Whatever happened to spending healthcare revenue on patient care?

As the independent candidate for governor, Mike Myers said during his speech at Democratic Forum (in between yoga and pushups) “Hospitals should be spending their revenue on patient care, not on basketball stadiums.”(sic) to which he received an applause.

Tell that to this guy;

As Kelby Krabbenhoft drove toward the outskirts of Sioux Falls in his pickup Thursday evening, he had plenty on his mind.

The Sanford Health chief executive officer was headed for the Pentagon, a five-sided, $19 million basketball wonderland featuring an old-fashioned Heritage Court that seats 3,250 and harkens back to “Hoosiers” with its throwback décor.

Long before the facility became reality and drew national attention by hosting an NBA preseason game — as it did Thursday night — it was a vision that struck Krabbenhoft while he watched his son, Joe, play summer basketball.

“It was a ‘Field of Dreams’ kind of thing,” said the 55-year-old health care CEO, sitting in his luxury suite above the court as the Minnesota Timberwolves went through warmups.

“When Joe was playing AAU ball, you’d go into these stale gymnasiums and get the feeling that if you ever had a chance to do something special, you would do it right. How great would it be to go back in time and try to capture the history of the game?”

Something special? Participating in wrestling tournaments throughout ‘stale gyms’ in this state, I never once thought it hampered the experience. In fact, there was a bit of charm to many of the school gyms across the state, I still laugh about the time we hit the showers in Lake Andes after a bout and the water shot from the wall instead of the shower head. But this should come as no surprise from a man who just went bear hunting (a trip paid for by sick people). And watches a game from a ‘luxury suite’.

Of course Kelby justifies it all;

“When we recruit high-end physicians, they always ask if they can see the children’s hospital and the sports complex,” he said. “It benefits us and everybody when we can boost the community like that.

So this is what we are building this town for? High end physicians? What about the nurses and techs that work at your facility? What about the working poor and middle class of this town? We now can justify using money from sick people who can barely afford medical care and use it for basketball stadiums so your physicians can be entertained? Forget calling this place Sanford Falls, I liken it to Rome.

“At Sanford, it’s the law of big numbers, and it’s hard for people to wrap their minds around that. But we spend one-third of 1 percent of our budget on community dividends, which means that 99.7 percent is spent on health care.”

What he doesn’t tell you is that .03% is millions of dollars that could be spent on patient care. Which brings me to the government shutdown. Whether you are for or against Obamacare, doesn’t really matter. The whole purpose of the ACA was to address the healthcare industry and the way they treat patients (like dirt). Isn’t it the epitome of Sanford to be building a basketball stadium while the Feds are screaming THE HEALTHCARE INDUSTRY IS SCREWING US OVER!

Oh the hypocrisy and irony of it all. And the crying babies in both parties whose only solution to reforming ACA (and it needs some reform) is to shut down the entire government instead actually just debating and reforming the actual law.

And while we have thousands of dead cattle and sheep in the West, we play basketball in the East and you can hear a faint murmur from Kristi Noem in some Mitchell, SD hair salon.



#1 Think About-It on 10.12.13 at 1:09 pm

The biggest problem with the medical industry is that no one knows the price for any procedure. Say you have a broken toe; I challenge anyone to find out the cost to set it. We can walk into a Jiffy Lube or any fast food joint and every item is listed on a big board with the cost, yet in a place that can charge you anything from $50 to $500,000, we’re expected to just walk in and tell them to bill us whatever they want. No comparison shopping, no waiting for a sale, no haggling. Why? Because we have abdicated the power of paying the bill to an insurance company that masks the cost by charging everyone a slice of the bill, whether they need the service or not, and Obamacare just forces everyone to participate in this charade (Obama promised us health care reform, if we wanted insurance policies to be mandated we would have voted for Hillary since that was her plan).

We cannot have a free-market medical system if there is no real market because it is hidden behind the insurance firewall (insurance is just socialism without the benefit of regulation) and hospital’s hidden pricing. Either change to a single-payer federal system and hold the government responsible for regulating costs of procedures or just go free-market all the way and let each person directly pay for their own services (after requiring doctors and hospitals to list their prices so we can compare). Nothing else will stop a system that designed to eliminate competition by price.

#2 Winston on 10.12.13 at 2:02 pm

In Cuba, the government builds the stadiums and provides the health care system. In America, a corporation builds the stadiums and provides the health care systems. What’s the difference? Neither is democratic and any actual debate is conducted from within….

I guess the difference is that in America anyone can become that one person who builds a financial empire, which then builds a stadium or two and a massive health care system…. and you can’t do that it Cuba. But to the masses what is the difference? A trickle-down dream that some day you or one of your off-springs will be that chosen person?…. Good luck! While you are paying off your 29.99% interest credit cards…..

#3 anominous on 10.12.13 at 2:42 pm

Hilarious. There is no doping in college or professional basketball programs.

#4 hornguy on 10.12.13 at 3:05 pm

I’d be way more concerned about how Sanford is justifying the other 99.97% of its spending.

American health care facilities (and their friends the private insurers) dramatically overcharge for services and use the revenue to pad the wallets of doctors and executives because, simply put, they can. I’d much rather see Sanford spend money on a recreational facility than another expensive and rarely used gizmo just to keep up with Avera.

Because, let’s be real, a lot of their health care spending is driven by nothing more than keeping up with the Joneses and trying to pander to high-revenue patients. To hell with affordable basic care; more heart hospitals for everyone!

#5 Winston on 10.12.13 at 3:17 pm

Absolutely! It’s a medical arms race. Imagine all of the duplicity which has to be going on between Sanford and Avera, and how that costs us, the consumers….

#6 Poly43 on 10.12.13 at 4:37 pm

The biggest problem with the medical industry is that no one knows the price for any procedure.

There is a place to compare. Seen it about in May. This much I learned. Most any procedure is about 20% cheaper at the Mayo Clinic than at Sanford. I’ll find the site and post. Then you’ll know why “Krabs” krabenoff can afford his field of dreams and write it off with a statue of t denny.

#7 Hilarious on 10.12.13 at 4:49 pm

And Sanford has extra money to keep Mount Rushmore open. Why does a hospital that announced they had to freeze hiring this week turn right around and donate to Mount Rushmore? Insane.

