Friday, March 19, 2010
The Kill The Poor Initiative
Regarding the reconciliation bill, I skimmed it last night. If you haven't read the Senate bill, reading the amendment makes no sense.
The bottom line is that the CBO's analysis is way, way off, because a ton of companies will drop their insurance and shift employees into the exchanges to buy subsidized insurance. Because of the very large subsidies, this will jack the cost up about double of CBO's prediction.
There are some offsets - for example, many employees will receive more in salary as a result (companies will give back some of the savings), which will boost Social Security taxes and income taxes. But there are also another round of nasty offsets, in which the mid-range employees will end up paying much more for their insurance and medical costs, which will inflict considerable economic damage.
Of course, that's if you presume that these employees bother to take out insurance if they are healthy. If not, and they don't buy insurance because they feel assured that they will be able to get insurance should they need it (open enrollment, etc), then these families will have a net boost in income but health insurance rates will shoot through the roof. That is the most likely result, and it will set up a cartwheel effect that will force more and more companies to drop insurance, and more and more mid-range families to drop insurance.
It's a beautiful statistical problem, but one not likely to produce the results CBO predicts.
The other problem is that this legislation does not address the real cost-shifting problem, which is from Medicare and Medicaid to private insurers. So we have ensured a continuing rise in insurance costs regardless, which is why I am so sure that many companies will drop insurance altogether.
The funniest part about this is that many mid-range income families would be better off in the short-term, as long as they dumped some of this money into savings, especially tax-preferred savings. Because of the rise of cash clinics everywhere, medical care in the US is cheap as long as you go to the right places for it. Really cheap. The result would be to essentially bankrupt many hospitals, which would mean that over the long term, your chances of surviving a true medical emergency would drop substantially.
The other thing this legislation does is basically cut lower-income elderly out of the Medicare system by a stealth process. This stealth process is well-explained by a doctor who happens to be Obama's cousin:
...consider the implications of Obamacare's financial penalty aimed at your doctor if he seeks the expert care he has determined you need. If your doctor is in the top 10 percent of primary care physicians who refer patients to specialists most frequently - no matter how valid the reasons - he will face a 5 percent penalty on all their Medicare reimbursements for the entire year. This scheme is specifically designed to deny you the chance to see a specialist. Each year, the insidious nature of that arbitrary 10 percent rule will make things even worse as 100 percent of doctors try to stay off that list. Many doctors will try to avoid the sickest patients, and others will simply refuse to accept Medicare. Already, 42 percent of doctors have chosen that route, and it will get worse. Your mother's shiny government-issued Medicare health card is meaningless without doctors who will accept it.People who call themselves liberal and support this really should be wondering whether the Catholic church is correct about purgatory. Because this change is meaningless for older people who are well off and on Medicare. They can afford to pay for a SuperDoc who will cheerfully refer them for any care they need. So the retirees that can afford to pay $500 out of pocket to see a doctor annually will continue (until the hospitals degenerate, which they will) to get all the rest of Medicare's benefits.
No, the persons hurt will be the retirees who are strapped and can't afford to go outside Medicare for their primary care. They will never know why they are being killed. Certainly the doctors who bow to this won't tell them. They won't see a cancer doctor, they won't get the cardiac tests, they will get the aspirins and be sent home to die.
If the Bush administration had proposed anything like this, every liberal organization from Pew on down would reacted with a storm of protest. Rightful and righteous protest. But no, this comes from a ???Democratic????? administration that controls the government absolutely.
I ask my burning question again. What will replace the Democratic party? Because this just isn't right or decent, and the US is not this kind of country. I'm not saying we're saints, but this is bounteous welfare for the wealthy and a walk-the-plank for those who are just scraping by. It's the nastiest piece of legislation I think I have ever read.
I have a lot more to write on this issue. Nothing will stop this bill from passage, because the Democratic leadership is convinced they have to have this, and they are going to hand out anything to anyone to get these votes. Nor do most of the representatives even know what's in this bill, but they will understand what they are being promised in order to vote for it. One of the reasons many are shifting to the undecided category is to get in on the pinata scramble.
But it's a very uncivilized piece of legislation. This is economic Jim Crow.
According to polls, most liberals support this bill. This convinces me that most liberals nowadays are either wealthy SOBs or people with good hearts who cannot add or subtract. SuperDoc said that this bill amounted to paying doctors to kill Medicare patients cheaply. He's not sure what he'll do, but he's not going to go along with this. I don't think many have his moral fiber, though, and most don't have his deep pockets.
