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Post by jspnrvr on Jun 30, 2009 20:55:40 GMT -5
I had a cousin who, for many years, ran a "naturist" resort, Treehouse Fun Ranch, in rural southern California, which was located in Sonny's district. He said Sonny was a heck of a nice guy who always looked after his constituent's interests, and his untimely passing was deeply felt. Especially the fact that it was a skiing accident and Sonny was known to be fairly comfortable on the slopes. There was even talk of a conspiracy; a lot of people suspected the tree had been planted.
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Post by joew on Jul 1, 2009 14:45:35 GMT -5
Well, Al Franken is the new United States Senator for Minnesota. God bless and save Minnesota and the United States of America. God bless and save us all. … I'm tempted to say we'll need it. Maybe he really is representative of Minnesota.
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Post by doctork on Jul 1, 2009 18:08:08 GMT -5
I had a cousin who, for many years, ran a "naturist" resort, Treehouse Fun Ranch, in rural southern California, which was located in Sonny's district. He said Sonny was a heck of a nice guy who always looked after his constituent's interests, and his untimely passing was deeply felt. Especially the fact that it was a skiing accident and Sonny was known to be fairly comfortable on the slopes. There was even talk of a conspiracy; a lot of people suspected the tree had been planted. [Groans and holds head in dismay] Jay you are so punny!
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Post by gailkate on Jul 1, 2009 18:53:50 GMT -5
Franken is a Harvard grad. Read here about his work with the USO - long before deciding to enter the race. www.alfranken.com/content/vets_NoteFromAlHe's no clown. I was for one of the cadidates who didn't get nominated, but I expect he'll do good work and surprise a lot of people.
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Post by gailkate on Jul 1, 2009 18:56:32 GMT -5
I will not be smiting those of you who express opinions with little information and an excess of prejudice. You know who you are.
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Post by sailor on Jul 1, 2009 19:17:23 GMT -5
I will not be smiting those of you who express opinions with little information and an excess of prejudice. You know who you are. Hmmm, I always express opinions based on little information, if any at all. I think I fail in the excess prejudice category but I do know who I are. Two out of three isn't too bad! Mike P.S. Franken for President when the time comes!
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Post by doctork on Jul 6, 2009 20:19:30 GMT -5
Tonight's news carried stories about the passing of Robert MacNamara, "architect of the Viet Nam War." Many talking heads debating whether that was fair or not, whether he should have expressed his doubts 27 years earlier than he did in his book "In Retrospect."
I bought the book in hardback when it first came out, and leafed through it, though I can't say I read it cover to cover. It didn't seem enough, but at least he admitted his mistakes. 58,000+ dead in that war. I dunno, I just don't feel a big loss at MacNamara's passing.
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Post by gailkate on Jul 6, 2009 23:10:48 GMT -5
Did you see the piece PBS ran, with a clip of an interview from a few years ago? He was asked pointedly about pursuing a war he'd had doubts about from the beginning and losing 58,000 Americans (never mind the millions of Vietnamese). He didn't flinch, but said something about learning so it would never happen again. I'm sure the families of all those lost in that lesson find it a comfort to know McNamara learned something.
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Post by doctork on Jul 7, 2009 15:59:03 GMT -5
That is why I cannot find it in my heart to regret his passing. 58,000 lives snuffed for no good reason other than educating war mongers what they should have already know. As Phil Ochs said - "It's always the old who lead us to the war, always the young to fall. Look it what they've done with a saber and a gun; Tell me was it worth it all."
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Post by doctork on Jul 16, 2009 16:35:27 GMT -5
Last night on the evening news, there was a feature on the alleged shortage of family doctors. They posted figures suggesting that lower income was a factor causing med students to choose other high-paying specialties, and list the "average family doctor" annual income as $190,000! I do not know any family doc that makes anywhere near that much, nor have I seen any job advertisements even claiming that (well except one in rural ND, and Brutus said I shouldn't go there, ever for a lot of money).