#8 LJL on 10.12.13 at 8:16 pm

As I’ve pointed out out several times now, party politics and the press’s categories of them hurts everyone. T Denny giving us the Dem healthcare shaft and Noem giving us the “so called Repub” farm bill shaft is the framework.

T Denny help write the loan shark laws and is now the biggest benefactor.

What happened to a so called conflict of interest. I’ll say it right here as I have elsewhere… Noem is a farm subsidy whore and now her own pimp. This is from 2010 http://www.constantconservative.com/2010/ag-subsidies-with-a-twist-of-noem

Weak at heart don’t read this next part: I fucking hate you Kristi for taking millions in subsidies and calling yourself a Tea party person. I will spit on you if you cross my path. I know for a fact “as I grew up with them” the conservatives around your “Rakota Farm” fucking hate your guts as well. Castlewood raised really? You make Shane M. look like mother Teresa son.
She knows who I am talking about.

#9 Poly43 on 10.12.13 at 9:39 pm

A few months ago a report was put out by CMS.gov about hospital procedure pricing. At that time, I felt Sanford was exceedingly high for most any procedure. That link is here.


Cumbersome to wade thru all the different spreadsheets tho. There is a better site tho that put together all the numbers in an easy format to follow. Try this place. Now you’ll understand why we have a field of dreams.


#10 ProudLeftWingNutJob on 10.13.13 at 10:00 am

Each insurance carrier prenegotiates prices for particular proceedures with differrent providers. One of the best examples is an infant circumcision (which is a fairly straight forward proceedure{setting aside your personal views on the matter}). It’s something that in all reality only costs about $150 (equipment, steralization, dressings, Doc time, nursing, documentation etc). However…doing them at $150 covers cost and makes a little profit (which is an ok thing), but it doesn’t make enough to cover the homelessguy who was assaulted, spends 3 weeks in ICU($3,000-$5,000/night) and needs $150,000 in constructive surgeries just so that he can chew down a twinkie.

So providers inflate prices to cover those who can’t pay. Charge $1,500 to insurance companies for that circumscision, they negotiate down to $750, with $100 copay or something. Hospital gets $850 – $150 (actual cost), pockets the $600, uses some of that to pay for homeless dude. What’s left over gets spent on other stuff (sports facilities, new buildings, helicoptor rides, statues, art walks).

I work for one of them, I got a 1% raise. I bet in Jan my insurace – which is ran by my employer – will go up more than that. Oh well, I got a job I’m good at and I help some folks.

#11 Poly43 on 10.13.13 at 3:46 pm

…So providers inflate prices to cover those who can’t pay…

So in theory my rates should go down if most will be covered under the ACA. Sorry, but I thinks this is much more about simple greed by Sanford. They are consistently 10 to 20% higher than Avera and in many cases 80% higher than the hospital in Watertown.

#12 rufusx on 10.13.13 at 6:15 pm

FWIW – In the European “socialist” nations with the top rated health care in the world (vs #26 rated USA) – guess what – no one in the health care profession “knows the price for any procedure” either. Why? because they don’t BILL anyone.

When traveling in Sweden, one of my travel companions became seriously ill. Went to the local hospital. She tries to give them her insurance information – they say “what’s that?”. Asks them what the bill is after being treated – they say – “There is no bill.”

#13 Joan on 10.13.13 at 6:32 pm

I have heard the same about Great Britain, and the other Scandinavian countries. As far as Sanford goes, it really irritates me when I hear about them building clinics in foreign countries. I also can’t figure out why all this city talks about is spending money on sports type recreation. There must be more people than me in the area that could care two hoots about sports.

#14 Detroit Lewis on 10.13.13 at 8:54 pm

Joan – on one front I will defend having sporting activities in this city, kids need to stay active. BUT, it seems to be the only focus. Kids need to have other cultural things to do. Also in terms of entertainment it seems that is the only way people are entertained in this city, which goes back to my original saying about cultural activities.

#15 OldSlewFoot on 10.13.13 at 9:12 pm

Don’t look at what they charge on that weblink Poly43, look at the reimbursement. BTW nice find – good site. I still can’t find the SD gov site I used to go to 10 years ago. Maybe they took it down.

Rarely do they get more than the reimbursement cost + supplemental insurance. And reimbursement is close to the same in SD for all hospitals. If I have a heart attack am I going to care what the hell it costs anyway. $40,000 in SF or $13,000 in Watertown. If you are half way in between, pick SF.

And Nut Job is right. You have a surgeon working all night to save somebody who can not pay and Medicaid pays little and they leave the hospital with overhead that is unpaid. Written off debt is well over 30% by the health industry. Who else has that? And Obamacare/insurance ain’t going to make a damn bit of difference.

I work with surgeons. Much of the stuff they treat in the ER are train wrecks with no way to pay. There is a reason they are in the ER – Low information citizen or noncitizen. I have worked in the OR when they need to get fixed up.

Fell off the 2nd floor apt deck onto their head, drunk, now they will have 2 brain surgeries because the surgeon is trying to save them and lay in ICU in a coma, maybe paralyzed until they die. But that doesn’t cost anything, right?

Before you criticize surgeons, ask yourself how many times you have worked for 6 hours in the middle of the night to put someone back together and know you are getting paid next to nothing for it or when insurance covers it, the insurance company haggles you on the bill.

#16 Poly43 on 10.13.13 at 10:00 pm

My point is this. I’m sure Watertown has just as many uninsured heart attack victims per capita as Sanford Falls. With that in mind both hospitals prolly have to write off about the same. So why the huge disparity in charges? Toys like the pentagon provide that answer.

#17 Winston on 10.13.13 at 11:20 pm

If our Governor would only allow an additional 47,000 South Dakota residents to be placed on Medicaid through the auspices of the Affordable Care Act, then these alleged
“homelessguy(es)” causing a $ 150.00 to be $ 1500.00 bill would matter much less.

Sure, all the taxpayers would still be paying for it through their taxes rather than their premiums, but when you factor in the unfairness of our tax structure, that problem could also be solved for the average tax payer…. The rich need to pay more!!…. And don’t tell me the rich never pay taxes, else why do they always try so hard to fight tax increases? Oh, I bet someone is also going to say that the rich actually pay more, which is true in an aggregate sense, but not as a percentage of their total personal income like the average Joe taxpayer………

#18 Sy on 10.14.13 at 9:27 am

@ LJL Unhinge much? Perhaps Obamacare will provide “free” meds and counseling.