Thanks to BobN, who whatever his politics, clearly can add and subtract.
Btw, if you are one of those liberals who can add and subtract, and are justifying this to yourself on the basis that we really do need to control Medicare costs, your thinking is way off. Because in the long run, this will hike medical costs. People will still be able to go to the emergency room, and when they do, they'll get treated. But they'll be very sick. So they'll wind up on Medicaid and in nursing homes, which will completely blow away the savings. You have no idea about how medicine works.
There is not a way to kill people cheaply in the US.
I have no doubt the Dems will come up with something for that.
How long before hospitals are allowed to turn people away from emergency care under some "special circumstances" the Uber-Government establishes?
That's where the end of life counseling comes in - and while I do tend to think that people have the right to end their own misery, I do NOT think it is right to induce that misery through lack of treatment. Nor do I think doctors should be compensated for providing such "useful" advice - to possibly confused, depressed seniors - instead of family members.
Unintended consequences. Unfortunately, that is the effect of many things Congress passes.
"The other problem is that this legislation does not address the real cost-shifting problem, which is from Medicare and Medicaid to private insurers."
They have not even thought about the real isolutions to lowering healthcare costs. One reason I'm convinced this isn't about healthcare as much as it is about more control by the Feds.
The provision to punish doctors who send Medicare patients to specialists shows more of their inability to understand unintended consequences or........their total lack of humanity.
So, what we have here is higher costs, less access, and earlier, sometimes more painful deaths. About par for the course for the oh so caring, generous Democrat Congress and their partner in thios travesty, Obama.
Anyway, I looked at your piece and the votes and the votes of the legislators I know, and the first thing I realized then was that some legislators had been strong-armed into it.
It would appear that we are in that mode.
Jimmy - I think that if legislators were voting their consciences (and if they knew what was in the bill) they would not do this. I am convinced part of the problem is in the current leadership.
But this is a nasty, unconscionable piece of legislation.
Your reference to 'Terror and Islam' turned on a light in my brain...This HCR vote is the Dems 'Fantasy Ideology' (ala Lee Harris). It's not about what it will DO...it's about how it will make them FEEL. Maybe not all of them, but enough.
To quote the key section from Mr. Harris' original article :
"My first encounter with this particular kind of fantasy occurred when I was in college in the late sixties. A friend of mine and I got into a heated argument. Although we were both opposed to the Vietnam War, we discovered that we differed considerably on what counted as permissible forms of anti-war protest. To me the point of such protest was simple — to turn people against the war. Hence anything that was counterproductive to this purpose was politically irresponsible and should be severely censured. My friend thought otherwise; in fact, he was planning to join what by all accounts was to be a massively disruptive demonstration in Washington, and which in fact became one.
My friend did not disagree with me as to the likely counterproductive effects of such a demonstration. Instead, he argued that this simply did not matter. His answer was that even if it was counterproductive, even if it turned people against war protesters, indeed even if it made them more likely to support the continuation of the war, he would still participate in the demonstration and he would do so for one simple reason — because it was, in his words, good for his soul.
What I saw as a political act was not, for my friend, any such thing. It was not aimed at altering the minds of other people or persuading them to act differently. Its whole point was what it did for him.
And what it did for him was to provide him with a fantasy — a fantasy, namely, of taking part in the revolutionary struggle of the oppressed against their oppressors. By participating in a violent anti-war demonstration, he was in no sense aiming at coercing conformity with his view — for that would still have been a political objective. Instead, he took his part in order to confirm his ideological fantasy of marching on the right side of history, of feeling himself among the elect few who stood with the angels of historical inevitability. Thus, when he lay down in front of hapless commuters on the bridges over the Potomac, he had no interest in changing the minds of these commuters, no concern over whether they became angry at the protesters or not. They were there merely as props, as so many supernumeraries in his private psychodrama. The protest for him was not politics, but theater; and the significance of his role lay not in the political ends his actions might achieve, but rather in their symbolic value as ritual. In short, he was acting out a fantasy."
"I think that if legislators were voting their consciences (and if they knew what was in the bill) they would not do this ..."
How can our dam'-fool "representatives" (-Hah!) know what's in this bill so they could "vote their consciences"???? It's 2700 pages long, just got released yesterday, and they're gonna vote it in day-after-tomorrow, UNREAD, YET AGAIN.