I think they were accurate in listing radiologists at $400,000 and cardiologists and neurosurgeons at $600,000. But most family docs like what they do and would continue even at salaries half that alleged $190,000 if only we weren't endlessly harassed by insurers and government with stupid paperwork that is "burdensome and unnecessary." That is what Secretary Tommy Thompson called it when he was head of HHS, and he was right.
I call the shortage "alleged" because we are a capitalist society (even in our healthcare, and even if it is "socialized") so we pay specialists more because they are preferred by many people and entities. If our society truly wanted more primary care docs, they would pay them more and quit blaming all the ills of medicine on them.
Not to mention that if there is such a shortage, why did it take me two years to find a job?
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Post by Jane on Jul 16, 2009 20:12:04 GMT -5
I went to a seminar thing last night put together by my Organize for America group (the Obama folks I worked with on the campaign) on health care. The speaker was a family care physician who is a member of the Physicians for National Health Care (PNHC)--I think that's the name of the group. It was eye-opening. At one point he said, "This is so screwed up! .....I think that will be my summary statement." He told us he made $160,000 and one of his best friends, a cardiologist, made $750,000! That is just wrong. What he said made so much sense--way too much sense for politicians to actually enact, of course.
What his group proposes is very much like the system in France--medicare like coverage for EVERYONE with the gov. paying the fare and supplemental insurance if people want to buy it themselves. On All Things Considered, the guest (I'm not sure who he was, but he's written a book on the subject) said the same thing--the French have the best system in the world.
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Post by doctork on Jul 17, 2009 6:46:54 GMT -5
I think I'm familiar with the group, and they do take a fairly extreme approach to healthcare reform. However, healthcare in France is quite good, none of the negatives portrayed here as the boogeyman of "socialized medicine." Check out "Sick Around the World" on PBS (may be on the web for view) and T. R. Reid's book of a similar name.
He is doing a presentation at the Colorado meeting I'm attending later this month, so I will have the chance to talk with him. All the heavy hitters in health reform will be there, and it is a nice small group with plenty of interaction and learning. Full report to follow....
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Post by booklady on Jul 17, 2009 6:50:29 GMT -5
Whatever is done, one component of reform has to be to separate health insurance from employment. And private insurance companies, if they are allowed to survive, must be made non-profit. It is immoral to make money off another's physical suffering.
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Post by jspnrvr on Jul 17, 2009 8:38:11 GMT -5
[quote author=booklady board=events thread=957 post=50105 time=1247831429It is immoral to make money off another's physical suffering.[/quote]
Well, then, let's start with tort reform, caps for punitive damages and "pain and suffering". That won't happen because the trial lawyers are big contributors to the Democrat Party. Malpractice premiums are a significant part of an MD's overhead; it's part of what is killing private practice, along with all the other pressures on any independent business these days. Threat of litigation also drives a lot of defensive, CYA medicine and testing. "Preventive" medicine used to mean sanitation, nutrition and vaccinations. Now it means MRI.
A truly negligent practitioner needs to be made to pay health care costs for an injured patient, also the professional organizations need to be do their own self policing. I know there are peer review structures in place; I don't know what it takes for a license to be suspended by a professional organization or the state.
I agree with separating insurance from employment; in fact the employers are peeing down their leg to do that right now. Let individuals shop for health care and pick what suits them best. Make it portable. How about the health care savings accounts? How about making available different "degrees" of health insurance. We insure our cars for collision, damage, etc. We don't insure for oil changes and new tires or batteries. How about insurance for so-called catastrophic or costs above a certain level? Get a sore throat or twang your twanger working in the yard and pay the doc as you go. That's the way it used to operate. Most of us don't wind up in a hospital until we get older, unless for injuries. Younger ladies or families could keep insurance for birthing, if children are planned.