@Nut Thanks for that description, very enlightening.

@ Winston The “rich” do carry most of the load, whether that’s paying taxes or spending money to send dollars through the economy. That surgeon who spent 6 hours last night fixing the homeless guy likes to unwind by driving his Benz with the top down to the detail shop and he also enjoys buying $10K slabs of stone for his kitchen. He buys the $100 ticket to the Twolves exhibition game and he also likes to take in a show at the Pavillion after having dinner at Parkers. When a kid knocks on his door he buys whatever they are selling and when someone calls him for a donation he grabs his checkbook. All of those activities are better for our economy then the Government taking that same amount of money away from him and sending it down the drain in DC. The “rich” fight tax increases because they know it’s like handing over another hit of crack to an addict, they will just come back for more and the next time they won’t say please, they will rob you.

#19 ProudLeftWingNutJob on 10.14.13 at 10:03 am

My only concern is that ACA doesn’t go far enough. We are still going to be running into people who don’t have insurance because it isn’t a universal given.

Sometimes the hospitals are smart about stuff. Smart hospitals will sometimes pay to COBRA a person for a couple of months who recently lost their job and perform the needed bajillion dollar surgery as opposed to eating that cost. Makes sense to cover the $550 x 3 months in that case and get paid. The funny thing is that the same person may have qualified for medicaid (based on short term disability if their need was that severe).

#20 Winston on 10.14.13 at 3:13 pm

Sy, Sy, Sy, all those things you mentioned that a “rich” surgeon does, he does at establishments which primarily hire $ 8.50 per hour workers, who prior to Obamacare lacked the opportunity for affordable health care. You cannot maintain nor rebuild a viable middle class with minimum wage jobs!!

“All of those activities are better for our economy then the Government taking that same amount of money away from him and sending it down the drain in DC. The “rich” fight tax increases because they know it’s like handing over another hit of crack to an addict, they will just come back for more and the next time they won’t say please, they will rob you.”

The following quote is a sweeping generality which goes beyond and actually tangent at best to the point I made.
Regardless of ones position on tax policy, the “homeless guy” will still show-up in the ER without insurance (assuming Obamacare doesn’t kick-in here in the future) causing the rest of us to pay for it through higher premiums and/or higher taxes. The former problem can be lessen by broadening Medicaid and the latter can be dealt with by taxing the rich and not the middle class or the working poor.

The next time you bast in your love for the rich and all that they do for our economy ask yourself how many little poorly paid Americans it takes for this to happen, then ask yourself how many rich Americans saw their sons and daughters go off to fight in the last two Bush Wars? I don’t want anybody to die before their time, and I definitely do not want anyone to die at war, but can you name a single established wealthy family in this country over the past 10+ years who saw one of their love ones perish in Iraq or Afghanistan? Don’t say Tillman, he was a self-made man who came from middle class values. There was a time when all the people shared in the burdens of our free society, Emmett Roosevelt and Joesph Kennedy, Jr., those are the first two names of individuals from wealthy and influential families who gave their lives for this country that come to my mind. Heck, even Jack Kennedy and Bush41 almost lost their lives as well in WWII. Today you cannot even image the thought. So the next time you love the rich, it’s also time you started respecting the poor, the working poor, and the middle class….. Oh by the way, many of these working class Americans buy cookies from kids knocking on their doors too….. that is if they still have their own home and it hasn’t been foreclosed by greedy banks and their rich friends and their credit default swap schemes…. We all want to be rich, but true and lasting freedom can only be maintained by preserving a viable and true middle class, which a honest tax structure can and should promote…….

#21 Craig on 10.14.13 at 5:08 pm

Sy: “The “rich” do carry most of the load, whether that’s paying taxes or spending money to send dollars through the economy.”

Ah yes… trickle down economics. That works so well now doesn’t it?

If someone really wants to stimulate the economy I would argue they should not give another tax break to the 1% or give billions in stimulus dollars to big corporations in the hopes they might dole a bit of it out to the masses. Instead, I feel they would see a much larger return on their investment if they added $500 to every tax return on individuals earning less than $100k a year or couples earning less than $200k.

Because you know what the lower and middle classes typically do when they get their hands on an extra $500? They spend it. You know what the wealthy do when they get an extra $50,000 or $500,000? They invest it (which has a much less significant impact upon the short-term economic cycle) – because generally speaking their expenses are fixed and it is less likely they will go on a spending spree if they determine their total tax bill has decreased by 2.4% this year.

By the way Sy, although the wealthy might give more to charity in gross dollars, as a percentage of income they aren’t even close.

For example, an article from Fox Business said this: “Americans with earnings in the top 20% of income levels contributed, on average, 1.3% of their income to charity. Those at the bottom 20% donated 3.2% of their cash to charity—more than double of what their more-wealthy counterparts donated.


Study after study, analysis after analysis has found much the same. The real kicker? Wealthier individuals tend to ‘donate’ to private schools and exclusive charities (aka: Former racehorse rescue organizations or the local Symphony) whereas lower income people donate to homeless shelters and food banks.

Many rich also donate for a tax deduction… the poor or middle class either don’t report their charitable giving, or they are unable to itemize and therefore see no tax benefit to their donations.

Reminds me of a phrase I once heard – the true definition of charity is to give without receiving. Anything else is merely the purchase of admiration or the building of a legacy.

Final thought – if you live in a private community with “No Soliciting” signs posted at the gatehouse… chances are the Girl Scouts won’t be selling cookies door to door.

#22 Sy on 10.14.13 at 5:13 pm

Winston, I don’t love or hate anyone based on their income or tax bracket. That’s a spear your side likes to chuck when they know deep down a viable point is being made. I simply stated that what an individual does with his or her own income is better for this economy than haven’t Govt. using (or abusing) the tax code in order to grease whatever group they are pandering to at the moment. Look at the last POTUS election, Obama had no choice but to make Romney look like an out of touch Daddy warbucks, as his economic record and the amount of “unpatriotic” debt that he’s piled up both make W look like a piker. We could’ve easily solved the problem of 11 or 15 million poor citizens who couldn’t get health coverage, but in no way did we need to disrupt the other 95% like me and my employees who were quite happy with their market based, employer provided coverage prior to the last two annual 40% rate hikes that were directly because of Obamacare. Do I eat the $400K hit because “they should pay more”? What if my profits are only $300k? What if it’s a tough year just to break even? Do I just keep raising prices and make the consumer pay that? If so, that’s essentially a tax increase on all those people who were told their taxes weren’t going up under Obama unless you’re a surgeon who drives a Benz. Now everyone is trying to figure out how to get it done with part time work or stay under 50 employees or buy machines to replace people. This was predicted prior to passage of the bill, now its coming true and the class warfare card has been played so well by the Left for so long that we now have the most divided society I’ve seen in my lifetime. You talk about Bush’s wars (that many prominent Dems voted for BTW) , how about Obama’s war on both the Medical & Insurance Industries that didn’t get a single Republican vote? Not only is he after their profits (they should pay more, sound familiar?) he’s on track to destroy both industries from the ground up without firing a shot, but the end result will bankrupt the entire nation (looked at the unfunded liability tally lately?)

