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4th November 2019, 12:33 AM | #121 |
Muse
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You keep going on about car insurance. I'm 57 live in the UK and have never learned to drive and therefore never owned a car or driven a car or paid insurance on a car. At 57 I am now going to the doctor more, need more medicines, need more help. I can't decide not to do that if I want to live. I pay a little more in taxes, I pay nothing for health insurance outside my general taxation and I'm damn sure I am better off in medical terms than your average USA citizen.
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4th November 2019, 12:58 AM | #122 |
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4th November 2019, 05:04 AM | #123 |
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4th November 2019, 10:05 AM | #124 |
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I am speaking from a USA perspective and auto insurance is an example of what insurance is supposed to be.
I don’t know how much “better off” you are than the average American. What can be said for sure is that the UK system provides similar outcomes in most measures compared to the US and the UK is able to run it cheaper. I have no quarrel with that. Where I think the US will have problems is in converting to an NHS style single payer because of how entrenched the current system is and how different the socioeconomics are between the two countries. I think the US needs to find it’s own way that takes the best from other plans and innovates something new. |
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4th November 2019, 10:24 AM | #125 |
Penultimate Amazing
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I have a feeling that Warren's plan to eliminate private insurance and force everyone immediately into single payer may be a fatal flaw, politically, if not in implementation. Americans do not like to be forced to do much of anything. Fore example, the mandatory purchase of insurance in the ACA was probably its least popular feature. People who have good insurance plans will certainly be very unhappy at being forced into what they will likely perceive, rightly or wrongly, to be the inferior government plan. I suspect Warren will have a lot of difficulty getting her plan approved by even a Democrat controlled Congress. An opt-in type of plan will likely get us to single payer over time, as many employers will decide that they do not need to offer a full health insurance plan.
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4th November 2019, 10:29 AM | #126 |
Orthogonal Vector
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4th November 2019, 10:33 AM | #127 |
Penultimate Amazing
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As I see it, Medicare for all is just the slogan being used to sell single payer. Of course a lot of changes will be made in the process of implementing it. The primary advantage of single payer over ACA is that under single payer, the government will have a lot more leverage to get a handle on costs. Of course, if they go too far in cost cutting, quality of care may suffer.
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4th November 2019, 10:34 AM | #128 |
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4th November 2019, 10:35 AM | #129 |
Penultimate Amazing
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4th November 2019, 10:52 AM | #130 |
Orthogonal Vector
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Public option was the option of a single payer plan, with the option to choose other insurance plans. Option is literally in it's name. That is the thing here, you are talking about a single payer option for everyone. That failed to pass already.
Look the insurance, drug companies, and health care providers have too much money to spend on lobbying and advertisement to get anything passed. I mean we can't even regulate that what they say is in supplements is actually in them because of this power and that is nothing to all those. We passed the event horizon to regulating and having a sensible system years ago, we just have to ride this out destroying the country before we can do anything about it. |
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4th November 2019, 10:58 AM | #131 |
Fiend God
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4th November 2019, 11:07 AM | #132 |
Penultimate Amazing
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That's an irrelevant distinction. Any costs related to malpractice insurance need to be covered by whatever fees the doctor or medical institution charges.
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The point is that if you go to a single payer without changing the malpractice laws, your costs may still be higher than they could be.
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Let me give you some real life examples... I have a cousin. He injured his shoulder (possibly a rotator cuff injury). He finds it very painful for him to raise his arms, but has to suffer though because his job involves physical activity. He was stuck on a waiting list for several months to get an MRI for a proper diagnosis. To you his pain and suffering doesn't matter because "gee wiz if its an emergency he'll get treated". Its not an emergency. He's suffering. If he were in the United States he probably would have had an MRI within a week. Here's another example that's a bit more personal... I may have sleep appnea... I often stop breathing at night. Its a condition that has been linked to an increased risk of Stroke or heart disease. I mentioned it to the doctor over 6 months ago, but they have yet to find a slot in a clinic to do a proper sleep study. So while it is not an emergency per se, it still may shorten my life. (I do believe there can be waiting lists in the United States, but those waiting lists are much shorter.) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2933773/
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In Canada, what treatments are provided/funded are determined by the government, which is sometimes slow to react and often has different priorities. Let me give you an example: There is a genetic diseases called Fabry's disease which can cause serious health problems (including heart and kidney problems). There was a point where treatment was not being provided in Ontario, despite the fact that such treatment was being done (and covered by many user's insurance) in the United States.
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What I am complaining about is people who ignore or hand-wave away all of the possible problems involved with various alternatives. And let me make a prediction... if the Democratic party does decide to push a true single-payer (i.e. no private insurance) option in the next election, you will see a rush of right-wing newscasters to Canada to point out every patient who has ever been on a waiting list, in an attempt to say "See? This is what the Democrats want for your health care!" |
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4th November 2019, 11:50 AM | #133 |
Orthogonal Vector
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Yes and no, a large part of the high malpractice payouts is paying for future medical care of those injured. If that was just part of the general health care costs you wouldn't have the courts trying to figure out what a reasonable amount is for someone who will live for years needing constant care.