I am so angry ... but I won't go there just now, I'm trying to stay civil.
When the revolution's over and we finally rebuild our country, I propose some kind of Constitutional amendment that FORBIDS both houses of Congress from being controlled by the same party. Also, let's have a One-Year Review after the first State of the Union message: if enough citizens of individual states petition their State Attorneys General to call a "Vote-of-No-Confidence" Election (with over half of the 50 states participating), and if over half of the 50 states have a 60% or more "No Confidence" votes, depose the President and install the Vice-President. After HIS first State of the Union speech, same thing. Keep the bastards aware that WE ARE THE POWER AND WE CAN THROW THEM OUT -- SOONER THAN THEY THINK.
Hissssss.... (Imagine the sound of a very upset Don't Tread On Me snake...)
If the consequences turn out to be remotely as you predict (and they seem likely), I'LL predict that true Single-Payer (or even a US-version of NHS [Doctor Corps(e) anyone?]) will be the solution proposed next, and the current plan WILL have turned-out to have been a Trojan horse. Of course, that assumes the whole Bismarkian Welfare State hasn't broken down by 2015 or so .
On a personal note, Darling Daughter is to be applying to Med Schools this summer (for entry in Fall 2011). The uncertainties going forward certainly make taking on the $150-250K in debt to complete school a really scary proposition.
This convinces me that most liberals nowadays are either wealthy SOBs or people with good hearts who cannot add or subtract.
Not necessarily wealthy, but people who believe themselves to be secure. I know folks with technical PhD's, who do statistics every day for their job, who not only believe this will work, but that anyone who disagrees can only do so out of evil or self-interested motives.
Normally I avoid armchair psychological evaluations, but I know so many of these folks so well that I think I can share some observations. It's not that they can't do the math, it's that they want so badly to believe in the health care fairy (and by extension the socialism fairy) they'll do anything to avoid thinking about it. They put blind faith in their leaders because to do otherwise would require a huge step into a frightening world where everything they think they have is at risk. Never mind that it's at risk anyway, maintaining the illusion is enough.
I have no doubt that the average leftist is more intelligent than the rest of the population. It takes a fair amount of intelligence to construct mental defenses around such willful ignorance.
If you want to substitute IQ (mental agility) for intelligence we could resolve our differences amicably....
In any case, the comments are converging on the question of fantasy. And for that please see Soviet of Washington's link above. I had never encountered that article and I was fascinated.
Thanks for the comments everyone. I'm always learning. Today I'm a little dazed by the spectacle, but the Harris article really helped!
A_Nonny_Mouse - I think the reason Congress' approval rating is so low is because they're not reading bills. People feel robbed of representation.
I might be willing to make the substitution as regards leftists in general, but my direct experience is largely with engineers, scientists, and medical professionals who have demonstrated problem-solving acuity in other circumstances.
I've known many, many people with excellent problem-solving abilities. But it's very difficult to apply that ability uniformly to everything one encounters. Especially when the immediate psychological incentives are to remain blind.
thin outside the box!
Perhaps hospitals, in an effort to find new sources of income, will merge with funeral homes.
Take two aspirin and call an undertaker in the morning.
Yep, narcissism writ large. Same thing that put Obama in the White House.
So here's Health Care. We're going to add 30 million people to the insurance rolls who aren't currently. Let's say 20% of those will seek medical care that haven't in the past. So please explain to me how the demand curve can shift up, with the supply curve unchanged and we are going to save $1 trillion dollars? Through efficiencies and cutting out waste?
Especially for anything covered by Medicare. My doctor bills Medicare $105 per office visit. Medicare pays him $43. My opinion - Either the doc's bill is too high or Medicare pays too little. This kind of transaction goes on daily throughout the system. Where is the truth? We are kidding ourselves if we think this HCR Bill is going to fix that.
My doctor quit taking new Medicare patients five years ago. He is weeding out his Medicare patients through "attrition." (DEATH!) He finds me disgustingly healthy for my age. Statistics show I've got 7-8 years left. I'm planning on 15. Heh!
