedures done immediately. In a country like Canada you may be dead before you can get the procedure done. In the US the medical services would cost you three times more because you wind up paying for all of the 'free' services for the people who use the emergency rooms but cannot pay.

You seem to have no clue about things that you are commenting on yet again. I suggest that you learn.

Thailand's Two Leading Hospitals

If you don't like the Bumrungrad Medical Center you can get wonderful care at Singapore's Parkway Health Hospitals. While my friends prefer the smaller clinics I found the service at HK's Adventist to be perfectly fine. But then I had no problems with the quality of care in hospitals that I visited in Xi'an, Chengdu, or Lhasa. There are hundreds of great hospitals all over the world. Most of them offer much cheaper services at the same quality levels as you can get in the best US hospitals.

 
At 4/24/2012 12:28 AM, Blogger Cody Rice said...

I think this post nails it.

Transportation costs coupled with some of the highest medical costs in the world make the us exceptionally unnatractive for international patients. most people can get good enough healthcare in their country, and if they can't, the us is certainly too expensive anyways...

It is going to come down to substantial government deregulation and a major introduction of corporate comptetition before we can even begin to talk about bringing anyone into the us for healthcare.

 
At 4/24/2012 6:48 AM, Blogger Larry G said...

just call me a serious skeptic that people are going to get routine care or care for chronic or life-threatening issues.

this is basically about elective treatments.

If you have Cancer, you want to go to the best Cancer centers in the world - and those are in the US not Thailand.

 
At 4/24/2012 7:31 AM, Blogger VangelV said...

Transportation costs coupled with some of the highest medical costs in the world make the us exceptionally unnatractive for international patients. most people can get good enough healthcare in their country, and if they can't, the us is certainly too expensive anyways...

I think that the point has been missed. If you can get an appendectomy in a great hospital in Bangkok for $250 why would you even consider flying to the US even if it were free? The Thai hospitals have better equipment than the average American hospital and provide a higher standard of quality than is available to the AVERAGE American. While the high end hospitals in the US offer similar quality the cost is much higher.

 
At 4/24/2012 7:35 AM, Blogger Larry G said...

you're going to risk your life by taking the time to fly somewhere instead of going straight to the local ER?

gazooks!

 
At 4/24/2012 7:42 AM, Blogger VangelV said...

If you have Cancer, you want to go to the best Cancer centers in the world - and those are in the US not Thailand.

The hospitals I cited are better than 99.9% of American hospitals and offer care at a fraction of the cost. They are certainly quicker to adopt promising procedures faster than the American system, which is still held back by the trial lawyers and the regulatory system.

And if you think about it the limits to treatment make certain options unwise regardless of how 'advanced' the hospital happens to be. The problem for the American hospitals is that by the time a treatment becomes good enough it has been adopted by other hospitals who can offer it at just as high a quality but at a much cheaper price.

If you can't get past the paywall for the link above try here.

 
At 4/24/2012 7:45 AM, Blogger Larry G said...

when I see US&WR publish - "the best hospitals in the world"... perhaps I'll be better convinced.

Until then.. for Cancer I see Anderson in Texas and Mayo in Minn and John Hopkins in MD.

but since you've looked into it.. perhaps you can provide the top 5 or 10 in the world from you point of view.

 
At 4/24/2012 7:49 AM, Blogger Larry G said...

re: "How doctors die"

doctors know more than non-doctors especially about the road ahead for disease and especially life-threatening diseases.

they know the realities AND because of their avocation - accept them.

The average person does not know the true dimensions of a given disease and it's outcome and to be honest, most folks, unlike doctors, do not accept death as inevitable whereas doctors are faced with it every day.

 
At 4/24/2012 8:31 AM, Blogger VangelV said...

you're going to risk your life by taking the time to fly somewhere instead of going straight to the local ER?

If I broke my leg I got 'lucky' and got to jump in front of the line. For that ER would be fine. But if I had trouble breathing or have tremors and need a special test that has a six month wait time, as my cousin did, I might consider taking a little vacation in Bangkok and having the test done a day after my plane touched down. If I planned my trip right the savings from my tailored shirt and suit purchases would pay for the trip and the hotel stay.

 
At 4/24/2012 9:00 AM, Blogger VangelV said...


The average person does not know the true dimensions of a given disease and it's outcome and to be honest, most folks, unlike doctors, do not accept death as inevitable whereas doctors are faced with it every day.


Ignorance of the outcome only decreases the quality of life and one's wealth. The only hope for a great outcome is to be a part of some new research study that extends your life without decreasing your quality of life. But that is not what you get in the cancer clinics. You simply get the approved treatments that would be rationed in the UHC system. If you had to pay for those treatments out of your own pocket and wanted to try them it is better to go abroad where you can get the same high quality care for a lot less money.