Reform is needed, but I'm of the opinion it means less government regulation, not more. If you love Medicaid, The Veterans Administration, the Indian Health services on the reservations, and the Department of Motor Vehicles, then a government "fix" is for you.
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Post by doctork on Jul 17, 2009 12:16:29 GMT -5
Most health insurance companies do not make money off of peoples' suffering, as most of their "covered lives" are healthy, and most people who are ill but insured get most things covered. The problem is those without insurance who cannot buy insurance at any cost because they already have a diagnosis ("pre-existing condition") or who have totally inadequate minimal coverage, usually because that is all that is available or all they can afford. Only a mandate will change that - everyone has to buy coverage (or obtain subsidized if they qualify) so there are no free riders, and every employer has to offer it, and every insurer has to cover everyone, not cherry pick only the healthy. If applied evenly, that is one regulation that would solve a lot of problems. The burdensome and unnecessary regs should be eliminated. Most of the real PITA stuff is private insurers.
The high deductible plans you describe Jay are already available from many employers. I don't know why they are not more popular - I loved it when I had my $6,000 deductible plan, which I always hit by March 1.
Depending on specialty, it's not so much the malpractice premium itself, it's the CYA medicine you have to practice, ordering zillions of expensive tests of marginal benefit. I don't see anything afoot that curb such costs. The government programs you describe are not what is proposed (and BTW, most VA care is now state of the art quality), though it may be what is in the mind of some of the far left. I don't think we are ready to go there, and MA has "universal coverage" provided through private insurers, so it can be achieved without handing all care over to the feds.
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Post by gailkate on Jul 18, 2009 10:12:37 GMT -5
My goodness this is a hot-button issue. Even Jay's normally flawless grammar falls to the bitterness of the times. To form an adjective from a word ending in -at, add the suffix IC: idiosyncrat IC, monchromat IC, melodramat IC. The Democrat IC Party has indeed taken more from trial lawyers than have the Repugs, because they see gross malfeasance as deserving gross punishment. But tort reform will change only 2-4% of overall healthcare costs (many conflicting theories about this, but here's a fairly objective report from the reputable Bloomberg): www.bloomberg.com/apps/news?pid=20601103&sid=az9qxQZNmf0o . All I've read and heard from reasonably reliable sources is that the last years of lives dragged out on expensive care/machines are what drive exorbitant medical costs. People are afraid to die. We carry (at our own cost) long-term care insurance. Our health directives are as clear as we can make them - DNR and no extraordinary measures to prolong life. BL, does your post mean that you haven't been able to get good insurance? What's your experience been since leaving your school in MA? I was always lucky, taking for granted the insurance that came with my jobs. I couldn't possibly have afforderd a $6000 deductible when I had cancer. It's a muddle, for sure.
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Post by jspnrvr on Jul 18, 2009 11:24:46 GMT -5
My goodness this is a hot-button issue. Even Jay's normally flawless grammar falls to the bitterness of the times. To form an adjective from a word ending in -at, add the suffix IC: idiosyncrat IC, monchromat IC, melodramat IC. The Democrat IC Party has indeed taken more from trial lawyers than have the Repugs, because they see gross malfeasance as deserving gross punishment. . Absolutely correct, gail, about the modifier. But it is the Democrat Party, not Democratic, or Dhimmicrats or Democraps. Likewise Republicans, not Rethuglicans or Repugs. We are not Daily Kos here, are we? Even if we disagree politically we want to be able to trade tomatoes and cukes over the back fence, not lob them at one another. I'm smiling.
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Post by gailkate on Jul 18, 2009 15:04:52 GMT -5
Darn right about the cukes, even eggplant and zuchinni. But the name has been Democratic Party since its beginning, and insisting on calling it something else, something harsher and less -well, democratic - is in your face and rude. Republican works as a noun and as an adjective. But Democrat cannot. We could come up with another adjectival form like Republicanan - or, better Republi cainian - to get you guys further from association with our ideal Republic. And as for the grand ol' GOP, what would be a grammatically correct locution? GOPiggan? "GOPiggan sources said today that they won't pay for heathcare, no way, no how..." I'm just sayin. No I'm going to bake cookies.
