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[yogi]

One of the most interesting ideas I've seen in restaurants is the Pay What You Want menu. It may not be the best in the house, but it's decent food and if you can't afford to pay at all, that's OK too. I read about a couple of those places and neither one is doing really well. Nonetheless, I like the idea.

Minimum wage was intended to lift people above the poverty level. There are conflicting stories about what that exact level should be, but the intent of the minimum wage was good. Enforcing it does not always bring up prices because the first thing the employer does is reduce the work force or the hours they are allowed to work. Some can't do that, of course, and must pass on the higher costs of manufacturing but not always. At Motorola the emphasis was on productivity. Instead of laying off people, the existing work force was encouraged to do more. So, the employer was getting more for the same price. I think it's already been shown that raising the minimum wage doesn't affect inflation much, if at all. The greatest benefit is the taxes the new wage earner must now pay because their income has increased.

People on fixed income are always screwed. Us SS benefit recipients are not really on fixed incomes given that there are increases from time to time. I'll be the first to agree that the increases never cover increased expenses. I did my income taxes recently and totaled up all the insurance premiums I am paying for healthcare, well me and my wife together. I nearly fainted when it came to $16k all told. I'm truly happy that I don't have to make claims to that extent because it means we are staying relatively healthy. However, the tide will turn one day. I'm still not sure we will get back what we put into it.

[Kellemora]

I paid my cooks in the 1970s about the same as what they were making other places in the 1980s.
I also paid my wait staff the same salary as I paid prep-cooks and dressers.
I never had a wait staff person quit unless it was to go back to school or their family was moving.

At one of the restaurant association meetings, where we fill out these forms about several things, one of which has to do with employee turnover. I was always at the top of the list as having the least amount of employee turnover in all four categories. Only twice was I down in second place on one category and that was cooks. But the next question made up for it. Did they leave for a higher paying position elsewhere, or due to school, or for a personal matter not associated with the industry. You could write in the reason too generically. One time it was because they were injured in a car accident, and the other time it was because they were going away to college in another state.

I had a list of about 100 or more gals and a couple of guys, who wanted to get on our wait staff, on the restaurant side I ran. We had no say so about the franchise side wages. Even so, I supplemented their corporate paycheck with a bonus paycheck to make up the difference between what I paid and what corporate paid.

Before I retired, I had a really great insurance policy and wanted to keep it. But once you reach retirement you are forced onto medicare and have to drop your existing insurance and get another supplemental insurance to cover what medicare don't pay, or at least some of it.
Debi's mom had an excellent insurance policy that covered everything not covered by medicare, so she never got a bill for anything. Policies like that were not available when I retired, and heavily controlled by medicare rules too.

I just got my medicare summary that shows charges, how much they authorize and how much they pay. You pay the difference between those two figures. Now some things they do not pay at all.
I get something similar from my drug plan.
One of the scripts I get is around 110 dollars a month, the plan pays 100 leaving me 10 to pay.
But then the next line is a Dispensing Fee of 130 bucks. Not Covered. Say what?
What the H is a Dispensing Fee anyhow?
I did find out my supplemental plan picks up most of it, leaving me 15 dollars to pay.

The next thing on the list that is driving me nuts is my Nebulizer machine.
They only cost between 30 and 50 dollars to buy. The brand I have only costs 38 bucks.
Yet the one I have is a rental and they are charging medicare 55 dollars a month for it.
I do have an oxygen concentrator and actually thought that is what the 55 bucks a month was for.
But no, it is for the nebulizer, and the reason they get 55 bucks a month is because they supply me with 6 cannullas and one mouthpiece every three months. The mouthpiece part costs 66 cents a kit, and the cannullas are like 1.50 each in a pack of six.
The sad thing is, whether I let medicare pay for it, or if I buy one myself, and the peripheral items, it does not change my cost for the medicare package.
It is all one big con game if you ask me!

[yogi]

I don't know too many people who are comfortable with insurance of any kind unless they work for the company. Even then there is a lot of eyebrow raising. My wife's first job was as a claims adjuster for a major insurance company and she would see all kinds of peculiar claims; some more so than the others. One such case was of a woman who had multiple nipples on her breast. Frankly I never knew such things happened until my wife told me about this claim. The claim was for removal of three, which actually left the patient with the usual two. After doing some research my wife had to deny payment for anything above the standard two. Apparently it was considered an elective surgery going beyond that. There is some degree of sanity in that logic. but the woman was very upset that she had to bear the cost of that extra surgery. The people who wrote the rules, obviously, were all males and never anticipated this kind of surgery. The premium costs were based on two nips and that is all they paid for.