I provided you with a link to a few great hospitals abroad. Here is a link to a Forbes article that gives you a few more of the top hospitals that people are evacuated to when there are emergencies. Note that most of the best facilities are not covered because they are small private clinics.

You may also wish to look at, Why Should You be a Medical Tourist? or Where to go for medical tourism?.

 
At 4/24/2012 9:09 AM, Blogger Larry G said...

re: dealing with realities.

if the reality is that your son or daughter has a 10% chance of living, chances are you're going to go for the 10% chance, right?

with respect to best hospitals, I'd look for rankings that utilize specific metrics - like seen in USN&WR.. things like how many open heart surgeries are done and the percent survivals, etc.

Anecdotal evidence as seen in the Forbes article is lazy, misleading and in large part irrelevant for most folks with specific problems.

When I see the "10 best cancer hospitals in the world" using specific metrics.. and it includes Thailand, AND the UHC countries, et al I'd be more interested.

Until then I'll stick with the US ratings.

 
At 4/24/2012 9:14 AM, Blogger Larry G said...

My personal approach by the way is to first find out how many times the professional has performed a procedure and how often she does it.

someone who does heart surgery almost every day and has a good survival rate - matters for US hospitals.. for any hospital in the world.

In order to have those metrics, the doctor and hospital have to be willing to provide the metrics.

I'd also listen to any factors the hospital and doctor think are important but not covered in the sanctioning organization metrics - as long as those metrics are ones that can be verified and compared with other facilities.

What I shy away from is anyone who has data that is not easily verified and comparable with equivalent operations.

 
At 4/25/2012 4:43 AM, Blogger natasha woreen said...

I think it can work if promoted the right way. O went through the comments and mostly people are unsure about the quality of medical care and trusted doctors. But a lot of other countries also have world class med schools just like US. We come across a lot of news related to successful treatment of deadly diseases and they don't only come from US. Just because some country has lower exchange rate, it doesn't make it poor in quality of people.

 
At 4/25/2012 8:22 AM, Blogger VangelV said...

if the reality is that your son or daughter has a 10% chance of living, chances are you're going to go for the 10% chance, right?

It depends on the needs of my other children and the limits to my finances. I would not condemn all of my children to poverty because one of them got a disease with a very high mortality rate. And if I chose to take the risks why wouldn't I take the high quality care at the most affordable price? That is no longer the US.

with respect to best hospitals, I'd look for rankings that utilize specific metrics - like seen in USN&WR.. things like how many open heart surgeries are done and the percent survivals, etc.

On that basis many foreign hospitals do much better than the US once you adjust for relevant factors. The problem is that USN&WR does not do a thorough enough job.

Anecdotal evidence as seen in the Forbes article is lazy, misleading and in large part irrelevant for most folks with specific problems.

It is not anecdotal. When Saudi or HK billionaires fly to Bangkok or Singapore for treatment instead of the London or New York we have all the information that we need about quality of service.

When I see the "10 best cancer hospitals in the world" using specific metrics.. and it includes Thailand, AND the UHC countries, et al I'd be more interested.

But that is your problem. You don't have the metrics. You are assuming that the US hospitals are the better option even though the market says otherwise.

 
At 4/25/2012 9:11 AM, Blogger Larry G said...

"But that is your problem. You don't have the metrics. You are assuming that the US hospitals are the better option even though the market says otherwise."

no.. I NOT assuming what I do not know and if I do not know then I have to go on what I do know.

I'm totally open to more evidence but metric info is (in my view) more reliable than anecdotal.

I'm from the Reagan 'trust but verify" school on issues like this.

If it's not in Consumers or USN&WR, then what other resources are available?

 
At 4/25/2012 10:02 AM, Blogger Larry G said...

" Anecdotal evidence as seen in the Forbes article is lazy, misleading and in large part irrelevant for most folks with specific problems.

It is not anecdotal. When Saudi or HK billionaires fly to Bangkok or Singapore for treatment instead of the London or New York we have all the information that we need about quality of service."

do you actually know how many get treated and what the outcomes are?

if you don't now then are you basing your view on what others like Kings "believe"?

do you really think that you'd get the same level of care that the King got anyhow?

I'll take metrics over anecdotal.

 
At 4/25/2012 11:16 AM, Blogger VangelV said...

do you actually know how many get treated and what the outcomes are?

if you don't now then are you basing your view on what others like Kings "believe"?

do you really think that you'd get the same level of care that the King got anyhow?