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Post by jspnrvr on Jul 18, 2009 16:52:31 GMT -5
Darn right about the cukes, even eggplant and zuchinni. But the name has been Democratic Party since its beginning, and insisting on calling it something else, something harsher and less -well, democratic - is in your face and rude. Republican works as a noun and as an adjective. But Democrat cannot. We could come up with another adjectival form like Republicanan - or, better Republi cainian - to get you guys further from association with our ideal Republic. And as for the grand ol' GOP, what would be a grammatically correct locution? GOPiggan? "GOPiggan sources said today that they won't pay for heathcare, no way, no how..." I'm just sayin. No I'm going to bake cookies. Gail, I stand corrected; it is Democratic Party, not Democrat Party. That kind of gross error on my part doesn't happen very often. I apologize for any offense.
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Post by gailkate on Jul 18, 2009 17:05:51 GMT -5
Have a tomato, chum.
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Post by booklady on Jul 19, 2009 12:38:02 GMT -5
gk, I'll be back to answer your question.
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Post by doctork on Jul 20, 2009 10:30:17 GMT -5
Good thing I missed the flying tomatoes and zucchinis, but I guess that's what happens when the subject turns to health reform. It's a mess any way you cut it! I'm headed to Colorado next week for my annual July health policy summit in the mountains - it's non-partisan, and we will hear from all sides, so I hope to return better informed. I hope someone has something positive to say.
gk, the $6,000 deductible is tough, but the truth is, if you are middle class to affluent and have a chronic disease with "regular" insurance, you will be spending all that and more on higher premiums (the high deductible plans have lower premiums because 90% of insured don't spend over $1,000 in a year), deductibles and co-pays. Plus you will have the headaches of limited networks and referrals. If you are on medications that cost $3,000 or more per month, it will all be covered 100% after the $6,000. So you budget the $6,000 (I had 1/26 taken out of each paycheck) and live with it.
That is why most people with chronic diseases are poor, and many do not take their medications as prescribed. A major problem with health insurance reform is how to cover those with pre-existing conditions. If you have had cancer or an organ transplant, or have diabetes, asthma, MS, rheumatoid arthritis or any of hundreds of others, no one will insure you unless required by law. About 80 million Americans have at least one chronic disease.
My "Bio-tech" injectable was $984 per month in 2002 when I began it, and now it is over $3,000 per month, with a 20% co-pay ($600) each month. I also have two other meds that cost more than $600 per month, fortunately with "only" $50 co-pays - brand-name only, no generic available, and life-saving for me. That is unreasonable for most people to pay. Added to premiums, other co-pays and various miscellaneous medical expenses, and before you know it, my health care costs $20,000 a year, typical for a non-poverty level person with an auto-immune disease. If I must, I can and do pay that, but most people can't. You certainly can't easily save much retirement or pay for kids' college with that type of expense.
I try to speak for the millions in a similar situation, since I speak knowledgeably as a patient, a doctor, an insurance executive, and a person with activist experience. In all the sloganeering, this reality is overlooked.
And those who want "individual choice" not to pay premiums if they are healthy - they only want it when they are healthy and save their own money. When they get sick (cancer, auto accident, premature child), they want others to pay. I used to object to universal mandates, but not any more. If someone wants to opt out by posting a $1 million bond, or agreeing that they will not receive treatment should a health catastrophe befall them, well maybe. Of course, federal law (and Hippocratic Oath) requires that all be treated regardless of ability to pay, so that is a no-go.
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Post by doctork on Jul 20, 2009 10:33:38 GMT -5
I watched the coverage of Walter Cronkite's passing. Bittersweet, as I have missed him for 28 years since his retirement on March 6, 1981. And yes I remembered the date even before this weekend's coverage. But fitting and touching to see the widespread appreciation and remembrances.
