Solo Practice Neurosurgeon speaks out on The Trouble with "Single-Payer Healthcare"

[galtgulch]

Dr. McKalip is a Solo Practice Neurosurgeon in St. Petersburg Florida and President of the Florida Neurosurgical Society.

The Trouble With "Single-Payer Healthcare"

By David McKalip, M.D.

Published 05/12/09

Pennsylvania HOUSE Health Council TESTIMONY

David McKalip, M.D.

Chairman, Council on Medical Economics, Florida Medical Association

President, Florida Neurosurgical Society

Chairperson, Florida Taxpayers Union

"Any society that would give up a little liberty to gain a little security will deserve neither and lose both." -- Benjamin Franklin

"Was the government to prescribe to us our medicine and diet, our bodies would be in such keeping as our souls are now." --Thomas Jefferson: Notes on the State of Virginia, Query XVII, 1782.

Thank you for bringing me to testify before the Pennsylvania House Health Care Policy Task Force. I am a private practice neurosurgeon from Florida and for over ten years, I have practiced in academics, small group and solo settings taking care of patients from all walks of life. While in my first practice at San Francisco General Hospital, I saw the many shortcomings of a government run hospital. Even with dedicated professional health care staff, the constant budget shortfalls, debt and politically motivated regulatory burdens drained the hospital there. Patients waited weeks to go to rehabilitation units while patients in private systems went in days. Repeat patients never took responsibility for their own health -- always assuming that the public system would be there for them. I went to San Francisco a young liberal and left two years later a disillusioned doctor. After about two years in private practice I began to realize that only the private sector could deliver high quality affordable health care in the most fair and equitable way without rationing. That is not to say that the current structure of private health care is perfect – it is encumbered by a complex and odd system of financing that few economists would design: third party financing of first dollar coverage. Nevertheless, the care patients receive through private health insurance is far better than that received by those with government funded health care. Better than private or public third party payment is the results produced when patients spend their own money from a health savings account backed by a catastrophic health plan. (But I will discuss that more later).

I saw Medicaid patients for seven years by choice even though Medicaid in Florida pays only 56% of Medicare rates and each patient entering my practice was the equivalent of me writing them a check. I couldn't blame other neurosurgeons who were not taking these patients and I saw patients drive hours to see me. Finally I opted to see Medicaid only for hospital emergencies -- not in my office.

Another publicly run health system also has neglected some of our most valued citizens: The Veterans Administration. Layers of stifling bureaucracy and limited resources have lead to long waits for advanced medical care. At multiple V.A.'s I saw Veterans wait months for a spine surgeon while living with crippling pain or slowly evolving paralysis, get put on another waiting list for surgery and have their surgery cancelled at the last minute simply because there wasn't enough staff to keep working after 3 pm or any interest of the employed physician staff to work harder.

I have seen Medicare patients denied advanced spinal surgical techniques or subject to overnight stays when others go home the same day due to arcane rules. I have had to perform two surgeries on Parkinson's patients for dual brain stimulator pacemakers since Medicare won't pay for the single pacemaker at the same price! I have seen how Medicare patients wait over an hour to see a Nurse Practitioner for 10 minutes and their doctors for 3 minutes and leave confused only to enter the mill again. I have seen referrals to specialists from Nurse Practitioners that a primary care physician could have avoided. But the number of primary care doctors has dropped as Medicare has artificially controlled the amount of payment for their services. I also routinely see able-bodied patients inappropriately granted disability for health care and disability benefits.

What I have seen is the slow death of the medical profession. Unfortunately, the final nails in the coffin are coming as even more arcane rules, price controls and political meddling are envisioned by governments all over the nation. Now I hear that Pennsylvania wants to enter into one of the most dangerous systems of health care financing ever devised: A single payer system.

Many utopian dreamers are motivated by the best of intentions and envision that the best way to achieve high quality health care is to create a system by which the government will control all health care spending and ensure that it is equitable, efficient and proper. They are basing their approach on an economic philosophy that has failed many times in history – one of collectivism and central economic planning. Many of those advocating such a system believe that if an elite group of all knowing and benevolent planners control spending, that nothing but good will result. Unfortunately this had never been the case as evidenced by the fall of the Berlin Wall, the lack of property and individual rights in societies under dictators, and recent examples of failing government-run school systems in America with a never-ending supply of money.