I'll take metrics over anecdotal.


You don't have the metrics but assume the US does better. As I pointed out, the medical tourism industry data shows that the hospitals that I am talking about have been growing rapidly. Note that Lee Kuan Yew flew to Singapore to get his heart trouble taken care of. He did not choose the London hospitals because they were inferior. And he did not choose the shorter flight to New York.

As I said, I prefer to look at what the market is telling me. Feel free to go by what you believe is true. It will still not help your case.

 
At 4/25/2012 11:31 AM, Blogger Larry G said...

" You don't have the metrics but assume the US does better.:

well no. I just don't partake if I don't have metrics. they actually may be better but I have to know.

" As I pointed out, the medical tourism industry data shows that the hospitals that I am talking about have been growing rapidly."

yes.

"Note that Lee Kuan Yew flew to Singapore to get his heart trouble taken care of. He did not choose the London hospitals because they were inferior. And he did not choose the shorter flight to New York."

noted.

"As I said, I prefer to look at what the market is telling me. Feel free to go by what you believe is true. It will still not help your case. "

the "free market" is very deceptive at times especially when it can convince people that other factors besides metrics are "better".

I won't buy a car because it is "popular" unless Consumers tells me that it has good metrics also.

I won't follow the herd just because there is a herd.

I have to be convinced that there is a GOOD REASON why there IS a herd.

I do not buy lottery tickets when the jackpot increases and ticket sales skyrocket.

I do not assume that if the King of ZuluLand comes to the US for treatment that I would get the same treatment ....unless of course there is some data to confirm it.

 
At 4/25/2012 2:04 PM, Blogger VangelV said...

well no. I just don't partake if I don't have metrics. they actually may be better but I have to know.

Then find out. A place to start would be asking a simple question. If the US hospitals were so much better why are so many Americans going abroad to get surgical procedures done at a much lower cost? Do you think that these Americans are fools who don't do their homework and are just taking chances? And if you do not trust your fellow citizens what about the rest of the world? Why are so many middle class and rich getting their care at specialty hospitals such as those that I referenced?

the "free market" is very deceptive at times especially when it can convince people that other factors besides metrics are "better".

No. The market tells us what all those consumers decided. I would trust the millions of individual choices much better than assessments by institutions that do not have all of the data and are biased towards a certain outcome.

Haven't you noticed that the ratings are not as meaningful that you claim? A great research hospital that tops the ratings in general may not necessarily be better than a clinic that specialises in the particular problem that you have to have solved. There are specialty clinics in India that are better than 99.9% of hospitals in the US for the particular procedure that they specialize in. If you need that procedure you are better off paying one tenth the price in India than having it done in the US. The savings will pay for your travel and stay as well as a nice vacation and a bit of shopping.

I won't buy a car because it is "popular" unless Consumers tells me that it has good metrics also.

A lousy product does not become a category leader. It sells many units because it offers to people something that they want at a price that they are willing to pay.

I won't follow the herd just because there is a herd.

I have to be convinced that there is a GOOD REASON why there IS a herd.


How ironic. The ignorant man with populist sentiments does not see that he is a part of a herd.

I do not assume that if the King of ZuluLand comes to the US for treatment that I would get the same treatment ....unless of course there is some data to confirm it.

If he uses the same surgeons then he gets the same treatment where it matters. The superficial stuff is very different but that is not what matters.

 
At 4/25/2012 3:55 PM, Blogger Larry G said...

"Then find out. " I cannot force them to provide metrics.

in terms of "herds" buying crappy cars and crappy medicine ...surely you jest.

the American people will buy anything no matter how crappy it is if it is "presented" them in the right way.

How many signed up for houses they could not afford?

How many owe students loans that in total now exceed consumer credit and auto loans?

you ask: " A lousy product does not become a category leader"

really? how many folks pay truly outrageous prices for cell phone plans and pay $3 a liter for coke or 25 for coffee because they buy it buy the 8oz cup?

you gotta be kidding guy.

do you know what the average FICO score is?

 
At 4/25/2012 7:58 PM, Blogger VangelV said...

"Then find out. " I cannot force them to provide metrics.

You don't have complete and accurate metrics for any institution, including those that were being evaluated by US News & World Report.

in terms of "herds" buying crappy cars and crappy medicine ...surely you jest.

No. Consumers are better judges of what they want than you are. The Civic and Corolla did as well as they did because they were good cars, not because consumers were stupid. The i-Pad sold well because it gave consumers a device that they needed and wanted.

the American people will buy anything no matter how crappy it is if it is "presented" them in the right way.