No Nation in history has ever taxed and spent it’s way into prosperity. Jack Kennedy knew this, so did Reagan. And don’t give me (insert favorite European Nation here) example you’re getting ready to cite because none of those Countries let people flow freely into their country to live, work, let their kids get free education, get health care all while allowing them to send ALL their unspent earnings back home (ie tax free) None of them are the world’s last remaining superpower essentially responsible for more than half of Global security.

#23 Sy on 10.14.13 at 5:28 pm

Craig: “Instead, I feel they would see a much larger return on their investment if they added $500 to every tax return on individuals earning less than $100k a year or couples earning less than $200k.”

Yes, this is the original definition of “Stimulus” and Bush did two of these I believe. $168 billion and he was hammered by folks like Winston because they said it was an expensive gimmick. Truth is it actually worked as advertised and you can read the article posted for a trip down memory lane when occasionally you’d get some actual bi-partisan leadership out of DC.


& what do we have? 3 gated communities like that in town with a total of about 20 homes? There’s plenty of apartment and condo complexes that also you can’t go door to door in so your final point makes no sense.

#24 l3wis on 10.14.13 at 5:48 pm

Wonder if I can borrow Kelby’s doctor buddies to cut Cancer out of my back on my Kitchen table or if I am going to have to rough it with a scrimshaw artist and bottle of rye whiskey?

#25 Winston on 10.14.13 at 6:13 pm

Sy, let me just say that sometimes the truth hurts and at times we have all been on that side.

“Dubya” was a piker? Obama’s deficits were the result of the mess he inherited from “Dubya.” In fact, since Obama became President he has actually cut the annual Federal deficit by 60% from 2009 to 2013, and the projected 2015 Federal deficit will be $ 350 billion; a lot less than the initial $ 1.5 trillion deficit Obama inherited from “Dubya” in 2009. And any short term increases in the annaul Federal deficit under Obama in his first three years, to the degree it can be blamed on Obama, were because unlike our “socialist cousins across the pond” we attacked the Great Recession with Keynesian economics rather than using the austerity approach which many rich conservative politicos in our country had advocated…. And what has been the result?…. Keynesian economics has caused the US to walk out of the Great Recession at a healthier and quicker pace than have our “socialist cousins.”

40% premiums increases? Whose is your insurance company? Why didn’t my insurance go up that much? You failed to mention that Obamacare requires insurance companies to pay-out 80% of their revenue as benefits to the consumers and the remaining 20% for administrative costs, which for many insurance companies prior to Obamacare was a 65/35 ratio and not a 80/20 ratio. Perhaps, your insurance company was attempting to grab a last chance cash cow…..?

As far as your full-time employment concern, actually Walmart of all employees is proving this concern wrong and they recently announced that they are going to hire 50,000+ new full time employees (too bad they are another example of low wage employment). In addition, over the summer MIT Business Review stated that to the degree there is a trend against full-employment in this country, it actually began in 2007, three years before Obamacare was enacted.

Then you talk about Republicans and Democrats, my piece has no partisan bent, I believe there were many enabling Democrats over the past 30 years who have helped the GOP and the rich get their way.

As far as a war on the insurance industry, if it’s a war how come many new insurance rates which have recently been published for the new health exchanges are coming out lower than expected? Having more people buying insurance seems to me to be a cash cow for the insurance companies, and if I believe you, that the insurance companies are increasing rates at 40% per year and getting away with it, then I don’t know how they could be in dire straits?

As far as the unfunded mandates, these are challenges we have known for years and we would be in much better shape today to deal with this challenge if the Bush43 tax cuts had never been enacted…… Another tax cut for the rich….. imagine that……

In conclusion, as far as “Jack Kennedy knew this, so did Reagan,” WOW! I will tell you what Jack Kennedy knew, when he cut taxes with a supply-side bent, he financed the tax cut by cutting other measures within the Federal budget, when Reagan cut taxes with a supply-side bent, Reagan just added the cost of the tax cuts onto the Federal deficit…. Ronald Reagan was no Jack Kennedy!

Oh yeah, as far as your global security rant, what is your point?…. And if I understand it, I believe Finland would definitely prove your thesis wrong…….

#26 Winston on 10.14.13 at 6:51 pm

Lewis, is your kitchen table inside or outside the network?

#27 Poly43 on 10.14.13 at 8:54 pm

Winston, I don’t love or hate anyone based on their income or tax bracket.

I’ll buy that statement. I’ve kinda known Sy now for about ten years or so, and if his business were a national model, then yes, trickle down does work. But sadly, the reality is, trickle down, is not working. One in ten nationally on food stamps? One in ten nationally cannot afford health insurance? The S&P 500 corporations over the last ten years have tripled their bottom lines while Joe SixPack and his family fall from the middle class to the working poor? Sy really does believe the current capitalist system works. But the the numbers say otherwise.

#28 Poly43 on 10.14.13 at 9:10 pm

None of them are the world’s last remaining superpower essentially responsible for more than half of Global security.

We’ve gone back and forth on this a thousand times Sy. Yes, it’s true, this country does spend more on its military industrial complex than the the rest of the world combined. What you call global security, I call nation building. (Feel free to replace the word “nation” with “oil”.

#29 Winston on 10.14.13 at 11:41 pm

Peace Sy, this will make your day:


#30 Detroit Lewis on 10.15.13 at 9:25 am

Well, it certainly applies to SD Democrats. Zombie is a compliment to them.