Those advocating single payer systems don't understand that what made America great was not centrally planned economies. Success in America came from free markets where individuals owned their own property and are supported by a rule of law to privately negotiate terms of payment and exchange with willing producers. Those pushing single payer financing mistakenly label the system of private health insurance as a free market when it is in fact an overregulated cartel that relies on political connections to protect its profits. The sad truth is that the American health economy has not had a truly free market for decades since patients don't pay for routine annual health care. And now, when control of health care financing by third parties has lead to runaway medical inflation and rampant dissatisfaction among patients – an expansion of third party control of health care financing is proposed. But this third party would be the State and the State would be forced to finance health services amid shrinking budgets and increasing demands. All while avoiding rationing and interference in the patient-physician relationship. History shows us that this is impossible.

In fact, as I have fought for tax reform in Florida, I have come to discover that the root of most of our budgetary shortfalls in government and even in private industry are unrealistic promises for health care and retirement benefits ultimately funded by the taxpayer. Whether through direct funding of government workers or by supporting private corporations and union members through bailouts – it is the unfunded “legacy costs” that are crippling our country. So it makes no sense that we should expand the burden of taxpayers and the dangers to patients by completely turning over to government the reins of health care financing and ultimately, health care decisions.

Single payer health systems produce consistent results: rationing, waiting lines, better treatment for the well connected, escalating and unsustainable public expense, cookbook medicine and less patient satisfaction. Sadly, the vision for health system reform in D.C. will lead to the same outcomes because they seek to create a command and control structure over medical practice and payment decisions and to further expand third party payment for health care financing.

Many myths are commonly used to support a single payer system are well enumerated in the 2004 Book by John Goodman and Devron Herrick "Lives at Risk" (a summary of their findings is available at the Cato Institute.) One popular myth is that there is a "right to health care". But in Canada the Supreme Court recently overturned the ban on private insurance stating that “access to a waiting list is not access to health care”. The U.S. Supreme Court has ruled that the Social Security program doesn't provide a guaranteed right to its retirement benefits; similar denial of Medicare rights is certainly justified since it is part of the Social Security Act.[1]

Some say quality is higher in socialized systems but technology and doctor time is limited and cancer survival rates are lower. Claims of lower infant mortality rates ignore that calculations in other countries don't include very low birth weight infants Americans try to save or babies that die within 24 hours after birth. Some believe that health care is made available on the basis of need instead of ability to pay when in fact the wealthy and well connected routinely "jump the queue" to get care. In England and France, it is the very existence of a private health care system next to the public system that allows many to receive care -- after paying taxes for the care of others too. Many say we get half the recommended health care compared to other countries. In fact, such conclusions are based on pseudoscience. For instance, a democratic process is used to determine what is "recommended care", rather than science and for these studies, nurses performed hasty chart reviews of substandard records to look at a small number of patients for each care process.

Among the worst myths is that countries with single payer system hold down costs by avoiding administrative expenses. The fact is that these countries hold down costs by rationing. In Britain, the life saving breast cancer drug Herceptin is denied patients on the cold calculation that it is more expensive than the government approved $45,000 per “quality Adjusted Life Year”. At one point, elderly patients there were required to go blind in one eye before receiving treatment for a visual disorder in the other (macular degeneration). There is also the soft rationing of people dying as they wait for heart surgery or for MRI's for their brain tumors. Further, most European countries with socialized medical systems have very limited defense budgets since they rely on the United States (see “Of Paradise and Power, Robert Kagan, Knopf Publishers, 2003). Finally a close examination of the administrative cost myths reveals that government administrative costs are higher when one considers the costs of tax collection and enforcement, legacy costs of government workers, costs to citizens and society in productive time lost for delayed or denied care. In this nation there are now illness priority lists for health care spending in Oregon and nationally.

Many myths about American health care are being used to push greater public funding and greater third party control of health care. For instance, many claim that medical bankruptcy is common when it accounts for less than 5% of bankruptcies. Many believe that the uninsured use emergency rooms more while only 17 percent of ER visits are from uninsured patients. Insured Medicaid patients are far more frequent users of the E.R. than the uninsured.