My wife goes to a doctor that doesn't take Medicare patients because she has a medical condition that requires out of the box doctoring -something like MOM's Super Doc. He just called her today and told here he cannot prescribe (an off label medicine) anymore because the FDA is after him. My wife has been taking nightly injections of the off label medication for five years with very satisfactory results. Now her quality of life is going to suffer because some government body has decided she cannot have a medication which has been helping her for five years. We are going to see much more of this if Obamacare succeeds in becoming law.
I'm still fighting against it. Called a bunch of fence sitters today. Going to a demonstration at my Reps office tomorrow. We have to get these people to understand that they work for us, not the other way around.
Unfortunately, that can only be done if they are poor, but our government seems to be achieving that goal quite rapidly and efficiently.
The root problem is the one Jimmy mentioned - that these government insurance programs don't pay enough to fund primary care. If they did, we would save considerable money at hospitals and nursing homes - they wouldn't be at the ER, and many of them would have much milder problems.
SuperDoc (who in theory does not take Medicare) has been treating an older black woman a few months ago. She came in just about flat out with just about every problem in the book and on way too much meds. Couldn't walk.
By now he has most of it controlled, and she's on much milder medicines. The BP is back down, the diabetes is controlled, and she is walking and able to get herself around. Also a lot clearer mentally. He is about to ease her into an exercise program, and in the end he's probably going to have to refer her for vascular surgery on one leg. But she's going to be able to live independently with a high quality of life and her health will probably improve for years to come. She is a responsive, cooperative patient.
Now all of that might sound expensive, but this woman probably wasn't going to die for years. However she was going to end up in a nursing home as an amputee, and probably pretty blind. So Medicaid would have picked up, and she would have cost the medical system a great deal.
SuperDoc saves us all a lot of money with his medical projects. If we want to put enough money into the system to fund that type of care, we will see eventual savings. If not, we get Massachusetts squared, where the waiting times to see a doctor can be more than a month, so everyone winds up in the ER anyway. And by the time they go, they are very sick indeed.
It's eerily impressive to watch what SuperDoc does for people, but the point is that he isn't paid to do it. He does it because he can. However, if he were younger and had all his loans and was paying off a mortgage, sending kids to school, etc, he wouldn't be able to afford to treat patients like he is doing.
But the really sad part is that all it would take to at least pay the costs on this woman he is treating would be about $400 more a year. So not paying that $400 is a very expensive proposition; there are other SuperDocs out there who can do the same thing, but many of them can't afford to do it for many people.
SuperDoc was running around the office in a frenzy last weekend hollering that Obama wasn't black, and I see why. Because in a few years Medicare is going to start disallowing the tests SuperDoc needs to pull this sort of thing off, and then he's up you-know-what creek without a paddle. Like on this lady, he needed a few scans to see what he could get away with.
He does this stuff over and over again. It's not a fluke.
He does this stuff over and over again. It's not a fluke.
Yup. Personalized medicine. We have most of the tools we need to do it now, but the regulatory system won't allow it to become economical. Everything from the FDA to Medicare to Blue Cross/Shield is set up on the assumption that every body works the same as every other body, and every instance of a particular disease is the same as every other instance of that disease. We can't start treating people as people until we tear down the system and start over.
Truthfully, Obamacare will probably have precisely that end result. Unfortunately, before it collapses it will destroy an awful lot of the useful parts of the system trying to keep the whole big mess alive.
Arizona kills SCHIP, puts Medicare on a diet
Sounds like the states can pretty much negate any expansion of coverage.
I am pleasantly surprised that you remember. I also remember your analysis was spot on.
Anyway, I looked at your piece and the votes and the votes of the legislators I know, and the first thing I realized then was that some legislators had been strong-armed into it.
BTW, Milton Wolf, Obama's cousin and also a radioligist, has his own blog:
This bill establishes a new Independent Medicare Advisory Board that is required to recommend Medicare cuts. Its goal is simple: to limit resources going to Medicare patients. Any recommendations made by the commission would go into effect, even if Congress does not act on it.
In fact, the actual language of the Senate bill works actvely prevents future Congresses from changing anything the commission does, by requiring super majorities not normally required for legislation.
Karl Denninger brings up the same point here:
"Here's how it will happen.
Congress will pass and Obama will sign something containing this "individual mandate."
This will generate immediate lawsuits which will begin their way through the system, headed for the United States Supreme Court. That process will take several years. Note that the so-called "benefits" of this reform will also take several years to show up. This is not an accident.
Meanwhile, the taxes begin immediately. This is exactly what happened in the 1930s by the way - taxes were raised right into the maw of an economic recession, and helped turn it into a Depression. Such it will be this time as well.