#31 Winston on 10.15.13 at 11:15 am

Now now……

#32 Sy on 10.15.13 at 11:53 am

@ Winston, first of all the “yeah but Bush” card is worn thin. Prior to being POTUS, Bush was a governor of a state with a booming economy and a budget surplus. Obama was in the US Senate and at least as responsible for the fiscal state of the Government as the other members of that body. Bush also had 9-11 to deal with which erased more than a trillion in global wealth almost instantly. Obama had to deal with TARP and the associated “bailouts”, but he also supported those as a candidate as long as his pals in Big Labor and “Green Energy” got a front row seat at the trough. Moreover, Bush spent $168 billion(see link above) and got hammered for that even though it worked as designed. Obama spent nearly a trillion $$ on his version of “Stimulus” (remember “shovel ready”?) and it didn’t work and somehow he get a pass from people like you. As for Iraq and Afghanistan, again those were bi-partisan supported and the policy of regime change in Iraq goes back to Bush 41 and continued through the Clinton years. Several prominent Dems are on record as far back as ’96 calling on the US to deal with Saddam militarily, and your current front runner voted “yay”. We can debate the cost vs. outcomes and that’s fair, but by that same token we can debate the cost vs. outcomes of Obama’s first term and his outcomes aren’t good nor were they passed with bipartisan support (at least he ACA & Stimulus, his two biggest accomplishments)

What about those outcomes? Well, like us many businesses have been hammered with premium increases, and those are being passed along to the consumer who’s paying more for the goods and services they consume. Like I said above that’s a stealth tax increase that hits everyone and the poor harder than the rich. Of course, you can & will blame the evil businessman for protecting his profits, but Obama made outlandish promises to the voters based on emotion and class warfare, not Economics. That surgeon above, do you really think he has an incentive to work harder and faster to treat the increased patient pool when his paycheck will undoubtedly go down? Will insurance companies lower their pricing and increase their service levels when they are dictated who they can cover and how much they can charge? None of these predictions match the laws of Economics. Just today, you have a story in the AL about how the electronic conversion for the paperwork is impeding care for doctors and 9 insurance companies have pulled out of the Nebraska market. They had 3 years and $600 million to get the web site right and they couldn’t even do that. What happens to the market if consumers in droves decide they’d rather drop insurance altogether and sign up when and only when they get sick? Think they planned for that when they can’t even get the basic architecture of the bill correct?

Obama wasn’t even honest in his campaign about how he favors single payer, and all the turmoil associated with the ACA in it’s current form will create the crisis that lead to a single payer solution. We can’t print enough money to afford that and everyone knows it. The table may already be set for another financial meltdown and how would we deal with that since our Bank of China credit card is nearly maxed out?

#33 Sy on 10.15.13 at 11:55 am

& peace back to you Winston, and nice clip….today they’d call Hope a racist for that comment.

#34 Craig on 10.15.13 at 12:03 pm

Sy: “like me and my employees who were quite happy with their market based, employer provided coverage prior to the last two annual 40% rate hikes that were directly because of Obamacare. “

Sy, I’m guessing you are stretching the truth a bit here, because if you are suggesting two consecutive 40% annual rate hikes you are far, far outpacing the industry norms which makes you wonder why your company has opted to gouge you when so many others have not.

The truth is, the actual increase in health insurance has been less than a quarter of what you have experienced – and only a portion of that can be directly attributed to the ACA. In fact, the average premium increases in the past two years are actually on a downward trend compared to the averages of the past decade.


Thus if you stayed with a company who raised your rates over 80% in two years, I’d suggest you need to start shopping around. Second, you might want to have your employees start looking at the new insurance exchanges and see how your rates compare. You have options.

To blame ‘Obamacare’ on your rate increases is intellectually dishonest, but I’m sure you already know that. The truth is the most expensive portions of the ACA (which in theory would have the greatest chance of impacting premiums) weren’t even implemented yet, and since healthcare insurance companies must spend at least 80% of their costs on actual patient healthcare… well it seems if their costs actually went up a substantial amount it was due to nothing other than an increase in healthcare costs.

So rather than blaming the ACA, you might want to ask yourself why Avera and Sanford have increased their costs so much over the past several years – which brings us full circle to the original point of this post. Spending millions upon millions on new scoreboards, sports stadiums, naming rights on various buildings, granite counters in the Doctor’s lounges and tens of millions more being spent on new facilities which are constructed primarily to compete with the other guy rather than fulfill a need doesn’t do much to improve actual patient care, and it surely doesn’t decrease the cost of a suture or an aspirin.

#35 Sy on 10.15.13 at 1:47 pm

@ a-holes in this thread calling me a liar. Yes we did get back to back 40% increases in ’11 and ’12. This year it’s only 6% and we are calling that a win. We are over 50 employees and there’s only a few options even available for us since our business is construction related. Trust me, we scoured every option. Our credit rating is stellar, however we’ve had usage on our plans, so we had several “options” that refused to even quote us so in reality we had basically one option..the company we were already with. This year (’13) is the first year we had to drop back to 85% as opposed to 100% paid for the first employee just to keep it as close as we could. Try looking a loyal, hardworking employee in the eye some time and tell them this is the best you can offer. It fucking sucks. So yes, all my employees got the equivalent of a tax increase as they now get to cover that other 15% out of pocket. I’m sure several of them think like you d-bags and figure I’m just making shit up to line my own pockets, but that isn’t the case.

Do any of you run a business where you have to make calls like this? If so, stop by and I’ll show you the paperwork. If not STFU, your links showing you what you want to believe is the norm are of no use to me. Ask some other business owners, 15-50% increases are the norm. The insurance industry is pissing their collective pants. You would to if your profits were under assault from your own Government. Several peer companies I know are dropping coverage all together as they have smaller competitors who never offered coverage.

This freakin’ ACA bill is a trainwreck, we had to pass the stupid thing to find out what’s in it and now we know. It’s stacked against businesses in general and now there’s zero incentive to grow over 50 employees. Guess where the bulk of the job growth (and not just minimum wage) has historically come from? Small companies who want to get bigger and today there’s a huge Barrycade called the ACA squarely in front of that.

#36 Sy on 10.15.13 at 1:51 pm

@ poly. Thanks for the compliment BTW. Still owe you a beer sometime.