Many claim that there are 46 million uninsured Americans when 9.7 million are not Americans, 16 million make more than $50,000, and 14 million are eligible for government programs leaving 8 million as chronically uninsured. The rate of uninsured in the U.S. is steady at about 15-16% since the early 90's. In Pennsylvania, about 92% are insured!

You are encouraged to closely analyze the insurance data from Pennsylvania. I have come to discover that Pennsylvania ranks 7th highest for number of insured patients and of the approximately 1.02 million uninsured in 2008, 53% were so for less than one year. Since 2002 there are about 100,000 fewer uninsured in Pennsylvania (Bureau of Labor and Statistics). Of those, 537,000 were eligible for government programs and 359,000 had incomes > $50,000. 91,000 were short term uninsured and that left only about 1.09% as long term uninsured (about 132,000 people). (References submitted with testimony). 58% state that the cost of insurance is the most important reason for being uninsured. Common causes of high insurance costs are laws that prevent purchase of insurance across state lines, or that require guaranteed issue or community rating of insurance rates. Under Guaranteed issue the sick can purchase insurance after they are sick and through community rating, the young and/or healthy face higher insurance costs to subsidize lower premiums for older and/or sicker patients. This drives the young away from insurance when they should have it for catastrophic care (further increasing the burden on public rolls if they become severely ill or injured). State mandate of insurance benefits is another common cause of increased cost. Many states require coverage not wanted by all such as chiropractic care, acupuncture or hair prosthesis -- all with their own special interest lobby. Pennsylvania seems to have resisted this to a greater extent, but that will end under a single payer system.

Unfortunately, in Pennsylvania, the cost to an individual to purchase health insurance outside or the tax-advantaged workplace is the 5th highest in the nation. Those purchasing through small groups however see rates that are 29th in the nation. Some of the cause for the lower cost in the small group market may be the growth of Health Savings Accounts and High Deductible Health Plans (HSA/HDHP) which are now estimated at 20% across the nation. When small group plan members are offered a choice between traditional insurance and an HSA/HDHP model, 42% choose the later. Unfortunately, Pennsylvania appears to have about only 1.6% enrolled in these plans overall.

The State is to be commended for low rates of uninsured, but providing universal coverage should not be your goal. The goal should be to provide universal access to affordable health financing products that people need and desire. The HSA/HDHP model is an attractive means to meet this goal. Under this model, patients place funds into a tax-free health savings account to pay for the first $1,100 -$2,200 of their health care themselves (or more). This allows them to shop for higher quality and lower cost insurance and medical care and still be 100% covered when they have catastrophic problems above their HSA level. HSA/HDHP enrollees are more likely to participate in health and wellness programs and have higher success rates in smoking cessation, diet, fitness and overall health. 27% of new HSS/HDHP enrollees are previously uninsured, use the Emergency room 32% less and have premiums that are 15-20% lower. 84% of plans have first dollar coverage for preventative care and 45-49% of these enrollees have chronic conditions (negating the myths that such patients couldn't receive care with such coverage). 40% have incomes less than $60,000.

As you see, free markets characterized by competition and choice provide the lowest costs services at the highest level of quality. There will always be a role for a government safety net. But if the government becomes the means for covering all your citizens, there will be an overall lowering of the quality or care for all citizens and endless politicization of health care. Also, you will not be able to afford coverage for those who are truly poor.

You are cautioned to avoid current financing gimmicks under examination in Massachusetts such as an individual insurance mandate where public costs are running out of control, rationing boards are being created, and primary care doctors are hard to find – even as about 3% of their citizens remain uninsured while facing tax penalties. Also to be avoided are command and control structures such as pay for performance, public reporting of physician data, mandated electronic medical records and creation of health boards that create “best practices”. These have been shown to have many unintended consequences such as avoidance of high risk patients, increased negative impact on minorities and lower income populations, gaming of the system to achieve higher scores, increase in inappropriate medical practices in some patients to achieve an overall higher score, and a failure to actually improve outcomes for patients. I would strongly encourage you to closely evaluate such programs prior to expansion (independent evaluation of Pay for Performance by this presenter included with reference material). I also strongly encourage you to set up strict reporting requirement for any government created program to see if any actual benefit has occurred using independent, unbiased consultants with reliable source data. It is also important to create a means for citizens to record complaints with any new government created health program designed to lower costs. Episodes of waiting, rationing, denied care, delayed care, patient dissatisfaction and the like should be recorded and reported publicly. Full judicial review rights for patients and their doctors should be allowed to ensure that their constitutional rights are not trampled in any system created or managed by the government.