That's just a small sample of how it seems that you are being cheated, but there is some logic in the parts you don't know about. I can't say insurance companies are any more crooked than other businesses. They are covered by the same laws as anyone else and in fact have an insurance oversight organization to answer to as well: the state insurance commissioner.

When it comes to Medicare we are talking about people who normally could ill afford the actual costs of healthcare. It's a Catch-22 situation in many instances where the insurance people can't pay out more than they take in, and the payouts seldom cover the full costs. If they did cover the full costs the premiums would be astronomically high and nobody could afford insurance at all. Thus, Medicare "negotiates" with healthcare providers to share the costs in what they think is a reasonable and fair manner. They have budgets too. The view you have of your payment share depends on your resources. If you don't have any, then co-payments look extravagant and unfair. I don't know the numbers, but I would guess-timate that at least half the people using Medicare can't reasonably afford the co-pays associated with major illnesses.

It comes down to being informed about what you are buying and being aware of the economics involved. You had to sell everything in order to pay off medical bills, and that would have come out of the insurance company's (or healthcare providers') bottom line if you didn't pay it. Somebody has to pay. You were the least capable of the three, and your daily life was affected the most. There is no question about who suffered the greatest losses. The insurance people didn't plan it that way, believe it or not. They simply came up with numbers that would keep them in business. Those numbers are published even if the ordinary man can't find them or comprehend them when he does. Insurance is not a covert business. They deal in money and statistics which is what makes it all so difficult. The fact that our health and well being is affected by it makes it all very stressful.

For all the good it does I am deeply concerned about your dilemma. You are my virtual friend for sure, but I see myself being vulnerable to the same scenario some day. At the moment I'm more pessimistic than I usually am because of what I read and hear about Medicare's role in the healthcare business. If the current political leaders have their way Medicare will be backing out considerably. In addition to my sympathies for you and people in similar situations, I feel anger that people with a political agenda have the power to affect the lives of so many vulnerable people. We could vote them out, but I don't see the replacements being any better.

[Kellemora]

How can a company bill Medicare $55.20 per month for a machine that costs $29.95-32.99, Medicare ALLOWS $33.00 but only pays $14.75 one month and $0.00 this month because I've not yet met my deductible for 2020.
This means I have to pay $18.25 out of my pocket for last month, and $33.00 out of my pocket for this month.
I just the bill in today's mail, else I would have had this data yesterday.

I think the gimmick here is, they won't supply me with the Cannula's and Mouthpieces, which I'm also paying for the part Medicare don't cover. I'll have to wait and see if perhaps my Supplemental Insurance picks it up.

After seeing this, it's no wonder my late wife hit the ceiling of her insurance so fast.

We are in the wrong business Yogi, we should be renting out medical equipment for the full-cost of the item plus some each month. Can't lose money that way! Only make money hand over fist!

[yogi]

I don't know about the nebulizer, it's attachments, or the meds it dispenses; my mom had all that but it was provided by the hospice care people free. What happened in that case was mom left the hospital diagnosed as terminal. Thus each month $400+ was given to the hospice people by Medicare to provide for mom's final needs. The equipment and services we received for that $400 was unbelievable. She was lacking in nothing. However, mom was misdiagnosed. She was not terminal as the doctors said, and she lived for more than 30 months after being discharged. This caused the hospice people to become concerned that she was too healthy to stay in the program and they wanted to drop her out because that measly $400 was not enough to cover what she was getting for so long. Be that as it may, that was the deal between the hospice providers and Medicare.

Getting back to how things are billed, I do know a little bit about hospital stays. There is a standard charge per day per given type of room. Each hospital figures out what that charge is and is supposed to make it public; so you can compare costs, I suppose, while you are in ER getting patched up. Anyway, that cost is the retail value sans insurance or any prior agreements. It's what you pay if you have no insurance or other prior agreements. Few people actually pay that price in practice. It would be the equivalent of the MSRP for an automobile. Nobody actually pays that price but it exists for accounting and tax purposes.