There will never be another like him.
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Post by doctork on Jul 22, 2009 12:37:33 GMT -5
Tonight (Wednesday) the President will be doing a television address which reportedly will cover health care reform and the various proposals pending. I will watch to see what he has to say.
I don't quite reconcile the antipathy for "government health programs" with the fact that Medicare is one of the most popular government programs in history. Of course, the care is all delivered in the usual private sites (doctors' offices, hospitals, etc), and it is actually administered by a bunch of private companies hired by the feds for the purpose.
That's a long way from government takeover, or the British or Canadian systems, though I think most Americans don't know what those systems are really like. When my son was in college in Canada, he was happy with the care either at UBC student health or the private doctor's office.
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Post by Jane on Jul 22, 2009 13:03:38 GMT -5
Did you all see the article in the NYTimes Sunday magazine by Peter Singer? Excellent points. I wonder if Barack read it.
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Post by doctork on Jul 22, 2009 16:41:29 GMT -5
I didn't see the article YET - NYT is not available for home delivery or purchase at retail in Sparta and environs, so I have ordered mail delivery. I guess I will read last Sunday's NYT next Sunday until I figure out some other possibility. Oh well - rural life.
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Post by sailor on Jul 22, 2009 17:43:59 GMT -5
It's still new news until you read it. Having dwelled overseas for most of my life I'm well acquainted with being the last to know... everything. I used to wait weeks for a letter from home, now it's practically instantaneous with e-mail. Frankly, I think some news is best left in the unknown category. There are things that we (at least I) don't need to know, like everything that has to do with the personal lives of celebrities.
Doc, an old newspaper is like an old friend that you haven't seen for a while. Read it, absorb it, and enjoy it; then, recycle it.
Sometimes I ramble on about nothing, like now!
All the best, Mike
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Post by gailkate on Jul 23, 2009 10:57:06 GMT -5
I thought the Prez made some important points last night - for those paying attention. (CNN's talking heads pronounced it "nothing new" and kind of ho-hum.) It seems he's expected to make serious tough stuff sound like Grape Nehi.
One thing I don't think people recognize is that healthcare has flattened their paychecks. Over the last 15 years where I worked, the only way to get more than a 1-2% raise was to be promoted. Thus a whole lot of time was wasted trying to get people reallocated - plus the very real costs of inflated expectations and bitterness of people who felt unappreciated.
Now that we're paying the full cost of our insurance (still with Jerry's company but with no match from them) our costs have risen at least 20% each year. It's staggering. I don't think all the people saying they're fairly statisfied with their insurance know what it's costing.
And, K, I do see your point about the deductible. We've gone back and forth on it, and our higher premiums seem now to be the better deal. I just called to find out how hearing aid coverage has changed, and I learned that I could get new aids every 2 years with only the specialist co-pay ($40) and 10% of the cost. When I think about the people really locked into silence (my problems aren't yet really bad), it breaks my heart.
I wish we could get past all the 'us against them' so people could stop thinking they won't sacrifice for 47 million lowlifes who don't deserve coverage. That's the way it's painted. Instead we need to see what all God's children should be able to count on - realistically it wouldn be Congress-level coverage, but basic and humane. You shouldn't lose your job and insurance, too, so that when you're already down and out, you could be homeless because of a medical emergency. If 60% of personal bankruptcies are caused by medical bills, something's gone terribly awry.
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Post by doctork on Jul 23, 2009 15:28:54 GMT -5
I agree Mike. It's no problem reading last week's Sunday Times this week, as most of it remains either new news to me, or the analytical part is what's important, and it's not so time-sensitive. And much of the so-called news (yep, Michael Jackson is still dead, and all the rest of the Hollywood types are up to the usual hijinks) does not matter to me a bit.