#37 Sy on 10.15.13 at 2:12 pm

@ Craig. You’re right about the most expensive parts of ACA not kicking in, but what has kicked in are the tax increases to fund it (at least the first round)…which Winston wants to hold up as a victory towards our budget deficit. Note how the taxes are in place and we (ie all of us one way or the other) are paying them now…in 2013. In 2014 and beyond, the chickens come home to roost and we will see if this bill has yet to meet a promised projection. When it doesn’t and more people realize the shell game that’s been played, the next election will be over and we’re stuck once again until 2016. The waivers will be expired and the true costs will be known. This current “recovery” is a jobless one. Unless this economy starts humming along at 6% or better GDP growth there’s no way we can pay for this without massive tax increases on everyone. And just for fun can anyone name a single Obama policy that might actually grow the economy?

#38 Sy on 10.15.13 at 2:18 pm

How about an actual Doctor’s perspective if you still think I’m full of shit:

“Over on the employer-based health-insurance side, unless you have a policy that grandfathered in before 2010, you will be faced with new plans that restrict the number of tests and treatments I can order while paying me less and less to see you. This is how insurers plan to save money. Like the failed HMOs of the 1990s, they will shrink the networks of participating providers to those of us who are desperate enough to work within these limitations or are crooked enough to have concocted some medical mill to make money despite them.

Keep in mind that Obamacare mandates that employers cover at least 60 percent of your premium while the most you, the patient, can be asked to contribute is 9.5 percent of your yearly income. The policy deductibles are also being limited to $2,000 per year or $4,000 per family. Coverage for preexisting conditions, no lifetime limits, and no dropping a policy for illness are now mandatory. All this coverage is expensive for the insurer to provide — something has to give. If the premiums go too high, then employers can quickly drop you from their insurance plan (since President Obama deferred the business mandate for a year) or cut your hours so that you’re a part-time employee. So insurers restrict tests and cut fees to keep premiums down, and the impact in the doctor’s office is huge. Here is one disturbing example. Can you believe that as flu season begins, one awful but popular insurance plan is no longer reimbursing me for flu shots? The same insurer pays me less than $30 per visit, and only $5 for an EKG. How can I possibly continue to work with this insurance and give high-quality care, especially when all the specialists I generally refer to are running away from it?”


#39 Winston on 10.15.13 at 4:12 pm

Dear Sy,

“first of all the “yeah but Bush” card is worn thin. Prior to being POTUS, Bush was a governor of a state with a booming economy and a budget surplus.”

REALITY CHECK: That was true with almost all of the States back in the late 1990s…. your going to love this one…. thanks to Clinton…. Oh don’t try to give Newt and his boys the credit. Remember back in 1993, when Clinton and the Democrats raised taxes? I believe people like Rush Limbaugh claimed that this act was going to be a jobs killer, but what happen? Under Clinton we experienced the longest period of sustain economic growth in the history of the United States; eight years!

“Obama was in the US Senate and at least as responsible for the fiscal state of the Government as the other members of that body.”

REALITY CHECK: Gee? Who should I blame? The freshman Senator from Illinois or the 2nd term President sleeping at the wheel?

“Bush also had 9-11 to deal with which erased more than a trillion in global wealth almost instantly.”

REALITY CHECK: I often wonder how the world would be different today if “Dubya” had only read and acted upon a daily national security briefing he received on 08/06/01 entitled “Bin Ladin Determined To Strike in US,” which elaborated upon the theory that Bin Ladin planned to have commercial airliners hijacked and then crash them into American skyscrapers.

“Obama had to deal with TARP and the associated “bailouts”, but he also supported those as a candidate as long as his pals in Big Labor and “Green Energy” got a front row seat at the trough. Moreover, Bush spent $168 billion(see link above) and got hammered for that even though it worked as designed.”

REALITY CHECK: So you agree that Keynesian economics does work? Amazing! But don’t forget, Bush43 didn’t want to bail out the Auto industry, but I am glad the Democrats did, GM and America are better off for it today…. Even the Tigers are now relevant….

“Obama spent nearly a trillion $$ on his version of “Stimulus” (remember “shovel ready”?) and it didn’t work and somehow he get a pass from people like you.”

REALITY CHECK: Oh really? Perhaps we should have done as our socialist European cousins did? You know, the austerity approach which they took and which many conservative politicos in this country advocated. What was the result? Our recovery has been much stronger than theirs, because if your car stalls you prime the carburetor you don’t starve it……

“As for Iraq and Afghanistan, again those were bi-partisan supported and the policy of regime change in Iraq goes back to Bush 41 and continued through the Clinton years. Several prominent Dems are on record as far back as ’96 calling on the US to deal with Saddam militarily, and your current front runner voted “yay”.”

REALITY CHECK: Bush41 didn’t march to Baghdad, he knew better. In fact, (imagine this) his then Secretary of War, Dick Cheney, advised Bush41 at the time that it was not a wise idea. As far as Democrats being implicated in the Bush Wars, hell yes! I don’t deny that, especially under Bush43. Your the one who is trying to turn this into a partisan debate for me its a philosophical debate where many Democrats, especially in the last decade relative to this issue, have been enablers. I ask, does Democratic involvement some how make it better??

“We can debate the cost vs. outcomes and that’s fair, but by that same token we can debate the cost vs. outcomes of Obama’s first term and his outcomes aren’t good nor were they passed with bipartisan support (at least he ACA
& Stimulus, his two biggest accomplishments)”

REALITY CHECK: No one can seriously judge the ACA for at least three to five years and maybe at that time some tweaking will be necessary. Every time I have been fortunate enough to buy a new car I have always had to bring it back for adjustments. As far as the Stimulus package, well the alternative is austerity and my aforementioned comments on this topic I believe suffice, but if you still don’t buy it, well let me just say that the DOW has gone from 6500 to 15600 under Obama, unemployment continues to decline, the auto industry has rebounded, the housing market has stabilized, and the annual Federal deficit has been reduced by 60%, and by 2015 the Federal deficit will be only 23% of the level it was in 2009, when Obama became President.

As far as for your ranting and raving about Obamacare. It is still too early my friend, it is still to early, especially when your source is an editorial piece by the National Review, which is subtitled “If the feds really wanted to help uninsured patients, they would have hired more doctors.” If that isn’t crocodile tears, I don’t know what is. Obamacare empowers people to afford health insurance. It allows employees to switch jobs without the fear of losing their health care and without having to be held hostage to their current employers plan in a feudalistic manner. The people who are really complaining about Obamacare are the ones who are afraid they are going to lose their “Cadillac Plans,” because they have the same attitude about health care as they do about who should fight our wars. And what really amazes me about most of the Obamacare critics is that they are actually opposing a prior Republican plan from 1993, which was an alternative to “Hilarycare”, and backed by the conservative Heritage Foundation at the time. Not too mention that Obamacare is also a carbon copy of Romneycare, you remember Romney, he was the 2012 Republican nominee for President… Hey Sy, you are the one who turned this debate into a partisan debate, not me.