Medicare and any other insurance organization who wants in on the action get together and decide on prices for every known procedure and piece of medical equipment you can buy or rent. The list is indexed by insurance codes so that a 6782vx will cost $375 no matter where that procedure is performed. Medicare will pay 80% of that price after you meet the deductable. Your supplemental may or may not cover the remaining 20%. The healthcare provider of a 6782vx has an MSRP of, say, $500. Like the hospital room stay that price is what is considered fair market value and exists for tax purposes mainly. If the doctor does a $500 procedure but only gets reimbursed $375, then that doctor has a $125 loss he can write off. That's nice for the doctor, but as you have been pointing out that so called MSRP is used to calculate your benefits, or lack of them in this case. It's a real number, but it's only a paper figure. Nobody actually pays it.

Is all this actually a scam? Well, no. That $500 price is the market value, just as the MSRP of a car is the market value. In the case of healthcare, there is very little negotiation for us folks who must pay for the service. All the negotiation was done among the providers and insurers. That kind of makes sense in that they are the only ones who know the real costs involved. Since we, the consumers, have no bargaining power and are left in the dark, it looks suspicious.

[Kellemora]

Oh I hear ya and do understand a lot of it.

On my medical doctors bill, it reads almost the same as a Medicare Summary Page, except he has one more column on his called Write-Off. To the Insurance Companies this is also known as Excess Charges!
It was my own doctor who said I should not pay for the highest Supplemental Insurance that claims to cover Excess Charges, because they only get like 10 to 20% anyhow, and it works better in their favor to use it as a write off.
The IRS also has ruling on how much of a deduction the doctors can get, and it is a percentage of their income. So even if they show an ungodly high price, or a more fair price, they can only take up to a certain amount anyhow.
In any case, the higher cost of the highest Supplemental Plan is not worth it to either them or us. While the next lower priced plan covers nearly everything we would have to pay, but not all. In my case, some things may cost me a 20 dollar co-pay, but those items are usually far and few between.

I have one doctor who sends the most awesome statement of my account.
He breaks down every charge, what he charges, what he had to write off, what medicare paid, what my supplemental plan paid, and what I owe. What I owe is always less than what the Medicare Summary shows, because they do not include supplemental insurance payments on those reports, only what they did.

I do feel sorry for those who got stuck on Obamacare though. I hear it pays a whole lot less than standard Medicare.

[yogi]

I hear what you say about so called Obamacare, but keep in mind that those people had zero-care previously.

I also understand there are IRS rules about deductions. The pricing schedules, however, must exist so that there is a way to calculate losses.

And, I don't understand why paying for supplemental insurance that covers ALL costs is a bad deal. I pay nothing out of pocket for that kind of health insurance. Wife had some leg surgery with the bills coming in around $40K and we paid zero. I do protest the annual costs as being too high, but I have yet to find a better deal than zero co-pay. Drugs are an entirely different story. That does cost me a bundle in co-pays. I have yet to figure out if it's worth having Part D insurance in terms of cost of the insurance vs cost of the drugs it buys. Unfortunately, I MUST have credible coverage or the drug enforcement team will come and get me.

Sadly, all this expense for insurance and the services it buys is an absolute necessity. If none of that insurance existed and I had to self pay, I would have been dead about twenty years ago because I can't afford to buy healthcare out of pocket.

[Kellemora]

Those without insurance were fined like 300 bucks for not having insurance if I recall.
I don't know much about Obamacare since it did not apply to me since I was already retired and on Medicare when it came out.
I do carry the drug plan and it costs 55 bucks a month. My current drugs do not come to that, except for the ones they do not cover at all, such as my inhalers at 500 bucks a pop, so I don't buy them.

I have checked all the drugs I am on, and what they would cost without insurance, and there is a MAJOR DIFFERENCE between the prices. If you are not insured, you can buy one of my drugs for 89 dollars. But with insurance they show it as 149 dollars, which drives me into the donut hole faster. On this drug I have no co-pay. On another drug I have a 4 dollar copay, on another a 6 dollar copay. And as I said, on others I have no coverage at all.
Insulin is NOT covered by anyone. This is why my wife has to fork out over 600 bucks a month for her Insulin.
Sad really, since the inventors of Insulin did not charge for the formula so it wouldn't cost so much.
But Big Pharma is GREEDY!

[yogi]

I only have a vague notion about what goes into the cost of making drugs. It can't be denied that pharmaceutical companies try to maximize there profits just like any other business, but I think it might be a stretch to say they are greedy. Research and approval are the big dollar expenses, but in the case of insulin all that is paid for by now. A lot of drugs use ingredients that cannot be found in this country so that in those cases we are at the mercy of some foreign power. It upsets me when I discover some drugs are not covered, and I'm not just talking about generic vs brand names. That tells me the costs are not negotiable for one reason or another. If the insurance people can't turn a profit, they don't bother covering it. So, based on what I know about insurance and the economics of supply and demand, I think insurance for drugs can be eliminated. All drugs should be purchased OTC so that the consumer has a choice of where to buy them and thus seek out the lowest prices. You will hear a lot of people moan about that too because it involves some homework on their part. They rather pay the insurance people to be the middle man in this game.

[Kellemora]

It's all a con game. All the drug companies and pharmacies get together to purposely NOT SELL a product, unless it comes from certain drug companies in a special way that costs and arm and a leg.
A very good example of this is Epinephrine.
A 100 ml bottle is under 20 bucks, not sold in stores or pharmacies.
A 500 ml bottle is under 70 bucks, not sold in stores or pharmacies.
A 1 ml vial for injection is like 80 to 150 dollars, but normally not available except to hospitals.
A 0.15 ml single dose in a shot dispenser is 275 to 300 dollars generic, much higher under a trade name.
Tell me that is not a gimmick and totally unwarranted to charge so much.
The only thing they can patent is the dispenser pen, and those require no real R & D.

Not only drugs, it applies to a lot of things. Take ink for ink jet printers.
You can find refill kits for anywhere from 10 to 50 bucks.
When I was in the tri-fold pamphlet printing business, I was buying the ink jet ink formula designed for my particular Lexmark printers by the gallon. I was paying about 10 bucks more per gallon than the company who was buying it to make refill kits they were selling. Even so, it was still only costing me around 60 to 75 bucks a gallon.
Those disposable printhead cartridges could be refilled anywhere from 7 to 15 times before they either burned out or some of the nozzles quit firing. Buying ink that way was the only way I could compete on my printing prices.

[yogi]

Your examples of Epinephrine and printer ink are good examples of the economy of scale. It's a lot cheaper to fill a single 100ml bottle than it is to put the same amount in 666 individual dispensers. But, I must agree with you that $20 for 100ml is way cheaper than $183,000 for the equivalent amount in individual dispensers. There is some cost involved in filling and distributing those smaller units but I can almost assure you that the company making the Epinephrine isn't seeing all that profit. I don't know what 666 individual dose containers cost, but I'm certain it's more than the cost of a single 100ml jug. Then there is the cost of distribution added to that. I can say the same about the ink supply although the ratio is a bit different. HP isn't making $17,000 per gallon profit on the ink they sell. But, unfortunately, SOMEBODY is.

I don't know what the solution would be to the high cost of drugs. It would be helpful if there was some sort of congressional investigation into drug pricing policies. I'd not want to pass laws to fix prices, but I would like to know how they got to the level they are at. Exposure of that kind of information would put a lot of pressure on the manufacturers.

[Kellemora]

I do know drug companies have a lot of R&D, and that is why a Patent is good for 17 years.
But we know they have gotten together to make sure NO ONE makes many generically after the patent expires.
THAT is what they need to look into.
Some of the companies who invented the product still maintain control of the active ingredients even though the patent has expired. Very few of these leak out are can be duplicated by other companies due to hidden formulation techniques not disclosed in the patents, when they should be.

[yogi]

Anti trust laws are already in place, plus it would be pretty difficult to hide a monopoly as big as pharmaceuticals. It would surprise me if any of them were not following acceptable business practices. The problem is in what has become acceptable. There's a lot of talk about revisiting the current patent laws but I don't know enough about them to say if it would help. If Coca Cola can get away with using a secret formula all these years, that same thinking should apply to the drug industry as well. It would interest me to know if the high price of healthcare is due to high R&D costs, inefficiencies in the process, limited resources, or greed. Nobody has been able to explain it yet, so the assumption is that they gouge the consumer just because they can. That could be the case but I've not read any reports proving it.

[Kellemora]

Coca Cola was NEVER Patented!
Coca Cola is not FDA approved because it does not contain any controlled substance.
However, every version of Coca Cola is sampled by the FDA to make sure it complies with current standards.
The FDA did not exist back when Coca Cola had cocaine in it!

As far as the so called secret formula. It is only how certain ingredients are blended.
It is passed on to two people, when one dies it gets passed on to someone else, so two people always know the secret formula. ALL of the ingredients are disclosed to the public!

Technically, my own product has a secret formula. All the ingredients are on the label.
The MSDS sheet gives all of their CAS numbers as well, and how much of which ingredient where it must be disclosed.
The trouble here is, no one knows how it is formulated, in what order, or exactly which specific ingredient types are used.
Labs know how to culture the enzyme in Petri dishes, and how long it takes. In other words, a known process.
But which ingredients are used to produce the enzyme? That I do not have to disclose, just list the ingredients, not what is done with them to achieve the final result.
I can tell you Ptyalin is an ingredient. But which of the hundreds of sources works in my product after it is used to make an enzyme culture? Impossible to guess!

I don't know of this is true or not, but the cola named Double Cola also had a secret formula.
Trouble is, it dates back to when Kola Nuts were actually used to extract the cola.
Sorta like removing the Nib from a peanut to make a better less bitter peanut butter.
The Kola Nut sans husk was first processed in a way to remove an undisclosed part of it, then the rest was crushed and processed in a certain way slightly different than how other soda companies did it.
The original owner of Stoecker Soda Company is who used to tell it this way.

[yogi]

I have no qualms with trade secrets. I also think that if you can make a better mousetrap, then you should be able to sell it for what the market will bear. If the market will pay an inflated price, I don't think the guy with the trade secret is gauging anybody. In the case of drugs and healthcare, the products are often critical to the well being of the consumer. This is the point at which corporations are seen as sociopaths. They show no mercy and only care about their shareholders. Well, that's what businesses were made to do. There are some deep divisions of thought about how to handle that need. For the time being it's given to free enterprise to determine costs. If enough people want to buy into something mandated by the government, then I suspect you will see fewer sociopaths selling drugs. Depending on how the government handles it, you will see fewer drugs, period.

[Kellemora]

I agree with free market, but even in the free market, although anyone can charge anything they want, the competition will cause them to get down to a normal price, even if some stay higher than others.
Price Gouging is when they up the price well above their norm due to a sudden shift in supply and demand. Now I feel doing this should be illegal. If not for the reason some folks will go out and buy all they can causing an even greater shortage in order to sell for ridiculous prices.
I think there is already a law concerning some things, such as a company cannot raise their prices by more than a certain percentage each week or month. I think this had to do with neighboring gas stations is how it started.

Healthcare on the other hand is a commodity, not much different than electric or water.
After a drugs patent has run out and the company has recouped their R&D for that drug.
Generic makers should not be locked out of making that product which is currently happening in the industry.
We can actually blame the Insurance Industry on a lot of the price gouging going on in the drug and health industry.

[yogi]

The idea behind free enterprise is to encourage people to do better than their competition. This increases creativity and productivity so that new and better goods and services can be developed. When you control prices and wages the incentive to be competitive is gone. To my way of thinking that is the downside of universal healthcare.

Price gouging is what you see going on today with this Corona Virus pandemic. The face masks have gone extinct and those that remain are priced out of this world. That is a classic example. The high cost of drugs and healthcare are not the result of any sudden change in the supply chain. It's different than the classic price gouging to which you refer. My curiosity is that I would like to know what makes it different.

Part of the answer to my curiosity is indeed the fact that insurance companies, or middlemen, are a significant part of the process. Think of your own business and how prices for the goods and materials you purchased increased at each link of the supply chain. It could be argued that all those links are necessary and thus you are at the mercy of the free market. Healthcare is a service and the drugs are a commodity; both being different than what you are doing in business. Your customers are choosing to pursue activity that requires what you manufacture. When it comes to health, there is no choice. The current answer to this lack of choice and the fact people cannot afford medical care out of pocket is the infamous insurance coverage. Insurance spreads the payments out over a longer period and distributes the costs over a larger group. At best this is a cushion for the patient. It does not give them alternatives so that the providers are forced to be competitive. As you suggest, the fact that there is insurance at all enables high prices because it takes away the competitiveness that would normally contain a free market. The problem here, of course, is that nobody has come up with a viable alternative.

[Kellemora]

So true Yogi!
I have friends who live in countries with socialized medicine and what looks good on the surface is truly a nightmare underneath. If it is not in their system they don't treat it, so you have to go elsewhere at your own expense.
And the cost is up in the hundreds of thousands of dollars to get treatment for their kids. Needless to say, they don't have that kind of money so lose a lot of valuable time trying to get funding to save their children or themselves in some cases.
Trouble is, a serious problem goes from bad to worse while waiting for enough funds to get the operation. Most of the time irreparable damage.
So socialized medicine is not the way to go either, unless it covers everything. Then who's going to pay for it?

[yogi]

I can't speak for other countries, but we are the only one without government provided healthcare. The success of the system depends on the resources of the particular government. I don't see getting the same quality healthcare in some remote region of Africa as you would in London, England, as an example. The resources and talent simply aren't there in Africa. It would take some restructuring of our system to make something akin to socialized medicine work, but we do have the resources. Not only do we have the wealth but we also have the talent.

Insurance companies have the right idea, but do not implement it efficiently. Premiums and coverage are based on what happens in a specific demographic sample. In other words, the costs to them are averaged out. That means your expensive surgery is being partly paid for by somebody who never made a claim. I've read more than a few people complain about that as an inequity, but it's not. Coverage may be sold as an individual policy, but again the rates and payouts are based on group statistics. There is no reason why all insurance companies could not be replaced by a single government taxing body to do the same thing. Well, then, I suppose we would hear people complain about Big Brother spying on us. That could be the case, but what we have going now isn't working as well as it could. The solution to make healthcare all private and to get our government out of the business altogether is scary. We have that to a large degree already and it's not working. Time for something different.

[Kellemora]

I doubt if you note the times of the posts, but that hour long gap in mine was because our electric was out for about a half hour and it takes another half hour to get all of my computers back up and running again, and talking to each other, hi hi.

Nothing is paid for by the government, it ALL comes out of our pockets in the form of taxes.
As greedy as private industry is, it is not as wasteful as the government.
Plus, government can put regulations in place to prevent price gouging by private industries.

Whether you have private insurance or live in a socialized medicine country, in both cases, you may not be covered.
And that is the biggest problem right now with both systems.

I wouldn't want Government as the provider of insurance or healthcare, because I believe it would cause more harm than good and cost more than it does now. I've seen that first hand in many areas where poly-tick-ians and government officials get involved. They always pocket most of the money, hiding that by spreading it out among their friends and family only to get back later in some other way.

What I do think needs to happen is that our insurance should cover all manner of illness or disease, no matter what it is.
This nonsense of saying this is covered, but that is not, doesn't even make sense.
They pay for drugs for drug addicts who get it for free, but someone who got diabetes from taking a prescribed drug, has to pay for their Insulin and grossly inflated price gouging prices.

Also, some of the things medical companies are getting by with is downright crazy.
I use a Respironics InnoSpire Nebulizer. It sells for $32.99 on-line or $35.00 at Walgreens.
The medical company who provides this machine for me is charging $50.73 per month rental.
Medicare does not allow that much and pays them something (I don't have that paper on hand for an exact figure).
But the amount Medicare allows, minus the amount Medicare pays, leaves me with a monthly balance owing of $7.36
However, the full $50.73 per month is added to my account that drives me into the donut hole.

I asked them what would happen if I bought my own machine. They said they would no longer be able to provide me with the mouthpiece I use with it (they cost 66 cents each if I buy 100, 78 cents each if I buy 50 from a third party supplier).
But here is how they NAIL YOU big time. The Albuterol I use with it I get from their Sister Pharmacy Company. It is paid for via a different insurance company, my supplemental insurance company.
The supplemental insurance company is actually who pays for the mouthpiece also.
Both the mouthpiece and the drug are considered an integral part of the MACHINE.
So, if I am not renting the machine, then I do not have coverage for the drug or mouthpieces.
WHY? I would still have the machine, and saving them a lot of money.
But that's just it, I'm NOT saving THEM (the supplemental company) any money by having my own machine, I'm only saving medicare from paying out the rental cost. And you tell me they are not in bed with each other, the insurance companies and the government.

Just like poly-tick-ians, they are in it for each other, not for the people!
If supplemental pays for the peripherals, what difference should it make whether I own or rent it from another company?
I'll bet they get a kickback from those rental fees!