Just a few words for you.

Apple Newton, Microsoft Zune and Vista, Sony Betamax, Ford Edsel, EuroDisney, New Coke. The marketing behind Ford, Sony, Apple, Coke, Disney, and Microsoft could not turn average products into successes. You are totally wrong because you are clueless about how markets work.

How many signed up for houses they could not afford?

They could afford them. The problem was that they could not afford them when house prices stopped going up and really could not afford them when they went down.

really? how many folks pay truly outrageous prices for cell phone plans and pay $3 a liter for coke or 25 for coffee because they buy it buy the 8oz cup?

What is your point? That Coke makes bad products? Or that people should buy pop in bigger bottles?

You really are clueless. No wonder you are such a supporter for central planning. But everyone is not as clueless as you are.

 
At 4/25/2012 8:10 PM, Blogger Larry G said...

"Then find out. " I cannot force them to provide metrics.

You don't have complete and accurate metrics for any institution, including those that were being evaluated by US News & World Report.

that's true. I can only go on what is available to me though.


"in terms of "herds" buying crappy cars and crappy medicine ...surely you jest.

No. Consumers are better judges of what they want than you are. The Civic and Corolla did as well as they did because they were good cars, not because consumers were stupid. The i-Pad sold well because it gave consumers a device that they needed and wanted."

and the crappy pickups and SUVs that dominate US vehicle sales?

The IPAD - IMHO is overpriced and has a nazi-style software environment.


"the American people will buy anything no matter how crappy it is if it is "presented" them in the right way.

Just a few words for you.

Apple Newton, Microsoft Zune and Vista, Sony Betamax, Ford Edsel, EuroDisney, New Coke. The marketing behind Ford, Sony, Apple, Coke, Disney, and Microsoft could not turn average products into successes. You are totally wrong because you are clueless about how markets work. "

really?

How many signed up for houses they could not afford?

They could afford them. The problem was that they could not afford them when house prices stopped going up and really could not afford them when they went down.

they were ...speculating? oh the horrors. would folks really do dumb stuff like that?

yes.



really? how many folks pay truly outrageous prices for cell phone plans and pay $3 a liter for coke or 25 for coffee because they buy it buy the 8oz cup?

What is your point? That Coke makes bad products? Or that people should buy pop in bigger bottles?

the latter...

You really are clueless. No wonder you are such a supporter for central planning. But everyone is not as clueless as you are.

okay.

 
At 4/26/2012 7:25 AM, Blogger VangelV said...

that's true. I can only go on what is available to me though.

That is your problem. Without the accurate and complete data all you have is your feelings and the subjective opinion of analysts who typically have a very large bias. On the other hand you ignore what the market is telling you and dismiss all those Americans who have chosen to go to other countries to get the procedures that they need. Or the fact that insurance companies also send their clients abroad for those same procedures. Or the fact that people of means for whom cost is not an issue choose those hospitals and clinics over American alternatives. When a Saudi prince goes to Bangkok instead of New York to have his heart procedure done it isn't because the wants to save $35,000 because for him the money is not a problem.

and the crappy pickups and SUVs that dominate US vehicle sales?

The IPAD - IMHO is overpriced and has a nazi-style software environment.


There is nothing HUMBLE about your opinion. You are one of those fools who is arrogant enough to believe himself more capable of making decisions for other people than they are themselves. For some people pickups and SUVs are a better alternative than the type of car that you would pick.

And your opinion is not shared by the millions of consumers who have purchased iPads. Given the fact that you are an irrational and ignorant fool I would rather trust the market than your preferences or opinions.

really?

You wrote that people would buy anything, "ithe American people will buy anything no matter how crappy it is if it is "presented" them in the right way."

I pointed out that the marketing power of Ford, Sony, Apple, Coke, Disney, and Microsoft could not make the Newton, Zune, Vista, Betamax, Edsel, Euro Disney or New Coke a success. That makes your statement obviously wrong and exposes just how clueless you really are on yet another subject that you keep talking about.

Did Disney's millions make a hit out of John Carter? Didn't Heaven's Gate push UA into bankruptcy even though the promotion was massive? How about Columbia's push for Ishtar? Big stars, big budget, good locations in Morocco and New York City. A decent scriptwriter. A great cinematographer. Massive publicity. Yet, it was a total bomb. Note that this is an area where your argument should be most influential. After all, movies is the one place where marketing and advertising budgets should be most effective. But history shows us that lousy movies could not be saved even by the biggest of sales jobs by the studios. And that great ones don't need much of a push to become a big success.