#40 Winston on 10.15.13 at 4:25 pm

Oh yeah, by the way, as far as your quote “‘yeah but Bush’ card is worn thin,” let me just also say that I still blame Hoover for the Great Depression, I don’t know about you? And vice versa, I will continue to blame Bush43 for the Great Recession and its complications. I don’t blame the thirteen Presidents after Hoover for the GD (Heck, Clinton, Bush43, and Obama weren’t even alive in ’29) and I am certainly not going to blame Obama for working to fix Bush43’s mess either….

#41 rufusx on 10.15.13 at 5:07 pm

Sy – there are maybe 3 to 4 actual “RICH” people living in SF. In reality – just like in the hundreds upon hundreds upon hundreds of the gated communities in Cali (for example) MOST of the people living in those gated communities are “upper middle class” – many not even “solidly” so. It’s a status/show-offy thing (I know, I know several of these folks) The truly rich – live in individually gated (and guarded) “estates” – not “communities” (again, from my 15 years in Cali experience). Example – one of my roommates’ dad was a retired Hollywood attorney who owned the side of a MOUNTAIN near Cambria – with ocean views from every room in the house. Replete with all the trophies from his various African Safari’s over the years. 1st, you needed to know how to get to the entry road about a half mile off the little used mountainous county highway – THEN you had to wait to be “announced” and cleared by the guard (unless of course, you were “expected” – even if family). Now, this guy was pretty “typical” of the people that lived in that part of the world – believe it or not. And not a scintilla of fame or notoriety to found anywhere near by. Most of his spending was done out of the country.

#42 Sy on 10.15.13 at 5:59 pm


“Remember back in 1993, when Clinton and the Democrats raised taxes?”

That’s cute, Clinton signed that into law in Sept. and GDP grew at 3.3% over the next 3 years while real wages fell. The boom you’re referring to kicked in after the Republicans took the House and Newt dragged Clinton kicking and screaming into Welfare reform and several other Contract with America items they passed, including more tax cuts in 1997. The next four year GDP grew at 4.4% and real wages increased by 1.7%.

Also, when Clinton took office we were in the 22nd month of expansion as the recession ended in March of ’01.

“The freshman Senator from Illinois or the 2nd term President sleeping”

You made the “inherited” claim, and as we all know a sitting US Senator has considerable more power over what the Federal Govt. does than a Governor, even if he’s in the minority. I’m glad you acknowledge that Obama did nothing while in the Senate to prevent a fiscal collapse or move towards a balanced budget, and certainly nothing that would indicate he was qualified to run the entire Country.

“Bin Ladin Determined To Strike in US,”

I’ve read that memo, you should try it some time. It talks vaguely about the first WTC attack, mentions the Millenium attack and cites LAX as a possible target and it conclude by saying the FBI is currently conducting 70 bin Laden related investigations. It also says it hasn’t been “able to corroborate the most sensational claims that bin Laden was planning on hijacking planes, but mentioned using them to free the blind Sheikh al Rahmen. Nothing in there about crashing into skyscrapers. In in no way “elaborated” on a plan that turned out to be what happened, that’s pure BS.

“But don’t forget, Bush43 didn’t want to bail out the Auto industry”

Incorrect, they asked for a bailout in Sept. of 08 and in December Bush agreed to $17 billion to be administered by the next POTUS. Google it. Chrysler and GM went into bankruptcy in May of ’09 well after Bush was out of office.

“I ask, does Democratic involvement some how make it better??”

The WMD info cited to go to Iraq was generated under Clinton. He, Gore, Edwards, Albrecht and Hillary all publically advocated to take Saddam out BEFORE Bush or Cheney ever got elected in 2000. Part of the dirty little secret is yes our CIA knew way back when that Saddam bought and used gas, we didn’t sell it directly to him, but we knew who did and did nothing to stop it. I fault both sides for that, including the Reagan & Bush 41 intelligence apparatus’. My problem since then has been the whole “Bush lied us into war” line of crap. Maybe the WMD was already gone (possibly to Syria if you believe Georges Sada) but the reason the kook Left could never get the “impeach Bush” ship to sail was that of it went to a trial all that would’ve came out. The Clinton machine didn’t want that any more than either Bush machine did.

” No one can seriously judge the ACA for at least three to five years and ”

Then no one can make any predictions on how the budget deficit will look then either because like my original point, way too much is unknown and damn near everything the bill was sold under hasn’t materialized. No one can seriously compare the ACA (the largest new entitlement since SS) to buying a new car because if your car is a lemon, you can cut your loses and sell it. We are stuck with the ACA and like SS it’s a built on a foundation that’s sinking and unsustainable. If we were smart we’d pick one and make it work and dump the other. SS was passed when there was 16 workers for every retired person. Now that number is closer to 3 to 1. Sure productivity and technology help that along, but like I said, unless we get back to 6% GDP growth SS will go tits up within a decade, and that prediction was pre-Obamacare.

“Obamacare empowers people to afford health insurance. It allows employees to switch jobs without the fear of losing their health care”

Dude, you’re puking back the campaign talking points, so tell me how that source is any better than NR? The NR piece was written by an actual Doctor, who like me is sharing real world experiences in real time. Obama told my employees they could keep their plan, not 85% of their plan. Had he said that I’d give him credit for his honesty and foresight.

“I still blame Hoover for the Great Depression, I don’t know about you?”

Leading up to the “Great Recession” every indicator you cited as proof Obama is effective was better (Dow, GDP, unemployment) under Bush. Like I’ve cited, Bush had many policies that were passed with bi-partisan support, Obama hasn’t done so at all. FDR and his massive social engineering actually prolonged the Great Depression, and apparently our current POTUS has forgotten that little detail much like he forgot how “unpatriotic” it is to max out our Bank of China Credit Card. He made that speech in reference to his Senatorial vote against raising the debt ceiling when Bush was President since I’m guessing that little detail was missed in your versions of reality.