I thought Obama's points were good, but I'd still agree that nothing was really new, at least to those of us who are health policy wonks who have been following the matter. He did a pretty good job of covering how health costs flatten earnings.
Family coverage typically runs about $12,000 - $14,000 per year (more than the total annual minimum wage income for a full-time worker, so it's no wonder employers balk), and for an older-but-not-yet-Medicare couple, $1,000 a month is a good buy. Only people on COBRA because they were laid off know the true cost, and they get the bill right when they can least afford it. The ARRA alleviated that by covering 2/3 of the cost, a real blessing for those in that boat - might approximate what their employer covered for them.
We spend $8,000 per person per year on healthcare in the US, which Obama translated into $6,000 more per person per year than other countries with better results. Canada pays about half what we pay, and the other 20 industrialized nations pay less than Canada, all with better health statistics, so the $6,000 is probably an average, but OK. Theoretically we could eliminate all that unnecessary care, cover everyone, and still pay less in total. Problem: No one thinks their own care is unnecessary, and they will scream if something is denied. But most other countries (Japan include, Mike!) do more and better with much less money.
USA Today had an interesting front page story today on Massachusetts' successful effort to cover everyone (97.4% have insurance); there have been some rapid cost increase problems, and some problems with access (not enough primary care docs now that everyone is insured and can see a doc) but overall it seems to have worked well. But they didn't deliberately set out to do cost, access and quality reform all at once; an incremental approach has worked better. There is a longstanding truism in US health policy that the whole thing is a 3-legged stool and the 3 legs are cost, access and quality. Supposedly you can have any 2 but not all 3.
And BTW gk, Massachusetts passed its universal coverage plan with mandates mainly on the basis of a "moral imperative." Like you (and me, and others), citizens there agreed it was wrong to leave hundreds of thousands uncovered, so the bill was passed by a Democratic legislature working with a Republican governor (Mitt Romney). I watched from afar at the annual July health policy symposium as it evolved from an idea to a proposal to a law passed to an actual implementation. We'll get a progress report from the head honcho next week in Colorado.
I noted that Massachusetts grants exceptions to those who can't find "affordable" coverage, and affordable seems to mean no more than 8% or so of total family income. Two nights ago I saw a news story on the annual out-of-pocket health cost of a person with a chronic disease - the estimates were $20,000 - $24,000 annually, which matches my own estimates. That is of course why a $6,000 deductible policy with 100% coverage over that amount is a good policy for those with chronic disease.
Those two figures don't compute or match though; I conclude that many people with chronic disease don't get recommended care, or they spend considerably more than 10% of the family income on it. Average family income in the US varies by location, but $50,000 - $70,000 probably covers the rural to urban waterfront.
I have no idea how or if this can all be worked out. My interest is health policy, but the beauty of our democratic process is that this can be made to happen in whatever area is important to you - environment, education, transportation, immigration - you can help make a difference. Stay tuned.
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Post by BoatBabe on Jul 24, 2009 0:57:58 GMT -5
"There is a longstanding truism in US health policy that the whole thing is a 3-legged stool and the 3 legs are cost, access and quality. Supposedly you can have any 2 but not all 3."
I find this very interesting.
Part of the problem of our health care system is that this ideology is being perpetuated by the insurance companies and HMOs. I certainly hope this is being rebuffed by actual medical professionals and not just accepted as a given truth.
A truism is an undoubted or self-evident truth especially one too obvious to mention.
That we should accept this American truism as inevitable, or even as the status quo, belies our Human [American] ability see a problem and find a better solution. Now that middle income people, and even upper income people, are being affected by this health care crisis, maybe we can start finding solutions that will also help low and no income people.
I had health insurance coverage when my primary doctor did tests and referred me to a specialist, who did the same tests over again, who referred me to another specialist who did the same tests over again. They got their money. They drove up the costs of health care for you and me and everyone else.
I'm not accepting this American truism.
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