As I pointed out many times, you are an irrational and ignorant individual who overestimates his own knowledge and judgment. Instead of commenting on issues that you are unfamiliar with and have not thought through it might make a lot more sense to pursue a strategy that would have you learn something.

 
At 4/26/2012 5:00 PM, Blogger VangelV said...

they were ...speculating? oh the horrors. would folks really do dumb stuff like that?

yes.


What does this have to do with anything? People always make value judgments. You are arguing that you are in a better position to tell Tom, Dick, and Harry what to buy that they are. I am saying that the market is a better guide than you are.

 
At 4/26/2012 5:23 PM, Blogger Larry G said...

" What does this have to do with anything? People always make value judgments. You are arguing that you are in a better position to tell Tom, Dick, and Harry what to buy that they are. I am saying that the market is a better guide than you are. "

not me...

each to his own and to his own FICO score courtesy of others judging you.

and as far as I know that has nothing to do with govt... we participate in the financial markets and others keep track of our "performance" and rank it with a score.

speculation is fundamentally an entrepreneurial endeavor... but not all entrepreneurial endeavors are particularly sane or rational either.

If you're gonna speculate - make it your job - not a hobby with your home.

My view is that you don't gamble with money you cannot afford to lose.

that's means.. gamble only with money you can afford to lose.

when you phrase it that way - it tends to get to who you really are. If you are well off and can afford to gamble.. good... you deserve it.

If you only asset is your house and you're gambling with it... bad karma....

 
At 4/26/2012 5:44 PM, Blogger VangelV said...

not me...

each to his own and to his own FICO score courtesy of others judging you.


You really should read your own postings. You favour government meddling and oppose free markets because you do not trust people to make their own decisions.

and as far as I know that has nothing to do with govt... we participate in the financial markets and others keep track of our "performance" and rank it with a score.

What the hell are you talking about? You support government meddling in health care, regulation of consumer products, drug regulation, licensing, etc., etc., etc.

speculation is fundamentally an entrepreneurial endeavor... but not all entrepreneurial endeavors are particularly sane or rational either.

You are diverting from the topic again. People make value judgments all the time. While they clearly choose the actions that they prefer to those that they reject it does not mean that they will be right in the long run. But as the markets prove they will clearly be right more often when they make their own decisions then when some bureaucrat makes decisions for them.

If you're gonna speculate - make it your job - not a hobby with your home.

The topic is market forces in medicine, not government sponsored bubbles.

My view is that you don't gamble with money you cannot afford to lose.

that's means.. gamble only with money you can afford to lose.


Why even gamble on government sponsored bubbles when there are sure things if you remain patient and clear headed?

when you phrase it that way - it tends to get to who you really are. If you are well off and can afford to gamble.. good... you deserve it.

If you only asset is your house and you're gambling with it... bad karma....


The debate is about market forces in medicine, not how government created the bubble in housing.

 
At 4/26/2012 5:54 PM, Blogger Larry G said...

not me...

each to his own and to his own FICO score courtesy of others judging you.

You really should read your own postings. You favour government meddling and oppose free markets because you do not trust people to make their own decisions.

nope. I just acknowledge that lots of us make bad choices....

and as far as I know that has nothing to do with govt... we participate in the financial markets and others keep track of our "performance" and rank it with a score.

What the hell are you talking about? You support government meddling in health care, regulation of consumer products, drug regulation, licensing, etc., etc., etc.

I was pointing out that FICO scores are non-govt ....I support industry certification but I think there needs to be standards and certification - preferably non-govt.

speculation is fundamentally an entrepreneurial endeavor... but not all entrepreneurial endeavors are particularly sane or rational either.

You are diverting from the topic again. People make value judgments all the time. While they clearly choose the actions that they prefer to those that they reject it does not mean that they will be right in the long run. But as the markets prove they will clearly be right more often when they make their own decisions then when some bureaucrat makes decisions for them.

as long as the govt does not "rescue" them after they make dumb decisions... right?


If you're gonna speculate - make it your job - not a hobby with your home.

The topic is market forces in medicine, not government sponsored bubbles.

I veered off track, eh?


My view is that you don't gamble with money you cannot afford to lose.

that's means.. gamble only with money you can afford to lose.

Why even gamble on government sponsored bubbles when there are sure things if you remain patient and clear headed?

oh..there are PLENTY of non-govt get-rich quick schemes too....


when you phrase it that way - it tends to get to who you really are. If you are well off and can afford to gamble.. good... you deserve it.

If you only asset is your house and you're gambling with it... bad karma....

The debate is about market forces in medicine, not how government created the bubble in housing.

agree... my bad

 

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