Your reality checks are bouncing, my friend.

#43 Winston on 10.15.13 at 7:18 pm

Just for fun I am going to response from bottom to top….

Point # 8

“better under Bush”???? Yah, my car looked the best just before I crashed it too….

“bi-partisan support”??? This reality is not in the cards as long as the Tea Party exists….

“FDR …. prolonged the Great Depression”??? Yep, Hoover’s policies or lack there of were definitely working and the right approach ….???? FDR saved capitalism. Up until the 1930s, Argentina and the United States had similar histories, except that beginning in the 1930s Argentina got Peron and fascism, while America got FDR and the survival of capitalism.

Your “unpatriotic” comment is the most disingenuous understanding of history I ever read in sometime. The America of 2005 was not the America of 2009. But you emphasize an interesting point, this point is what I call the true Bush43 legacy, which is that his policies tie the hands of future leaders…. it is truly the gift (not really a gift rather a burden) which keeps on giving….

Point # 7

Show me a NR article from 1993 which indicts the Heritage Foundation plan of 1993 (you know it now as Romneycare…. I mean Obamacare)…. How convenient that they criticize their fellow conservative idea now…. I guess you just never know who your friends really are….

“Talking points”? Your TPs out number mine about ten to one.

Point # 6

I am confused are we debating SS or the ACA here? Oh by the way, my 14 year old SUV still works, but at times I still have to take her (sorry, feminists) in…..

Point # 5

Well first of all, taking Saddam out is one thing, doing it in a World War II Normandy fashion is an other thing. Also, with all do respect, (I know this will be hard for you Sy to swallow) but Al, John, Madeleine, and Hilary often don’t pass my personal liberal test, but there you go again with your partisan bent…..

Oh, as far as impeaching Bush43, I thought the reason it never happen was because the Democrats were just cowards or maybe I should just give them the benefit of the doubt and hope they just wanted to move the country forward ….???…. Oh by the way, the Democrats should have impeached Reagan too for Iran-Contra…. Sy! Sy! are you still with us or did that one cause you to fall over?

Point # 4

Yep, Bush43 gave the Auto industry $ 14 billion, but the only problem is that they actually needed $ 74 billion. The extra $ 60 billion came from Obama…. “Hey, I have an idea let’s just give them enough dough so that the problem can land on my predecessor’s lap. That way if it fails they will blame Barack and if it succeeds we will be sure to remind people like Sy that we played a part in it….”

Point # 3

Here is a good cite on this issue:


Note also, that parts of this memo are still classified. Also remember that a FBI agent out of Minneapolis was instrumental in having an Al Qaeda member detained prior to 9/11 because all he want to do was learn how to fly a plane. He didn’t care about take-off or landing, but was there any follow through here? Also, remember that the one major warning that Clinton gave Bush43 in their first interregnum meeting was that Bush43 needed to watch Bin Laden. Remember also that then CIA Director Tenet and national security advisor Richard Clark constantly warned the Bush43 Administration throughout 2001 about the terrorist threat from Al-Qaeda to deaf ears from the Bush43 administration, they claimed to be more concerned about pornography.

Point # 2

In January of 2005, the Republicans controlled the White House, the Senate, and the House of Representatives. Based on your Obama power theory, then definitely Bushe43 should have had a handle on things prior to 9/11 given the facts I have just presented to Point # 3, which then conveniently indicts your Point # 2 premise as well.

Plus, backed then the majority Party was far more concerned about the Schiavo Case then the collapsing housing bubble.

Point # 1

The economy grew 3.3%? I guess Limbaugh was wrong. The 4.4% growth is merely the multiplier effect of continued growth. If the Republicans did such a great job back in the late 90s, how come they were the first major Party, which did not control the White House at the time, to actually lose seats in the US House in an non-Presidential election year with even the sitting President of the opposing Party having Articles of Impeachment hanging over his head?

And Welfare Reform, are you taking about the program which even Red State Governors are asking to have the right to opt out of now, because it doesn’t work.

It is also disingenuous to try to take credit for an increase in real wages, while also taking credit for the Welfare Act; an act which increases the number of workers thus potentially reducing the wages for the other workers already in the workforce…. And if that doesn’t happen, the W Act at least puts people to work at best at minimum wage…. So much for championing real wages…..

Talk to you later, I have to go fix my washer now…..

#44 Winston on 10.15.13 at 7:20 pm

“predecessors”??… successors = Point # 4

#45 Sy on 10.16.13 at 12:27 pm

Winston, does it make it easier to swallow if it’s from a reliable mainstream paper like USA Today:

“”While the rest of the U.S. economy is stabilizing or improving, health care is entering into a recession,” says John Howser, assistant vice chancellor of Vanderbilt University Medical Center.

Health care providers announced more layoffs than any other industry last month — 8,128 — largely because of reductions by hospitals, according to outplacement firm Challenger Gray and Christmas. So far this year, the health care sector has announced 41,085 layoffs, the third-most behind financial and industrial companies.”


#46 Winston on 10.16.13 at 3:25 pm

Whatever happen to Sy’s Spanish piece? I am currently working on my response…..

#47 Winston on 10.16.13 at 6:22 pm

Oh, as far as your USA Today piece, I still remember what one of my USD professors once said about the USA Today newspaper. He said, “USA Today is the ‘Weekly Reader’ (do you remember 1st grade?) of adult newspapers… They even have a full colored page devoted to the weather and two pages which are devoted to trivial news from all of the 50 states.”

But as far as the content of this article, I cannot believe you are relying on it. It indicts the Tea Party sequestration headache. It proves that Obamacare appropriately penalizes poor hospitals. It blames “Dubya’s” Great Recession. And then it blames Baby Boomers for turning 65 and relying on Medicare…. Oh, so now we are against LBJcare too? Then it goes on to criticize Republican governors for not adding the working poor onto Medicaid. Did you read this? Its conclusion is the best part:

“Still, J.P. Fingado, CEO of API Healthcare, a consulting firm for hospitals, says the layoffs are shortsighted because the providers likely will have to add staff as soon as next year to handle increased patient volumes resulting from the health care law.”

and then,

“‘The cuts are a particularly short-term reaction,’ he says.”

#48 Craig on 10.17.13 at 10:08 am

Remind me to never pick a fight with Winston.

#49 ProudLeftWingNutJob on 10.18.13 at 10:40 am

Go Winnie go!