Finally, as you consider further increasing the role of government in health care, you should consider whether your state budget can realistically handle it. This is especially true considering the increasing burdens on the Federal government and the decreasing likelihood they could provide rescue funding as you have budget shortfalls (as they are now doing in Massachusetts).

Pennsylvania is the cradle of our country's constitutional framework to protect individual liberty from intrusive government control. It should not be the place where individual liberty in health care is lost as a precedent for the entire nation. Please remember the importance and power of the free market as you continue your deliberations and its proven superiority at decreasing costs and increasing equity and access and quality.

"Any society that would give up a little liberty to gain a little security will deserve neither and lose both." -- Benjamin Franklin

[1] Fleming v. Nestor (1960). Justice Harlan states for the Majority "To engraft upon the Social Security System a concept of 'accrued property rights' would deprive it of the flexibility and boldness in adjustment to the ever-changing conditions it demands".

www.campaignforliberty.com 11May 11PM 152030; 12May 5AM 152067

Needless to say I am in agreement with the above.

gulch

Edited May 12, 2009 by galtgulch

[Brant Gaede]

Well, GG, this is the single best thing you've done here--posting this.

--Brant

[Selene]

Folks:

I told you guys yesterday he is coming along real well!

Hey Gulch excellent post.

Today on Dennis Miller's radio show a young lady stood up and asked about the Audit the Fed Bill.

She did a fine job. The show was live from the Reagan Library. She did a great job and got a solid piece on it out over the

air and Dennis said he did not want to know because there was probably no money there!!

She jumped in with and there probably was never any money there and the show ended.

Real nice promo.

Adam

[caroljane]

I just came across this and it is one of the most blatant pieces of lobbying I have ever seen.

America has never used, or suggested singlepayer, yet this guy claims that it has "always failed" everywhere, using communism and the Berlin wall as analogies.

He does not mention Canada where it has failed to fail for forty years now, nor Denmark, Sweden etc... obviously no other countries or health systems could ever be analogous to America, except its big opposite enemies. Politics is much more important than public health, after all. In fact, health is such a private issue, we should not even talk to each other about it. Only to our doctors, or insurance companies.

[jts]

In a free market, doctors would be in the business of helping people to get well and to stay well. In other words, doctors would be in the business of putting themselves out of business. And doctors would be in competition with other doctors. People would prefer doctors who have a good success rate. Given a choice between a doctor whose patients get well or a doctor whose patients don't get well, which would you choose? That's a no brainer. It depends on whether you want to get well. In a free market, information would be available on the success rate of various doctoring methods. And people would demand this information, and businesses would arise that provide this information.

The doctor who is the most effective in putting himself out of business would get the most business. And the doctor who is not in the business of putting himself out of business wouldn't get any business, and he wouldn't have any business being in business anyway. Against competition, the only way a doctor could stay in business would by doing his best to put himself out of business.

Over time, this competition would result in a healthier population and little need for doctors and low prices of health care. In addition to having good health habits, people would demand, and in a free market, get a healthy environment (air, water, food, workplace, etc). And health care would be mostly literally health care, care of health, instead of what it is mostly now, care of disease. It would be mostly about living -without- disease instead of being mostly about living -with- disease.

And that would be the end of all this bullshit about health care. (which has little to do with care of health)

The solution is free market.

[caroljane]

The fact remains jts, that if you collapse in Edmonton and get carted to hospital and operated on while unconscious, you WILL NOT HAVE TO PAY, I and the rest of your fellow socialist state slaves would be paying. Whereas if you did that in your spiritual home of the brave, you would be free to scorn the doctors because you could not afford them.

[Selene]

The fact remains jts, that if you collapse in Edmonton and get carted to hospital and operated on while unconscious, you WILL NOT HAVE TO PAY, I and the rest of your fellow socialist state slaves would be paying. Whereas if you did that in your spiritual home of the brave, you would be free to scorn the doctors because you could not afford them.

You would get treated though...