Young, healthy people will pay the "fines" under protest and refuse to buy coverage (it's cheaper than complying with a $15,000/year mandate to pay the $750/year fine!) and join said lawsuits in Step #2. This will in turn begin to force private companies out of the system (remember, there are also price controls in there!) as adverse selection will not be eliminated as promised.
At some point the courts will strike the individual mandate. Free to not pay the fine or buy insurance and prevented from raising rates adverse selection will collapse the remaining private health insurers.
At this point you have:
1. Permanently higher taxes (since it is constitutional to tax!)
2. NO private health insurers left in the market.
3. The "standards and practices" remaining and impossible to remove (note the super-majority requirements in the bill - intentionally put there to prevent the removal of those standards and practices!)
What comes next? Unable to impose mandatory individual payments to private companies The Government will then have "no choice" but to put in place a Canadian-style system.
For good or bad, you will get both rationing and a tax-funded medical system in The United States."
Karl has been known to go off the deep end, but this is theory that explains an awful lot of facts.
For example, in the waste and fraud provisions, there is a new directive for HHS to set up a new audit for physicians and care facilities. They fund this by charging the individual physician $200. It includes things like fingerprinting.... The PQRI provisions are to force reporting of exactly what you do, etc.
A lot of doctors will drop Medicare. If they are losing money on it now, and they get harassed to boot, it gets to the point at which they won't even be able to keep their practices.
I am trying to work on a summary of these provisions in the Senate bill right now. If they vote tomorrow, we don't know if the amendment will be adopted by the Senate, but the Senate bill will go through and be law.
Thanks for that blog link. It looks quite interesting, and I will try to find the time to listen to the radio interview tonight.
I realize that we have to cut back, but this is not a rational or just way to do it.
-- Army Mom
-- Army Mom
I consider myself a "Recovering Liberal".
I disbelieve in AGW, Gun Control, DemCare, amnesty for illegals, and "cap and trade". I voted against all Democrats in November 2008 - after 20 years of voting against all Republicans. (Sadly, this means I voted for Republicans in 2008, including Juan McCain).
On the other hand, I'm still not the corporate apologist that Carl Frank is. I still believe that de-regulation (bi-partisan, as M_O_M has pointed out to me) and non-regulation (think of the Bush OFHEO - which had the actual responsibility for regulating the GSEs - and the Bush SEC) along with incredibly vile greed on Wall Street, mostly caused the financial crisis. (Not that people didn't lie on their mortgage applications.)
But I also think that government needs to stay out of things where a market can do the work. Social Security and Medicare being beyond bankrupt demonstrate why.
And I remain mostly agnostic, religiously speaking. I do not, however subscribe to the idea that Rights come from government - they come from being human. ("The Right od self-defense is the first law of nature." - St. George Tucker). I don't think we need to postulate some Creator, beyond nature, to find these Rights self-evident - though I seem to align better politically with those who do.
And I am still convinced that the Bush administration damaged individual rights, argued improperly in Heller, and went into the Iraq war stupidly.
Army Mom, I wish your son the very best.
I worry about Afghanistan, and I pray for them all, and for our leadership. That's all I can do. Well, I donate to military support funds, but that doesn't help in the crux. Where they are.
The only reason I ended up picking McCain despite my strong conviction that he should not be President was that I thought Obama was too hawkish and had no perspective.
Like you, I am inclined to be agnostic religiously. I simply am not, generally speaking, a "believer". However, I recognize a tremendous problem with agnosticism--it is not a stable societal construct to the second generation, at least in any form available today.
I have known too many people my age raised as agnostics, who adopt Islam, Buddhism, Wicca, Druidism, you name it; all out of a hunger for belief. I have nothing against those religions, I'm just pointing out that in my experience, agnosticism practically speaking is not agnosticism, it's just "Anything But Christianity".
This wouldn't really be an issue, except that most of the substitute religions do not have the same philosophical tradition of "natural rights", and I have not as yet seen a vigorous secular defense of the concept of natural rights. Quite the opposite--as you point out, it seems that most people that accept the existence of such do so out of religious conviction.
We must stop the abomination that is being foisted on the US from within. If unconstitutional legislation is going to be passed, then we HAVE to find people who will vote to repeal later on no matter how hard it is to do it. We must change our politicians not be changed by our politicians.
