Lambert here: As NC readers know, Yves views shopping for ObamaCare — indeed, shopping — as a “tax on time,” as do I. And to update the old adage, nobody on their deathbed has ever said “I wish I had spent more time shopping.” But ObamaCare mandates we go shopping, because markets. So it’s good to see KHN catching up.
Jay Hancock, Kaiser Health News. Originally published at Kaiser Health News.
Cyndee Weston can barely remember the last time she didn’t have to switch health plans during an Affordable Care Act sign-up season. By her count, she has been on five plans in five years.
Every fall, after she has spent months figuring out her insurance plan’s deductibles, doctor networks, list of covered drugs and other fine print, she receives notice that the policy will be canceled as of Dec. 31. Because her job doesn’t come with insurance, “it’s agonizing going through all the plans and trying to compare,” said Weston, 55, who has diabetes and a history of melanoma. “Every year it’s the same scenario: ‘We’re not going to renew your policy.’”
Under the market-based system set up by the ACA, individuals are encouraged to “shop around” each year to find insurance that better suits medical needs and income. In fact — like Weston, a trade association executive in Sulphur, Okla. — they are often forced to do so when plans drop out of the local market or eliminate preferred hospitals and doctors from the network.
The ACA increased the number of Americans with health insurance by 20 million and cut the uninsured rate to about 9 percent.
But the task of finding new insurance annually often undermines the continuity of care for people with ongoing medical needs or chronic conditions. That challenge is immeasurably harder this year as policies change under the Trump administration, spurring unstable networks and turmoil in many state and local markets.
“There’s quite a number of people who are either temporarily uninsured or they move into different plans” each year, said Marianne Udow-Phillips, head of the Center for Healthcare Research & Transformation at the University of Michigan. “And I’m guessing this year that will be much greater, given all the changes that are happening in the marketplace plans.”
Fewer than half of those buying individual coverage in 2014 kept the same plan the following year, according to a Michigan survey done by Udow-Phillips and colleagues. Nearly a third of marketplace enrollees for 2017 were new customers, meaning they had other kinds of coverage before or were uninsured. For the 2018 enrollment season that began on Nov. 1 and ends Dec. 15 in most states, millions of consumers will find themselves switching coverage.
The imperative to shop for insurance affects mostly those who buy insurance for themselves, such as small-business owners and those who are self-employed.
Enrollment for 2018 through online ACA marketplaces has been particularly complicated, due to big premium increases for some plans, the mistaken belief that the health law was fully or partially repealed and the administration’s decision to terminate $7 billion in subsidies.
Many of plans that people relied on for 2017 are being canceled, the result of insurers exiting the marketplaces or redesigning coverage to try to keep premiums down.
Aetna and Humana stopped selling individual marketplace plans for 2018 after losing money on the products. UnitedHealthcare has sharply pulled back. Hundreds of counties have only one marketplace insurer next year, although competition is higher in metro areas.
The average number of carriers selling individual marketplace plans in each state has fallen from five in 2014 to 3.5 next year.
“I wouldn’t call it ideal. It’s what we have,” said Sabrina Corlette, who studies insurance for Georgetown University’s Health Policy Institute. “Ultimately, the consumers have to read the fine print and probably expect that things are going to change from year to year.”
Such instability impedes what was supposed to be the ACA’s other big goal besides coverage expansion. Former President Barack Obama talked of fixing a “broken system” that neglects preventive care, orders billions of dollars in unneeded procedures and shuffles patients among doctors who don’t talk to each other.
The idea was to push insurers to help diabetics improve diets, keep patients on their blood-pressure medication, prevent asthma flare-ups and otherwise improve care and control costs.
Investing in prevention upfront, the thinking went, would pay off for carriers over time as members needed less emergency and inpatient care.
That equation fails when people find themselves with a new policy or a new insurance company each year — or more often.
Insurance churn “is a long-standing problem in the U.S. health care system,” said Benjamin Sommers, a physician and health economist at Harvard’s Chan School of Public Health.
“But there’s a concern that with the ACA you’ve added a whole new layer.” Insurance turnover is especially frequent among lower-income families and those with irregular work.
Unemployed people might be eligible for a plan under Medicaid, which the ACA expanded to most low-income adults in most states. But getting a job and a salary might make them ineligible for Medicaid, bumping them up to a subsidized marketplace plan and a coverage change.
Medicaid, which often comes with its own confusing menu of managed-care plans, generally covers those with the lowest incomes. Subsidized marketplace plans are for medium-income households.
In a 2015 survey by Sommers and colleagues, about a fourth of low-income adults reported they changed coverage during the previous 12 months. That was lower than expected but still problematic, Sommers said.
More than half the switchers had coverage gaps between policies, causing many to report skipped medications and poorer health. Even plan changers with no coverage gap were more likely to swap doctors, to have trouble booking appointments and to seek treatment in the emergency room.
Even though laws in some states allow patients in active treatment to keep doctors from one plan to the next, that’s not a recipe for stable medical relationships or long-term treatment strategies.
“Coming up with the right balance and right approach to a patient’s condition takes time,” said Sommers. “If you wind up with a new set of doctors and new coverage every year, it’s going to make that much harder.”
Cyndee Weston has navigated the shifting ground better than many. For years she has had the same insurer — BlueCross BlueShield of Oklahoma — which has dominated that state’s market for individual plans and is the only marketplace player for 2018.
But even though the carrier is the same and the health law requires insurers to take all comers, canceled plans each year force her to learn a new coverage design, file new paperwork with doctors and worry her primary physician will be dropped from the network.
One year BlueCross “automatically enrolled us into a bronze plan which we didn’t want, so we chose another gold plan,” Weston said.
Even when insurers stay in a particular market, they often redesign plans from year to year, changing drug coverage or raising out-of-pocket costs to keep premiums as low as possible, Corlette said. As in Weston’s case, that often requires canceling the old plan and having subscribers switch.
“Each year, we assess our plan offerings and make any necessary adjustments to best meet our members’ anticipated health care needs,” BlueCross Oklahoma spokeswoman Melissa Clark said via email.
After Weston’s primary physician left the plan’s network this year, she’s had trouble finding a new one, although the insurer said its physician list has not changed significantly.
“I take some medications, and I worry that if I go to a new doctor they’ll change my medication or it won’t be covered,” she said.
A few weeks ago, she got a new notice from BlueCross saying her current plan is canceled as of Dec. 31. So she’s shopping again.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
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ACA= mandated subsidy of the rentier insurance industry.
(Consciencious Objector)
I have to re-up my no longer cadillac corporate medical plan (thanks ACA) once a year, but it does stay in default mode if I don’t bother. Now my plan provider (not employer) has been bought out by another company. So I expect next year, I can’t just let it ride, but have to spend 15 minutes choosing a new one.
But on my mother’s medical insurance, they would fairly often cancel her sub-plan, and we would have to renegotiate before Jan 1 onto a new sub-plan. But calling up the company wasn’t too hard.
So things like this, to a lesser extent happen outside ACA. ACA is worse because so many subsidized providers are dropping coverage entirely within a given area. Because medical insurance just isn’t profitable.
If medical insurance isn’t profitable, perhaps it shouldn’t be handled by private companies.
Just saying …
No kidding. I’m genuinely astonished that cut-rate, 3rd party insurance LLC types from wall street or sovereign wealth funds have not participated in the looting.
Those who argue that we need a “free market” in health care insurance surely don’t understand free markets.
By the sounds of it, it’s like Americans have to go through something akin to doing their taxes for a second time each year – only much more complicated. Has anybody ever added up all the time spent doing this each and every year, the form-filling & filing, the processing, the paperwork and the like – it must be costing America tens of billions each year which amounts to lost productivity. I suppose that you can consider it a type of tax for not having single-payer health.
And while the article is focused a lot on individual coverage, the same dumbfuckery is going on with those insured through their job.
Also, in America, that’s supposed to be “the good-times”…getting your health insurance subsidized through your employer. How that insanity works, big-picture, is that no matter what industry, business, or serviced provided, every employer that has health insurance plans has to also be in the health insurance business – key f’in word: insurance – not care.
Yeah, but all that time “choosing.” Freedom to Die For.
“Aetna and Humana stopped selling individual marketplace plans for 2018 after losing money on the products. UnitedHealthcare has sharply pulled back. Hundreds of counties have only one marketplace insurer next year, although competition is higher in metro areas.”
….that’s the plan……
Monopoly isn’t just a board game, it’s a business model.
Shopping is, in any event, impossible: the doctor directories provided by insurance companies are universally inaccurate. Years-old errors are commonplace — the doctor was never in the network, long ago dropped the network, hasn’t been at that address for 5 years, etc. And don’t expect that calling a doctor’s office will resolve the question. Errors frequently go as far as the consulting room.
None of this, however, is unique to Obamacare.
We’re well on the road to a poorly performing ‘Medicare for all’ system with the rest of us becoming cash payers.
I have zero faith in politicians ever being creative, smart, brave and honest enough to mimic the best of other Healthcare systems elsewhere.
People are more upset about Trump than they are about their own Healthcare choices.
As a small biz owner, I’ve purchased individual health insurance for over 20 yrs. While the ACA is flawed, at least the info I need to purchase a policy is in one place and relatively easy to compare. This was not the case before the ACA. One year I spent over 100 hrs trying to figure out what would be the policy that best fit our needs (to be fair, I was changing insurance companies).
Also, I am protected in that the premium is scaled to my income (via a subsidy). If I have a horrible year, I get subsidized on the premium payments. This is a huge benefit. I no longer have to worry about heath insurance premiums if my sales drop unexpectedly. The security that I get knowing that I will be covered even if the bottom falls out of my biz is very important.
I am not a ACA lover, single payer universal heath care is the answer. Our entire system needs reform. My local hospital keeps upscaling….because….markets….right.
We should all start by DEMANDING that medical pricing be transparent. It is the only thing we purchase where we do not know the price up front. If you want to claim “because markets” then you better follow those rules and price transparency is one of them.
Still:
How about demanding pharma, hospital supplies, hospitals be regulated. Transparency is great; but, you need more.
I fully agree with the “tax on your time” description. I personally despise every second I have to spend shopping for anything and that goes double for insurance products. Disturbed Voter is correct that corporate plans require some decision making. My own plan has three different levels of deductible/premium combinations and also flexible spending options. Since the premium levels and deductibles change from year to year (as can your health situation) it does require quite a bit of work to determine which choice is best including estimates of how much out-of-pocket spending you will incur, how much to allocate to use-it-or-lose it (there is some rollover) flexible spending accounts. So just letting it stay in “default mode” is not always a smart strategy.
But Obummer-care sound like a whole other level of suck in this respect with having to worry about different insurers, doctor availability and eligibility for subsidies. I had the unfortunate experience to have to rely on expanded Medicaid three years ago when I was out of work and my COBRA premiums doubled (that’s right – doubled) due to Obummer-care and no, the prior plan was not a skimpy, limited coverage plan (it was Care First BC/BS). In fact, the new plan was actually no better in terms of coverage and a bit worse in terms of co-pays. The big difference was that Obummer-care allowed the new plan to charge me a higher premium because of my age despite this being a group plan. That’s because my former employer had < 50 employees.
And the "shopping" experience was pretty bad too. The providers' physician directories were hopelessly out of date and inaccurate in terms of doctors that actually accepted the coverage and were accepting new patients. The amount of time I had to invest in finding doctors who were actually available and had acceptable credentials was enormous.
I've had other interesting insurance "shopping" experiences. I had the same auto insurer for 30 years and had never shopped around because I couldn't imagine that there could be that much variation in rates based on the same driving record and I was foolish enough to think that customer loyalty meant something. But my premiums escalated dramatically over a two-year period despite no tickets or accidents for many, many years. I called the insurer and was told that they were raising my premiums simply because of the state I lived in. So I called other insurers and was inevitably asked within seconds of reaching them "How much are you paying now?" which meant that they were only going to offer me the highest rate they could get away with based on my current premium not the best rate based on my driving record. I eventually found a rate that saved me > $1000/year and no, they didn't ask me about my current premium. But I had to invest quite a bit of time to get that result.
My point is that "shopping" is not going to be the savior of the insurance consumer if the prices are going to be set unfairly, underhanded sales tactics that would make used-car salesmen blush are being used and accurate, up-to-date information is unavailable to the consumer without an inordinate amount of effort. Only naive, elitist policy-wonk fools believe in this "magic of the market place" claptrap. mostly because they are in a position to tilt the playing field based on their insider connections or are too rich to care about being ripped off. For auto insurance its bad enough. For health insurance its unconscionable.
Shopping for health insurance:
Pick your sh** sandwich
Oh but we are out of everything except the doubleturd
EXPENSIVE doubleturd.
A few weeks ago, something got lodged in my left eye. I could not blink or produce enough tears to flush it out.
So, I called a nearby clinic and asked for help. First question I was asked: What kind of insurance am I on?
Not this again.
And, as it turned out, they don’t have an eye specialist on staff. Next call was to my optometrist’s office. Which gave me an appointment for the next morning.
The cure turned out to be a good night’s sleep. I woke up with no foreign object in the left eye. The optometrist confirmed that it was gone.
My story could have been quite different. But my insurance status should not have been an issue.
Silly you! You’re treating your eye problem as a medical issue rather than what it really is in the American ‘medical’ system, a financial issue.
I’ve found out that most of the ‘clinics’ around here are feeder stations for one or another of the big hospital conglomerates.
I vaguely remember that revered exemplar of olde tyme American pioneer exceptionalist hagiography, “Little House on the Prairie” as having a story, or story arc where the family patriarch must go off to work at a very dangerous job to earn money to pay for one of the children to have a needed medical procedure. During that character building ‘work experience’ I believe some foreign person is killed doing the job to underscore the depth of commitment the family patriarch has to his family.
As far back as then, the social story arc of the Neo-Liberal Dispensation was being constructed.
Loved Breaking Bad, and one of the many underlying plots in the series, is Walter White needing very expensive medical care-which isn’t covered under his insurance, so he turns to producing meth to make the money to afford it.
Also several films predicated upon people turning to a life of crime to ‘make ends meet.’ “Going In Style” comes to mind, both versions. Also, “Widows,” which was first a good English television show, and soon, a film.
The myth of Robin Hood has universal appeal, for good reasons.
I agree that the “what insurance do you have” question is just so rude. Doesn’t this set the tone for the complete lack of compassion you should expect? Especially when the medical office staff knows good and darn well how capricious every insurer is on covering things.
I have had fights about which “network” our pediatrician is in when the “network” had a different name on every plan document (insurance cards, website, plan documents, etc.).
I usually end up sorting things out but it takes a lot of time, a lot of knowledge and sometimes calling a person (social capital) to get things done.
I especially enjoy when the appointment reminder robocall is really a “bring payment at time of service” reminder call.
One bland number (9% uninsured) does not mean much, because
not everybody is equally covered by the multitude of policies offered. A person who has a policy that covers only ingrown toenails counts as equally ‘insured’ as as a person covered by a cadillac plan that includes pedicures at home.
Just as statisticians devised disability adjusted life years (DALY) to give a more useful number than bare mortality, we need coverage-weighed averages to tell us if coverage is really improving. If 100% of people are covered for only 50% of expenses, it’s the same as if only 50% are covered for all expenses.
The adage “what gets measured gets managed” applies.
To qualify as coverage under the ACA insurance policies sold in the individual and small group markets must cover the ten categories defined as essential health benefits. Except for catastrophic coverage, plans must have at least a 60% actuarial value.
About 70% of people who purchased insurance on an ACA exchange in 2017 chose silver plans (70% actuarial value) (Link).
This is for informational purposes, not to dispute your essential point, that “coverage” doesn’t mean affordable access to care.
The network is what actually makes or breaks a plan, and the ACA networks are squeaky narrow. Even if you have a low deductible plan, it doesn’t mean you can actually find a decent doctor on that plan.
Obamacare has created a newer and much lower class of care even for people with low deductibles. It’s essentially just one step above Medicaid.
To add to your point: some networks are deliberately narrow to keep out specialists for high cost ailments.
Agree. Narrow networks have been a serious failing of the ACA from the beginning. As far as I know the defenders of the ACA have never acknowledged this, let alone offered even a fig leaf of law or regulation to constrain the insurance companies on this point.
Some know that I volunteer to help people with their medicare application and paperwork.
Medicare makes quite a big to do about shopping and comparing health plans, and particularly the drug plans (often referred to as Part D).
I am not old enough for medicare, but even if your under 65 you can see how the drug comparison plan website works.
https://plancompare.medicare.gov/pfdn/PlanFinder/DrugSearch
So when people come in, we fill this sheet out of the drugs they take, and it spits out an estimate of what the total yearly cost to the beneficiary will be under their plan, and lists other drug plans and their cost. First, some or many plans will not cover all the drugs (the drug plan formulary” or list of drugs the plan covers doesn’t reimburse for prescribed drugs not on the list) that are prescribed to the beneficiary, particularly if it is a really expensive drug . Second, some of the covered drugs, even generics, can still be expensive.
And third, even common, generally very inexpensive generics in some plans will be just insanely expensive – like, a thousand times more expensive than what most other plans charge.
This seems irrational to me. How and why would one plan charge over a thousand (I AM NOT EXAGGERATING) times more for a rather common generic drug than what other drug insurance plans can and do charge??? Now, you can buy, say, potato chips pretty cheaply at Walmart, and they are more expensive at the 7-11, but they are not 1,000 times more expensive. A REAL functioning market would eliminate such disparate prices.
My initial theory, but I don’t have enough examples to be sure, is that it is the drug plans that have formularys that carry the more expensive medications not carried by other plans than make up for it on the medications that are typically cheap but they sell at a very high price. Patients are so fixated on the drug that they can ONLY get in the formulary of one plan that they ignore the price of the other drug that should, in a REAL market, not vary by more than a few percent from the lowest offered price. Still, I am dubious of my own theory – Occam’s razor tells me the real reason is that it is because in trying to fit the square peg of medical need into the round hole of the medical insurance “free” market, that so many byzantine, contradictory, rigmarole rules and procedures make pricing perverse.
INSURANCE DOESN’T MAKE THINGS CHEAPER – IT MAY MAKE THINGS MORE EXPENSIVE. Insurance with higher deductibles, higher co-pays, higher co-insurance, and more exceptions to what is covered is not a solution. People don’t NEED insurance…they NEED medical care.
But it seems such an obvious ploy and people would find an alternative – just because your on a drug plan doesn’t mean you can’t buy a drug without the drug plan. A lot of people would be better buying SOME of these common generics at Walmart. But the thing of it is, people don’t know the Walmart prices, many of these people have mobility issues, most generic drugs are not available at Walmart and even many, many common generics, when bought WITHOUT using an insurance plan, are very expensive without the “discount” insurance plans get for the generic drugs in particular pharmacies and networks.
It seems very obvious to me that the whole system is a minutely crafted whack-a-mole scam….no matter how much time and effort you spend to try and save money, you save on one drug, they will make up for it elsewhere, all while yammering about how wonderful the market is….BTW, we are the moles….
You make me glad I don’t bother with Plan D. Of course, it wouldn’t cover anything I actually take.
OTOH, I’ll be out of luck if I get something that requires expensive medications, so I guess I’m still on the American Plan: don’t get sick.
Yes!
Absolutely nothing in the American medical industrial complex produces cost-effective care. Drugs aren’t listed on the formularies because of patient need. Low-dose naltrexone, for instance, isn’t covered under my policy despite its cheapness and widespread effectiveness for several conditions, including chronic pain and autoimmunity. It’s not addictive or deadly and costs about $200 a year if it works. So of course insurers will pay for opiates instead.
Insurance formularies are determined not by doctors or scientific evidence but by virtue of the private negotiations among rent-seeking cartels. Prices are set by the hidden forces of the PBM price-fixing/kickback system. You’ll see the same effect on internet prices and service when net neutrality ends – and you did see exactly this behavior among railroads before they were regulated.
In free markets, goods are rationed according to price. Expensive items are hard to find whereas plentiful ones are cheap. The drug market is the complete opposite. The only shortages that occur are in the cheap generics. The expensive stuff is always available – although often in such large unit sizes that one patient has to discard much of it (which is often the case with sterile injectables). This is reflected in the artificially high formulary prices you’re seeing for what are essentially common goods. Companies do this to rig their profits higher.
Also, insurance churn isn’t a “long-standing problem” in the system; it’s what the system is specifically designed to produce. You want to give the customer the goods but also make it clear not to return for more. If you don’t tax the customer, you can’t ration the goods. Giving them a useful, stable insurance product is anathema, especially if they are sick. The same way a privatized military can’t win wars – because that would end their profit stream – health insurance can’t actually insure against anything. It also has the effect of hobbling customers so we’re too sick and tired to get organized about it.
It’s like that scene in _Time Bandits_ where Robin Hood (John Cleese) hands out riches to the poor and one of his men socks them right afterwards. When the thug is asked if it’s totally necessary, he mumbles unintelligible gibberish which translates to, “Yes, sir. I’m afraid it is.” (That’s the essential meaning of all the gibberish that’s in the fine print of every health insurance policy.)
Wade Riddick
December 11, 2017 at 2:11 am
Your exactly right in every respect. There is a ton of reasons BY ECONOMISTS why the market doesn’t work for health care, yet we have been so propagandized by market ideology that the debate is more like a religious argument than a rational discussion of the most effective and efficient means of providing health care.
AND
https://www.nytimes.com/2017/12/09/health/drug-prices-generics-insurance.html?rref=collection%2Fsectioncollection%2Fhealth&action=click&contentCollection=health®ion=rank&module=package&version=highlights&contentPlacement=1&pgtype=sectionfront&_r=0
Patrik Swanljung found this out when he went to fill a prescription for a generic cholesterol drug. In May, Mr. Swanljung handed his Medicare prescription card to the pharmacist at his local Walgreens and was told that he owed $83.94 for a three-month supply.
Alarmed at that price, Mr. Swanljung went online and found Blink Health, a start-up, offering the same drug — generic Crestor — for $45.89.
It had struck a better deal than did his insurer, UnitedHealthcare. “It’s completely ridiculous,” said Mr. Swanljung, 72, who lives in Anacortes, Wash.
Continue reading the main story
RELATED COVERAGE
Why Are Drug Prices So High? We’re Curious, Too SEPT. 17, 2017
Have You Had Difficulty Paying For or Obtaining Prescriptions? JUNE 15, 2017
Amid Opioid Crisis, Insurers Restrict Pricey, Less Addictive Painkillers SEPT. 17, 2017
Take the Generic, Patients Are Told. Until They Are Not. AUG. 6, 2017
In an era when drug prices have ignited public outrage and insurers are requiring consumers to shoulder more of the costs, people are shocked to discover they can sometimes get better deals than their own insurers. Behind the seemingly simple act of buying a bottle of pills, a host of players — drug companies, pharmacies, insurers and pharmacy benefit managers — are taking a cut of the profits, even as consumers are left to fend for themselves, critics say.
…..
Even as more Americans have health insurance since the Affordable Care Act was passed, insurers are increasingly asking consumers to pay a larger share of their costs. In 2016, about five million people in Medicare hit a stage in which they had to pick up a greater share of their expenses.
Reporters at ProPublica and The New York Times examined whether they could get better prices on 100 of the most prescribed drugs, identified by GoodRx, without using their insurance. ProPublica’s prescription claims are managed by OptumRx, a large pharmacy benefit manager owned by UnitedHealth Group; The Times’s medication coverage for reporters is managed by Express Scripts.
Both reporters found lower prices on GoodRx for at least 40 drugs on the list (many were drugs that can be purchased for $4 at Walmart, without any coupon).
I live in the UK, in Scotland and receive care via the national health service. Care if free at the point of delivery. You walk in, they take care of you, you go home. The Conservative Party has been cutting the funding every time it gets into power and hopes to privatise healthcare so its members can profit. These stories of private healthcare in the US undercut their ‘message’ of efficiency of markets. What is so important is to attach alternatives to the tax on time that is US healthcare: when getting new car or visiting a clinic or whatever, talk about the NHS if you wish or talk about the Canadian System or the German system–whichever takes your fancy. Wikipedia has an excellent overview of the differences between them. Like Mother Jones said: don’t mourn, organise. And the first step in organising is telling everyone you talk to about healthcare there are better and cheaper alternatives in the world.
I find that a very effective way to do this is to learn by heart a few simple numbers, specifically health expenditure by percentage of GDP. So for example, when someone talks about bringing’choice’ into healthcare, just say something like ‘the UK health care system costs 9.1% of GDP, the US system costs 17.1%. Is bringing ‘choice’ into the system really worth 8% of the entire nations wealth?’
Thank you!
exactly the type of trade-off I am interested in and get people to do. It’s just a shame it’s not within NC remit (as I’ve been told) so I stick to more specific ‘micro’ examples. (NB not criticism of NC – they already need a 28 hour day so have to draw the line somewhere…. which is partly why I intend to keep certain discussions ‘offline’ with people on here. I don’t want to cause trouble again.)