[caroljane]

That is true, of course. You know jts just gets under my skin because he is like Perigo, a non American who knows better about America than Americans do. I know I am an irritating foreign substance but at least I do not do that.

[Selene]

That is true, of course. You know jts just gets under my skin because he is like Perigo, a non American who knows better about America than Americans do. I know I am an irritating foreign substance but at least I do not do that.

Except when the Second Amendement comes up...

[caroljane]

Even then I do not claim to know better . Just to know best.

[jts]

The fact remains jts, that if you collapse in Edmonton and get carted to hospital and operated on while unconscious, you WILL NOT HAVE TO PAY, I and the rest of your fellow socialist state slaves would be paying. Whereas if you did that in your spiritual home of the brave, you would be free to scorn the doctors because you could not afford them.

The question is, in a free market, what happens to people who are down on their luck?

Do you really give a rat's ass about the poor? The answer is either yes or no. If no, then you don't bother with the question of what happens to the poor. If yes, then in a free market, you would be free to help the poor. In either case, the government would not take your money from you by force.

Four points:

1. Smaller problem.

In a free market, there would be very few poor people and they would have greater means of solving their own problems and probably wouldn't stay poor very long.

2. Greater means of solving the problem.

In a free market, most people would be fabulously wealthy and therefore would have the means of helping the poor. They could choose to help the poor or choose not to help the poor. They could choose how much to help the poor. They could choose what way to help the poor; simply giving them money might sometimes not be the best way.

3. Solving the problem with greater wisdom.

Voluntary charity would be done with greater wisdom than socialist schemes. There would be an attempt to help people help themselves if possible, a hand up instead of only a hand out.

4. Perhaps greater benevolence.

I'm not sure about this but I suspect that in a super affluent free market, people would be more benevolent and therefore more inclined to help the poor. I got this impression from a big fat book I read many years ago about life in the Soviet Union. It consisted of interviews with people who lived all their life in the Soviet Union. There didn't seem to be much benevolence in the Soviet Union. On the other hand, in the pioneer days of USA and Canada, people helped people; someone's barn burned down, the neighbors built him a new barn.

[jts]

That is true, of course. You know jts just gets under my skin because he is like Perigo, a non American who knows better about America than Americans do. I know I am an irritating foreign substance but at least I do not do that.

A free market is a free market. Period. It doesn't matter where it is. It doesn't matter whether it is in America or in China or on the Moon or on Mars or on a planet circling Alpha Centauri A.

[caroljane]

Please explain how most people would be fabulously wealthy in a free market.

[Derek McGowan]

My problem with posts like the doctors above, is that there is no 1. statements about the downfalls of the current (before ObamaCare) healthcare system and 2. there are no statements about the good that other systems provide. Whatever, and I mean WHATEVER the discussion is about, if you can not see, and be honest, about the problems (current or future possible) with your personal belief and you cannot see not a single benefit of the other side's argument, then you are not participating in a debate. You are too close minded to to serve any role in a debate and you have no room for growth. The doctors statement was entirely too one sided and he makes the other countries' system seem like they are on the point of collapse while ours (his idealized version of ours) is the bees knees. All systems, when dealing with people, will have problems and it is dishonest to assume that any that you come up with will be perfect. After all you can't accuse liberals of living in Utopian dreamworlds and at the same time promote your own.

Also I have no idea why he would advocate against information on doctors being made public. In a free market the buyers are not just dependent but "strapped to" information. His reasoning against the transparency is not up to snuff I think. Then he says that bad reviews of government plans should be public...

I just think that regardless of the topic, whether I agree with the proponent, we should all be honest with ourselves and accept that other people have SOME good ideas too. Their full plan may not be feasible but there is something in there that is good, and we should state that. And SOME of our ideas are that great either, we should state that as well. There is two sides to every story and the story of the human race is a complex one.

[Selene]

DereK:

Welcome to OL.

This is why the Affordable Care Act is on an economic head on collision course either way this breaks. It has been one of my major concerns because the only two/threee (3) places on the planet that has a socialized medical system with some private partnerships is/are France and either Germany and/or Canada which I have to confirm...and they apparently work.

An insurance death spiral?

Posted: 25 Oct 2013 09:12 AM PDT

(Paul Mirengoff)

[jts]

Please explain how most people would be fabulously wealthy in a free market.

Wealth, unlike money, is not a zero sum game. A free market consists of a bunch of creative minds working in synergy. When the stops are pulled and human creativity is unleashed, expect spectacular results.

Take the computer industry as an example.

In the 1970s, computers were like Star Trek. They were mainframes in a university and you had to pay for computer time at a computer terminal. The idea that some day everybody would own a home computer seemed fantastic. What would you compute with it? Why would anyone want a computer?

I got my first computer in 1984. I bought my most recent computer in 2013. That is 29 years apart. Let's walk thru the advances in computer technology in the last 29 years, made possible by an almost completely free market in the computer industry.

Speed:

My 1984 computer had a speed of 1.7 MHz, 1.7 million clock cycles per second. My current computer has a speed of 3.4 GHz, 3.4 billion (1000 million) clock cycles per second. Two thousand times as many clock cycles per second. But to get a complete picture of the difference in speed, you need to also consider how much it does per clock cycle.

Memory:

My 1984 computer had 64 K of memory. That was a respectable computer in those days. My current computer has 6 gigs of memory. Do the math. 6 billion divided by 64 thousand.

Multi-tasking:

My 1984 computer did not have multi tasking capability. It could run only one application at a time. If you wanted to run a different application, you had to exit the one you were running before you could run the different one. All modern computers have multi tasking capability. It is normal for my computer to run 100 or 150 'processes' all at the same time. It is powerful enough that it can do this without breaking a sweat.

Graphics:

My 1984 computer did not have graphics. It had text. It had 40 characters across and 25 or 28 lines down. It had limited colors. My current monitor has 1440 pixels across and 900 pixels down. Each pixel is a dot of color made from 3 primary colors, red, green, blue. Each primary color goes from 0 to 255. Multiply 256 * 256 * 256. That's how many colors each pixel can have. That is more colors than the human eye can distinguish. But there is more. I can have up to 8 'work stations', each 1440 * 900.

Data storage:

My 1984 computer had only floppy disks for data storage. In those days, floppy disks were 5.25 inches wide and stored only 160 K. Now I have 1 internal hard drive and 3 external hard drives, each with a capacity of 1 terabyte. A terabyte is a thousand gigabytes. Do the math. A thousand gigabytes divided by 160 thousand.

Data transmission:

I got my first modem in about 1985. it had a speed of 300 bits (not bytes) per second. Divide that by 8 to get bytes per second. My Telus router at max speed can do 300,000 bytes per second, altho it usually is much slower. I am told that with 'ultra high speed', perhaps not yet available in Edmonton, the speed is about a hundred times as fast as what I have.

Printers, etc.:

Printes used to be crude. Now they are silent, print in color, and some are 4 machines in 1: printer, copier, fax machine, scanner.

Price:

I know someone who in the early 1980s bought a computer for $4,000. What would that be in today's money? It was a laughable excuse for a computer compared with what we have in 2013. I bought my current computer for under $700.

That is how most people can become fabulously wealthy in a free market. Let's extend the free market to all industries, not just the computer industry.

[merjet]

The fact remains jts, that if you collapse in Edmonton and get carted to hospital and operated on while unconscious, you WILL NOT HAVE TO PAY, I and the rest of your fellow socialist state slaves would be paying. Whereas if you did that in your spiritual home of the brave, you would be free to scorn the doctors because you could not afford them.

Our resident (willing!) slave has been suckered by Progressive propoganda.

[caroljane]

Ah yes Merlin.

I am a critical thinker who examines facts and draws logical conclusions.

YOU have a good mind but can get confused or misled.

HE has been suckered by propaganda/is a dishonest evader/downright stupid.

[Derek McGowan]

JTS

Im sorry I have to disagree with your last statement only because computers are usually the object brought forward to show how prices go down while features/abilities/sophistication goes up. But from where I stand (retail for 18+ years) computers are the one of the few, if not the only thing that seems to follow that trend. Everything else seems to be made more cheaply (not the cost of production but the quality of the finished product) yet priced higher. I'll see if I can throw out ten wide ranging examples real quick

1. Candy- Whatever happened to penny candy, now it's 7 cents apiece. Thats a 700% increase in price over the past 12-15 years.