We must change our society of victims and entitlement to one that shuns such things. We used to look askance at people who refused to contribute to our society. We have never refused to give someone a hand up and should think nothing of refusing to give hand outs.
This is our fight. Your blog helps in that it passes on much needed information. Please don't be depressed...please fight on.
-- Army Mom
However, I recognize a tremendous problem with agnosticism--it is not a stable societal construct to the second generation, at least in any form available today
Why is that? One theory I heard advocated is that the first generation is raised religiously and retains the values while rejecting the dogma. Is it really true that we can't instill respect for the laws of nature and the rights of Man, without also instilling belief in God? Do we really need the feeling that "somebody" is watching all the time in order to be moral beings?
have not as yet seen a vigorous secular defense of the concept of natural rights. Quite the opposite--as you point out, it seems that most people that accept the existence of such do so out of religious conviction.
Ayn Rand made a good stab at that, IMO. She is utterly in favor of individual rights and opposed to the initiation of the use of force, with no reference to religion of any sort. But she takes it all the way to an insistence on pure laissez faire capitalism - and IMO we've had a good demonstration of the problems with that, several times in our history. (I don't buy that we've never been close enough to full capitalism to see it in action.)
The Democratic Party shed any vestige of true liberalism decades ago.They offer a totally corrupt "Mean Mommy/Sweet Mommy state".And I see the republican party as equally corrupt in their actions,but offering a "Stern Daddy" state.
Call it Communism or call it Fascism - in either case it is Statism and that is the enemy.
My fear in all of this legislation is that one day, he will need another revision and be denied. I can easily see this legislation dooming folks to life in a wheelchair. The burden will fall on family members to provide the care. I'll never be able to convince him of this, because all he can see is that it is supposed to cover folks without insurance. He's still a true believer.
Good question. I don't know the answer, but I do know that blundering around trying to do without religion is killing Western civilization, much to my personal chagrin. Since much of our behavior is imprinted on us at an early age, perhaps it has something to do with the need to express things in terms that can be grasped by a 3 to 12-year old. Small children need a ghost in the machine, and Daddy's feet always turn out to be made of clay.
Ayn Rand made a good stab at that, IMO.
Ayn Rand made a coherent argument in favor of fulfillment of individual potential. Unfortunately, her ideals require the banishment of jealousy, greed, and fear from humanity, so that some few may soar with eagles while others live in the mud, accepting table scraps from the eagles and looking on in awe. Even if her philosophy provides for the ideal path toward the improvement of the human condition, I don't think it is a stable, achievable situation. It fails because it lacks the teachings provided by religion.
Everyone needs a sense of self-determination, a sense that they can provide for themselves. Failing that, they will seek a strong man to provide for them. Judeo-Christian religion (along with Greco-Roman logic) is the only body of philosophical work that I know of that provides the philosophical underpinnings for both high achievement of the capable and a sense of well-being for the less-capable.
Belief that basic rights are endowed by a deity also has the advantage of anchoring them in something that's at least more difficult to rationalize away. It's similar to what the Bill of Rights does -- it places some fundamental guarantees outside the realm of discussion or waiver.
Likewise, the concept of original sin, even if not literally accurate in the way it's often perceived, makes a good shorthand for man's basic moral shortcomings -- our tendency to misjudge the long-term consequences of our actions, or even to know that an action will hurt ourselves or our loved ones in the long run and then go ahead and do it anyway. Call it original sin, call it Poe's "imp of the perverse," call it the evolutionary leftovers in our subconscious from our reptile ancestors, or whatever, it definitely seems to be there in spite of our best efforts to be rational and prudent. (Think of a gambling addict who knows exactly how bad the odds are and who still can't pass up the tables.) Ignoring these flaws and assuming man in his present state to be perfect or perfectible leads to policies that completely ignore unintended consequences.
Unfortunately, her ideals require the banishment of jealousy, greed, and fear from humanity, so that some few may soar with eagles while others live in the mud, accepting table scraps from the eagles and looking on in awe.
A genuinely enlightened self-interest recognizes that offering the people who help make your dream a reality only table scraps while keeping the red meat for yourself won't keep them on your side (and that if all you're being offered is table scraps, you should let the greedy SOB do his own grunt work and either go to work for his competitor or try working for yourself). Again, though, realizing and following through on that before it's too late is the hard part.
Links to this post: