Would you like a picture of Sioux Falls’s march toward becoming Sanford Falls? Check out this map from KELO-TV, which shows Sanford Health’s property acquisitions to the east of its current campus:
If you look at this map from South Menlo Avenue to Minnesota, between 18th Street and 22nd, very few of the homes are individually owned anymore. Sanford Health has purchased more than 100 properties, both residential and commercial, under three different corporate limited liability company names. Sanford says it made its purchases that way over the last decade, so that property owners wouldn’t inflate their prices, knowing that the hospital wanted all of the land [Angela Kennecke, “The Gateway to Sanford Health,” KELOLand.com, 2015.05.07].
The purchases are part of a 25-year expansion plan to, as Sanford president Paul Hanson says, make the hospital complex visible on Minnesota Avenue, a straight shot from the airport.
That’s an awful lot of hospital… but with an again baby boomer population, we’re going to have an awful lot of people heading to the hospital for heart attacks and hip replacements.
The house we lived in for 14 years is in the red area. Seven years ago we put it on the market and had an offer the same day. It was a realtor buying it for an LLC – we didn’t find that out it was Sanford closing. We get sick driving by the home as we had it fixed up nice. Today it’s overgrown, a soggy couch on the front porch and in disrepair. It’s had multiple renters in their since. No bulldozer yet.
Hard to conceive this is a non-profit outfit when you do the math on these housing acquisitions.
Also, it’s a tougher sell that they need Medicaid expansion to care for those in the gap when one factors in the money they have for everything but healthcare as a non-profit.
I agree with you Steve.
How are we going to go about making up for this lost housing? Many people dream of homeownership, and many of these houses are within an affordable realm. How do we replace that?
Yes, I lived in Central Sioux Falls for 3 years, and I am well aware that many of these houses aren’t necessarily the nicest, but it seems to be a bit contradictory to the mission of a healthcare system to willfully remove so many houses, and the ones you keep, to play slumlord for until you have an excuse to bulldoze them.
Maybe it is time for Sanford to cut the facade and just move to the for-profit realm.
This reminds me of Mayo Clinic overtaking Rochester MN. Over 38,000 Mayo employees work in Rochester, and it is still growing. A small piece of advice I would give, is if you don’t want Sanford to expand as much as it is, fight it now. The complaint in Rochester is Mayo has too much of a say in City Council proceedings, too much clout. Mayo does give back to the community but not as much as I think it should.
This must be happening in another South Dakota city but instead of Sanford it is Avera. This house was owned by Avera several blocks away from their campus and it was located in a well known historic district. I believe the house was a Queen Anne style. It was a unique, fairly original and cute house that must have been purchased as a rental and they didn’t maintain it. I was sick to find out they were tearing it down! This house was owner occupied and immaculate along with the others in this district when I participated in the annual historic tour 20 -25 years ago. What a loss!
It seems like Avera has moved far away in how they operate today compared to when the nuns first founded it and had such an active role. I question whether they or Sanford should remain as non-profit entities.
Rep Hickey. The issue of your position on Medicaid expansion shouldn’t hinge on your personal wealth envy of Sanford, or your nostalgia for your real property and possessiveness over your earthly works. Without expansion – those folks either go without health care – or when they do go to an emergency room – the county gets the bill. How are our counties doing budget-wise? What can you state legislators do to address THAT?
On another aspect of the topic – Sanford also owns considerable property both to the South and to the West. My brother-in-law has property directly across the street from the Children’s hospital – his boyhood home, which he has made into rental property himself. I also grew up in that neighborhood, but I accept the changes that are occurring there. That’s the nature of life. Later on in life, I – and MANY other college students and hospital employees lived in rental units in those neighborhoods. That’s what much of it has been for decades. Of course, that’s a distraction from bashing the evil hospital as an excuse for denying poor people health care.
This is great for Sioux Falls. I haven’t heard a legitimate reason yet to be against their expansion.
Thanks Richard for the reproach. No wealth envy, really. Full on hospital pressure to expand medicaid all the while we see stunning amounts of money spent by a non-profit on the monopoly board.
If there has been full on pressure from SD hospitals to expand Medicaid then the SD Legislature is much better at shaking off corporate arm twisting than I ever realized.
If the governor would shift on the issue, it’d pass. That’s my take.
I’m still a no but for reasons no one else seems to care about. My remaining opposition to it is we need to figure out ways to reduce SD’s federal dependency not expand it. A massive financial shake up is coming nationally. I’d like to see us less dependent and more neighborly.
Good book for your summer reading list – God and Guinness. It’s the story of Guinness beer and how the company for centuries has been a massive force for social good. Dublin was once like Calcutta until Guinness started giving back and investing in people and the community. Incredible story. Imagine SD with corporate compassion at that level and the power of a benevolent business culture. The government is beyond broke and the rest of us, including corporate SD, get a free pass from an obligation to help the poor because we think that’s the governments job.
There is more empathy for 100,000 dead cows from a blizzard than 100 native kids dead from hopelessness. These days I have some “not in my state” rising up in my spirit. Government programs and dollars give the rest of us an out from being part of the solution.
Sanford might think a bit about improving signing and entrance from I29 to the west. They should have signing designed by somebody who has never been there before. Those who are well aware of route etc will find completely worthless signing and routing perfectly good.
Right now part of the federal gubmint is all that stands between us and a total korporate take-over of ‘murrica.
Much ado about nothing.
Sanford is the greatest philanthropist in South Dakota history and one of the most generous the nation has ever seen, if one measures the staggering size of his contributions against his total net worth. He gives. A lot. And his gifts are unquestionably meaningful in their positive impact upon our community.
I have no stake in this fight other than my perception of what is good for South Dakota. Mr. Sanford wouldn’t know me if he tripped over me. He’s not a client and may not share my opinion on every political issue I could describe. But I can see that his contributions to South Dakota, and particularly to Sioux Falls, are staggering, in that same way I have repeatedly saluted Steve Hickey, whom I like and respect but from whom I might part company on some political issues. To denounce what Mr. Sanford’s done as some sort of “corporate takeover of America” seems ludicrous to me, almost jealous in its intensity, as though we’d all be better off if he bought a big yacht and a small island and lived out his lift like a Millennial Billionaire.
When I was growing up one of the worst things my father might suggest about you was that you were “the dog in the manger.” That one made us wince because the dog in the manger was the one who couldn’t eat the hay but wouldn’t let the horse eat it, either.
Let’s heed the Aristotelian maxim and not let the perfect become the enemy of the good.
“Lift” should be “life.”
No pun intended.
Mr. Hickey …. Our government is far from “beyond broke”. The latest Z1 reports lists USA as being worth $225 trillion. Our debt is $17 trillion. That’s a debt of 7.5%. Add up what your personal net worth is and multiply by 7.5% and you’ll see that promoting unnecessary Nat’l debt fear is just a plank in your C.C.O.P (Chronically Contrary Old Party) platform. Putting a light on that cockroach sends it and those who spout your foolishness on a dead run for the closet. ~ On Sanford: What? Liberals complaining about growth? And why do you think companies won’t move to SoDak when the biggest is treated with this disdain? Progress equals growth and that means things get bigger. Progress equals NEW THINGS and NEW IDEAS and NEW JOBS. Progressives must embrace them like a new gift.
Rep. Hickey, thanks for the suggestion to read “God and Guinness”, I’ll have to look it up.
I share your concern about South Dakotans being left behind and so despondent that suicide seems the only way out. The politician, or even non politician, who shows the will to tackle that problem and make progress toward fixing it will rightly be considered one of the greatest South Dakotans ever.
It’s called the Guinness Partnership and it owns more than 60,000 homes and houses 120,000+ low income people.
http://en.wikipedia.org/wiki/The_Guinness_Partnership
However, as with Sanford, no good deed goes unpunished. Guinness evidently is upgrading some of their properties and many of the displaced renters are protesting their evictions.
http://www.brixtonblog.com/regeneration-in-brixton-loughborough-park-estate/13814
http://www.dailymail.co.uk/femail/article-2606422/As-councils-shut-homes-disabled-roar-anger-mother-girl-Downs-Syndrome-Thrown-homes-penny-pinchers.html
https://www.change.org/p/simon-dow-stop-the-social-cleansing-of-brixton-stop-the-evictions-of-tenants-from-loughborough-park-estate/u/9673431
This map does not show the total of the property that Sanford has purchased. My daughter rents a house at the corner of 25th (three blocks south of 22nd St) which is the south border shown on the map and Covell Ave, one block east of Grange. Sanford has owned that for at least 4 years, when my daughter moved back to SF.
Put another credit card industry there.
Whether it’s bashing the evil hospital, bashing the evil billionaire, or bashing the evil Federal Government, they are still all simply lazy excuses for denying poor people good health. That INCLUDES good mental health, BTW.
I heard they are eventually going to take over USF and then USF will be building where their fb stadium is.
Evil hospital? No not at all. Both Sanford and Avera provide great healthcare for those that can afford it. Just remove their non-profit status.
Speaking of evil and a bit off of the topic but does anybody know if Mr. Sibby went to Watertown to protest today?
I was a patient in Sanford in September and one morning one of the housekeepers was telling me that she figures she will have to retire a year earlier than she had planned on because she was renting one of the houses that was in the area to be demolished and it was within walking distance of the hospital. This means that she will have to move further away and that would mean taking a cab to work, which she can’t afford to do. I have also heard the same thing from other people who say that both the hospitals taking over all of those houses, are demolishing a lot of affordable housing for low income people.
No one should be surprised that Sanford, Avera, and/or other business expand. There is a saying that goes something like ” if you are not growing, are dying.”
If the expansion of Sanford means providing more services so that people do not have to travel to Mayo, Omaha, or other out of state medical providers, that IMO is a good thing.
They cannot build “up” much because that would infringe on the FAA approach exclusion zone for FSD – so they either build out or, far more expensively, move out. This appears as a reasonable long term plan given the accidents of geography and airport siting 80+ years ago.
They could build a hospital building out on the edge of town and then donate a monorail system to the town of Sioux Falls that would carry people like this housekeeper lady or elderly infirmed like my friends around and then have special cars that could carry nurses and patients from place to place if needed.
T. Denny could build it.
Progress always leaves victims in its wake.
Kind of like the KXL, right rwb?
I have no cat in this Sanford fight. My quibble is with the means people like Sanford use to become, and stay, exorbitantly wealthy.
How many people suffered great stress and financial losses due to Citibank’s usurious practices? How much were the employees paid, top to bottom? Was it enough to make a decent living? Or did the tax payers of SD subsidize Sanford’s wealth accumulation by providing food stamps, housing and heating assistance, free school lunches and other programs to the workers he employed? Is that still happening?
Based on those kinds of things, I feel no gratitude to Sanford based on current generosity. Perhaps needs would be less if he had operated like a responsible, ethical American citizen from the beginning. We applaud people who earn their way. How then, do we respond to those who use their economic position to hinder individual accomplishments?
I bet Mr. Sanford is a kind and generous man to those who worked for him. There are probably thousands out there now. I ask them to speak up now, alay young Ms. Geelsdottir’s fears.
You could also argue that while providing a vital service, healthcare also takes advantage of the poor, especially related to the Native American reservations out west. Why has T. Denny and the rest of the Sanford health business not taken ownership of the health status of Native Americans? Yes, they do have a small portion of Sanford Research dedicated to healthcare among indigenous peoples, but as far as improving the healthcare on the reservation, that does not seem to be a priority. Instead, they are happy to dispatch their air ambulances to retrieve patients to feed their system, leaving an incredible burden on an individual’s family to try and make the trek to support their loved ones, and an even more incredible burden to receive proper follow up care.
Maybe they should re-think their purchasing priorities. A lot of this money could be taken to be placed towards prevention. Not prevention through funding facilities for career athletes, funding for the individual. If they truly want to maintain their non-profit status, and their standing as a community provider, they need to further prove to us that they are focused on those that need them most.
Yes, the same can be applied to other healthcare providers, the Sanford organization just seems to want to flaunt their abundance.
If you want a nice example of how questionable their community health mission is, just take a look at their library of community health needs assessments. No real solutions.
Well Grudz, I worked for Premier Bankcard in Spearfish. I needed a job bad when I first moved there, and folks told me that Premier pretty much hired anything that breathed. When I went in, I had no idea what the heck they did overall, just thought they were a credit card company and I was happy to have a job to help me pay my bills. After going through the training and being on the floor for about a month or so, I ended up quitting with no job waiting for me. Why? Because what I saw was nothing but legalized loan sharking and praying on the poor/low income. It was encouraged! Every day I went home feeling like I needed a shower. I couldn’t take it anymore, and although cautioned to give at least two weeks notice, I didn’t. I couldn’t. Luckily, I am a little older and a little more savvy that I found some other employment elsewhere. Many other folks I worked with at Premier felt the same way I did, but felt stuck that they could not quit. In other words, “it’s a job” and I have some money coming in.
I applaud Mr Hickey for how he is trying to quash the predatory behavior of pay day loan industry. Mr. Sanford’s credit card company is truly no different from what I saw. Sure, Sanford is a “job creator”. Sure, he is a “good guy” who does alot of charity, but the devil is in the details. How was I treated as an employee? Well, by the direct supervisors, pretty good. But my schedule kept getting switched up, etc etc.
I have no doubt that the Sanford hospital system and medical center is top notch. I hope so. It should be, and I’m sure there are awesome doctors, nurses, other staff, etc that are the best and the brightest.
But when I hear that Mr Sanford does soooo much for people and so forth……Well, it reminds me of the ole statement, “there will be casualties when we take the hill.”
I am often in awe of our hospital campuses with the buildings that look like glass and the extravagant landscaping. My dad recently had knee surgery at Sanford. After spending a couple of days with him in his hospital room, I came away with this thought. Our healthcare is incredibly expensive and the food they feed the patients is beyond disgusting and often inedible. I guess I would prefer they put some of their money back into patient care, rather than taking homes away from people who need them. Although, I have heard nurses report the doctors eat like kings. Apparently, they get lots of organic and fresh produce. The patients? Not so much.
R.I.P. Patrick Duffy
http://www.kotatv.com/news/south-dakota-news/attorney-patrick-duffy-dies/32906666
What?! Duffy was just here? How can he—what—how….???
Pat Duffy’s post here yesterday was one of the last things he did. Life is short, make the most of it.
I can’t believe this, Mr Duffy was a good man. My sympathies to the family.
MD, how much does medical care cost Native Americans? Does it make any difference to them how much their care costs?
Oh my god. This is tragic. Duffy was a great South Dakotan, a great citizen, a great American. What happened?!?
I’m so sorry for your loss, Duffy family. RIP.
There are many Native Americans, including myself, that want a higher quality of medical care that IHS doesn’t provide and have their own private or employer insurance.
Of course racist Indian haters have their own perceptions that are usually wrong.
And Roger’s blather is as usual playing a nonsense racist card and as usual is distorting reality. Just answer the questions. The whining gets a bit old. My wife daily fills in waiver forms so that Native Americans getting free care at the hospital where she works can also get free transportation as well. There are exceptions of course. A few Native Americans work their butts off and have insurance from their employers and several work with my wife at the hospital. What is even more discouraging is that now Whites have as well discovered the travel vouchers and are also applying for them. Even with getting free health care too many have no regard for the time of professionals desiring to help them. They show up hours late for appointments or they may miss appointments so many times the specialists refuse to schedule them again. Healthcare is a two-way street.
Claiming the care is unavailable or poor is distorting reality.
Glad to see that Sanford is expanding and also glad to see Avera doing the same with new building in Mitchell. Rapid City is adding urgent care locations as well. More and better healthcare for all is what our goal should continue to be and that should include the IHS as well. One of the issues that confront Native people off the reservation is that they are not in network of the IHS. An example would be a Native in Pennington Country that may require services in Spearfish. These are two different county locations so then you would be out of network of Sioux San. There seems to be an idea that because you are Native means that you get to do whatever it is you want to regarding healthcare, that is not the case. There are many Native people that have taken the ACA for the reason of securing available, affordable and comprehensive healthcare because of lacking IHS issues.
“MD, how much does medical care cost Native American? Does it make any difference to them how much their costs?” Now tell me who played the race card with their typical anti-Indian blather.
Jerry, I served on the board of directors for the Black Hills Community Health Center as well as serving on several advisory for Regional Health. It is not uncommon for health clinics, Indian or white, to have problems with no-shows that result in scheduling problems. Most clinics put the no-shows at the bottom of their scheduling and those that are late are relegated to the bottom of the daily schedule.
IHS does have a serious problem with contract healthcare, that is contracting for medical services needed that they do not provide. Often times people are constantly put off because IHS claims they don’t have the money.
When I was working with the community health center, I was surprised to learn that in the category of insured users, Native Americans with insurance were always strong.
That such a large number of insured Native Americans could be attributed to a number of things:
The user not being enrolled in recognized federal tribe.
Dissatisfaction with treatment or care at Sioux San. (Waiting to see a doctor can be an all day event at Sioux San).
Some of those insured are also covered by Medicaid and Medicare, just like whites have, and choose to use different clinics.
IHS collects on private and government insurance as well as Medicare and Medicaid.
I’m wondering if the Rosebud Hospital is aware that the wife of an avowed racist works there. I’ll have to make a call.
Jerry,
To follow up on your comments about Sanford Health, John Steele, President of the Oglala Sioux Tribe, is currently working with Sanford Health to contract all services at the Pine Ridge Indian Hospital.
Doug, I wish you wouldn’t make it sound like it is racist situation. It is a sickness in our society as far as the travel is concerned. The DAV, (Disabled American Vets) has raised tens if not hundreds of millions of dollars, to purchase vans in outlying areas to bring veterans to the VA hospitals around the country. There are vans in Several outlying cities in SD which also stop in other towns along their way to the VA hospitals to pick up veterans.
As a volunteer I used to drive one, hauling veterans from Sisseton, to the VA hospitals in Fargo, Minneaplolis, Sioux Falls and even used my own vehicle to take a veteran to Omaha, with a stop in Sioux Falls on the way back from Omaha.
The van system was well used around the country until recently when the federal government allowed travel pay to veterans for driving their own vehicle for healthcare. The cashier at the VA here in SF, told me that she regularly pays our ten to twenty thousand dollars a day in travel pay.
That would be most excellent if the contracting could be done with Sanford. What is somewhat surprising to me is that Rapid City Regional would not be the one that would be contracted as they seem to be the big dog in West River healthcare. If I am not mistaken, they operate the Hot Springs facility so Pine Ridge would not be so far of a jump for them. Who knows, maybe with Sanford in the picture as a contract hospital in West River, there may even be competition between the two healthcare providers, a win win for all. In my opinion, what is most needed in the IHS system is care and treatment for mental health. The idea that there are so many young lives taken by their own hand is just too much. There has to be a better way than what is now available.
Richard S.
Wiken can’t help himself, he needs to inject his racist views whether a topic is about Indians or not.
Jerry,
You are right on target. I have been stating that with all the discussion about teen suicides IHS Behavioral Health needs to play are larger and broader role.
Laying blame for the culture, bullying, incidents of racism, etc. may be contributing factors, but the problem is depression and or bipolar and needs to be treated as such with necessary medications and therapy.
Naturally IHS will say they don’t have the money, I take sharp exception to that.
IHS is huge bureaucratic machine that shallows money in Washington, D.C. the Aberdeen IHS area office and finally local hospital administration.
Terminate about half of these IHS lazy bums and hire competent mental health specialists.
How many useless clerks are really needed at the Rosebud Hospital?
MD raised the racial issue in his rather off-topic post. It gave the impression that Native Americans had a nearly unbearable medical burden that Sanford was not addressing. It also suggested that only Native Americans got fed into the Sanford system via expensive air ambulances.
These same problems impact whites in exactly the same way in rural areas. It is not racism, but Roger and apologists always suggest that the evil white devils are the source of the “problem”. That may be the case, but the problem is also so for whites in the same systems.
I am no fan of Denny Sanford and his bottom-feeding credit card exploitation, but Sanford Medical has brought specialists out into this area. They see both Whites and Native Americans.
Native Americans need to stop howling racism when they get the same crappy treatment and exploitation that hits Whites in Rural areas. Medical services are a problem for all people in rural areas. It is the same rural problem with electrical services, fire services, water systems, etc. What urban residents expect as routine services are too often luxuries in rural areas.
There should be a natural alliance between Whites and Natives in regard to economic issues in rural areas and the mal-distribution of services and taxes compared with urban areas. There will not be such an alliance so long as those desiring special services for Native Americans claim that the only reason they do not get these services is because of evil White racism. That is not the way to build natural economic and political coalitions. It is a near instant turnoff for Whites who get the same kind of crappy service or treatment.
I do not appreciate unfounded claims playing a race card when the race issue is not the actual problem. Roger is a specialist at it. Some readers here are apparently fooled by his nonsense and acute distortions of reality.
As a rural resident, I would much rather see Sanford putting more assets into rural areas rather than into advertising and building expensive sports facilities as MD suggested. That would be better for all rural residents, Whites, Native Americans, whatever…unless of course, that leads Sanford into controlling rural health facilities as it is trying to control housing access in areas around the Sioux Falls campus to shift ever more patient money into Sioux Falls.
And despite Roger’s wall of fog, it is still the case that only a small percentage of Native Americans pay anything for their medical care. That is a treaty matter.
Well Douglas, Roger, et al. There was/is a solution to the entire problem and that is to get capitalism out of healthcare, with Universal Single Payer healthcare which gets the insurance industry out of the delivery of our healthcare and stops healthcare from being for profit and makes it a right as guaranteed in the Constitution, you know, as in life, liberty and the pursuit if happiness.
Well said, Mr. Stricherz. #HearHear!!
I agree Strickerz. But for now we are stuck with the current mess. Do away with Indian and Veteran’s health systems or fund them only with single payer system payments. The US system is incredibly wasteful and needlessly expensive.
Everyday I wonder how many people have their lives disrupted because Do-Nothing Daugaard has his head up his ass in regard to expanding South Dakota Medicare and Medicaid at federal expense.
I concur with the single payer solution. Too bad so much was wasted on a fruitless attempt to mollify the “conservatives” in designing ACA.
Obamacare has done really well. Insurance companies can no longer sell you a policy they could refuse to renew if you got cancer or diabetes or MS. That’s all but ended medical bankruptcy. The rates have stopped the insane yearly increases that was killing us. And no more “free riders”. Everyone has to buy a policy.
If there were a universal healthplan, then the hospitals and doctors would accept the payment schedules with the government just like they presently do with Medicare. If the plan were to be made in such a way that there would not be a need for an insurance company other than to process the payments through a regional clearing house, it would save billions. In short, why would we then need insurance company’s to negotiate pricing with providers. Rounds would have to hope like hell he did not have to resign from the senate for the EB-5 as he may not have any other job.
Yes, we’re moving that way absolutely. Medicare Part E … E for everybody. Health Insurors will be
Ike tobacco companies but it takes many years. Too many people work in that field to be put on the street by a government takeover. That’s not America! Those big insurance companies are already beginning to diversify into other businesses and in twenty years they’ll be made over into something else and we’ll have single payer for much cheaper. All the predictions about Obamacare by conservatives have proved to be just lies so why believe when them at all?
In Europe, there is universal healthcare and there is also private healthcare. There are big ole buildings there that have insurance company names and in those buildings, a whole lot of folks work there. There will be no one put on the street in America, other than those that actually contact people for the big ole buildings.
In Europe universal healthcare began after the war when everything was gone. The insurance companies began business to sell upgraded service to those wealthy enough to want it.
If we had single-payer, Mike Rounds would not be the 8th-richest freshman in the 114th Congress, the Sanford campus would not be quite so big and shiny, and that nurse would not be getting priced out of her house within walking distance of the hospital.
Way up at the top, Porter chided liberals for complaining about “progress.” He says, “Progress equals growth and that means things get bigger. Progress equals NEW THINGS and NEW IDEAS and NEW JOBS.” I feel a GOED/Mars-like use of the word “progress” in Porter’s statement. Political “progressives” need not embrace that mostly economic vision of “progress.” Bigger buildings, bigger factories, bigger health-care provider monopolies don’t always represent an improvement in our situation. The GDP getting bigger doesn’t mean real improvement if that growth is concentrated among the wealthiest and denied to the masses. New ideas don’t necessarily flow from more massive institutions.
That just got me thinking: we like single-payer around here. Do we also like single-provider? Is the Sanford-Avera duality healthy? We we be better off if Sanford swallowed Avera and the Rapid City system and provided all care in South Dakota? Or is the absence of lots of new smaller players blossoming in South Dakota’s growing health-care sector a sign of something going awry?
Maybe Dakota Free Press needs a new discussion on healthcare options and experiences.
One of my friend’s just found out that the inflammation of her lymph glands had a cure. That was the good news. The bad news was that it would cost $15,000 per month.
A year or several years ago, I started checking on comparisons between size of hospital accounting staffs in the US and Canada with single-payer system. The multitude of forms and payment systems in the US required something like 10 times as many people in accounting and collections than in Canada. I haven’t checked on that recently, but Canada is not paying health insurance executives $20 million or more per year with a bunch of underlings also getting $millions. The health insurance industry literally sucks the blood out of people and the hospital system in the US. It is a totally unnecessary parasite.