2. Soda- same story as above and there is no way that the cost has somehow gone up as dramatically as the price. The margin on soda is so high, friends who worked in fast food told me that the margin from a large drink will cover the cost of an additional burger.

3. houses- we are aware of the fact that houses cost more now (even with inflation factored in) then they did 100 years ago but that's not all the house I live in was built in 1910. it is a row-house with three floors. The ceilings are fifteen feet high, ornate wood floors throughout, 6 marble fireplaces, marble steps, two sets of entrance french doors, marble use in the back yard, ornate and wide moulding around all ceilings, and hand applied plaster walls. Forget inflation, how much would it costs to get a house built today to those specifications?!!!

4. Cars- and Im talking about base models here. No more then 8-9 years ago you could get a brand new Hyundai accent off the dealer floor for $5000. Now you cant find a new car for under 12-14,000 and 12,000 is for a two door Smart car : (

5. Cable- I don't know about you but I'm of the opinion that the quality of TV has gone way down since we've been swamped with reality shows and countless carbon copies of cop and hospital shows, yet the price of cable continues to rise.

6. Plane tickets- price goes up, seats get smaller and smaller. Nuff said.

7. Broadway- Prices have gone through the roof and there has been no noticeable increase in quality (not saying it has gone down) and I've been to see 17 major shows.

8. Fairs/Carnivals- the food is getting worse and worse over the years, the rides are more an more ricketety but the entrance fee keeps going up.

9. Movie Tickets- there is nothing to justify the price of a movie ticket these days with most of the explosive increase coming in the past 5-7 years.

10. Halloween Costumes- I've seen prices double in the past 10 years and the quality is down to- "a sheet with a few cotton balls and glitter partially glued on.

11. Why can I not get a lunch for 5 dollars anymore? And why are salads so expensive? They literally should be the cheapest meal out there. I mean really, a head of lettuce and some tomatoes costs 7 dollars?

12. Tennis shoes- are they more durable then they used to be? I honestly dont remember but they definitely haven't gotten any better. And if you have sweat shops set up, why are some sneakers still priced at 100 or more?

13. Cutlery/Plates?Cups- the pack used to cost X and come in quantities of X. Now the quantity has gone down and the price has gone up. Example from my job- the box of assorted plastic forks, knives, spoons. Used to be 7.99 for 300 pieces. Now its 12.99 for 240 count. Same with bags of balloons.

I'm going to blame the increase in prices on the credit system that we currently employ because it artificially creates extra buying power in the market which allows prices to go up. Why many items are made more cheaply, I chalk up to business doing what it was made to do- find more and more profits. But what ever the reasons why, justified or not, that prices go up and quality goes down, clearly the progression in the business environment has NOT always helped the consumer. Im not even saying that they should help the consumer, I just think people should stop saying that businesses do, the better we all do since they past down savings and progress to us. Hell, many tech companies don't innovate beyond adding a camera and steadily increasing it's pixel count.

On the positive, I will say that bicycles HAVE benefited from the continuous research and technology passed down from the top tier bikes down to the bottom bracket pedalers.

[caroljane]

The people who manufactured and assembled, the early computers mostly made above minimum wage in the US. Now they make minimum wage, And they live in China.

[jts]

JTS

Im sorry I have to disagree with your last statement only because computers are usually the object brought forward to show how prices go down while features/abilities/sophistication goes up. But from where I stand (retail for 18+ years) computers are the one of the few, if not the only thing that seems to follow that trend. Everything else seems to be made more cheaply (not the cost of production but the quality of the finished product) yet priced higher. I'll see if I can throw out ten wide ranging examples real quick

You missed my entire point. Those other industries are not as free from government as the computer industry is.

[Selene]

The people who manufactured and assembled, the early computers mostly made above minimum wage in the US. Now they make minimum wage, And they live in China.

Carol:

And their "live style" is infinitely advanced from Toronto? Yes? Or, No?

A...

[caroljane]

Beats me, I do not even understand Gangnam Style let alone Live Style.

[caroljane]

Furthermore, did you know that at least six people have been murdered in the Philippines at karaoke clubs, just for singing "My Way"? I read it in the National Post today so it must be true. I hope the offenders got off on musical technicalities.

[Selene]

I read it in the National Post today so it must be true. I hope the offenders got off on musical technicalities.

This is really weak...