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4th November 2019, 11:51 AM | #134 |
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4th November 2019, 12:15 PM | #135 |
Lackey
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There are examples of myriad of different universal healthcare schemes, what they all have in common is cheaper and more people covered. The USA is in one way in an enviable position in that it has decades of emperical data to draw on to determine the best system. It needs no hypotheticals, no trials no further research, it simply needs the will to change.
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“If only it were all so simple! If only there were evil people somewhere insidiously committing evil deeds, and it were necessary only to separate them from the rest of us and destroy them. But the line dividing good and evil cuts through the heart of every human being. And who is willing to destroy a piece of his own heart?” Aleksandr Solzhenitsyn, The Gulag Archipelago |
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4th November 2019, 12:20 PM | #136 |
Orthogonal Vector
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But look how much less profit that is being generated by the worthwhile classes from the UK system, a total failure in that. I mean if you are the kind of socialist fool who measures a health care system not by the number of billionaires created but by the average life span and quality of the country what else totally antithetical to american values will you suggest?
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4th November 2019, 12:35 PM | #137 |
Penultimate Amazing
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True. The USA does seem extraordinarily prone to trying to solve even the smallest problems with law suits, an expensive business.
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But no system can afford to have a personal doctor and a fully stocked radiology suite and surgery suite and pharmacy standing by everywhere for every single person in the country. I exaggerate to make the point that available resources are scarce and not readily available everywhere, so patient care needs to be prioritised. That's what the waiting lists are, and the process is actually quite complex. Do not for one moment think that people get put on these longer lists because of neglect. Medical staff feel their pain and would love to treat everyone immediately. The reason is simply the lack of resources right now, NOT because some faceless wonk in Ottawa decided a rotator cuff injury is of no consequence. The clue to better service is to have more resources available immediately, of course. And that means more money from government. And that in turn is an ongoing food-fight that happens in every country that has socialised medicine. And the generosity of neighbours like the USA in providing some specialised medical care for Canadians is another solution.
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4th November 2019, 05:04 PM | #138 |
Seasonally Disaffected
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1 - total cost would be about the same, but most or all of it would be out of my pocket, no assistance from the employer.
2 - same 3 - yes, and there is an "enrollment period", about a 2 month window. If you miss the enrollment period you are without insurance until the next one rolls around. |
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4th November 2019, 05:56 PM | #139 |
Penultimate Amazing
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Thanks for that.
Would it help if your health COVER was consistent regardless of your employment status? And your age? Would it help simplify things if you had one consistent method of contributing financially towards your health benefits? E.g. a small percentage levy on your pre-tax earnings? |
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...our governments are just trying to protect us from terror. In the same way that someone banging a hornets’ nest with a stick is trying to protect us from hornets. Frankie Boyle, Guardian, July 2015 |
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4th November 2019, 07:50 PM | #140 |
Penultimate Amazing
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We could always build it and have Canada pay for it.
Hey....it worked for Trump and his wall! |
4th November 2019, 07:52 PM | #141 |
Penultimate Amazing
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5th November 2019, 01:37 AM | #142 |
Penultimate Amazing
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Just want to point out that health care is always "rationed" to some extent because society can't afford to, or does not wish to, deliver all procedures to all patients. X-amount of money is available to pay for Y numbers of procedures. Which procedures are to be paid for must be determined by some means.
In most countries with government run health care these decisions are made by panels including doctors and ethicists. This is not inherently evil: e.g. most people agree with limiting purely cosmetic surgeries, or one million dollar treatments in deep end stage disease patients unlikely to benefit at all or for more than a few days. In the USA these decisions are based on how rich the patient or, if less wealthy, by their insurance company. A poor person with bad insurance may never get a crucial treatment whereas a wealthy person in less need will. And to emphasize, if less than wealthy it is one's private, profit-driven insurance company, not one's doctor, who determines whether you have an expensive treatment or not. Neither are ideal and each has flaws. But ethically and in terms of fairness I feel the former is better than the latter. And in fact the wealthy usually find a way no matter what. |
5th November 2019, 02:40 PM | #143 |
Penultimate Amazing
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This is one of those things that seems true but really isn't. When Republican voters were polled - more than once over a long period - they quite liked the Affordable Care Act. It was only when pollsters called it Obamacare that the approval went down.
There's a reason the Republicans couldn't get rid of the ACA, and it's not just because they never came through with an alternative: People generally like it and consider it a positive step. |
5th November 2019, 04:10 PM | #144 |
Penultimate Amazing
Join Date: Jan 2002
Location: Canada, eh?
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This depends on how the system is implemented, but I suspect that doctors 'adding fees' (in order to cover expenses like malpractice insurance, or anything else) would be considered illegal. That's the way Canada does it... everything (at least in terms of basic medical coverage, not including dental/eye care) is covered by the government program.
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But, here in Canada it is due to a combination of slow government response and a need to fulfill multiple priorities that also include non-medical needs (such as basic infrastructure, defense, policing). Plus, the priority of the patient may not necessarily line up with the priority of the officials making the health care decisions. Again, the issue is if people push for single payer because "gee wiz, its cheaper" then they will have to justify how people may have their health care treatments delayed.
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But here's the thing: keep in mind that many (probably most) people DO have health insurance of some kind. And those people can often get better treatment (read: faster service, better tools) than people in places like Canada. Now, the problem when people discuss health care is that not everyone agrees on the same terms. To many, "Single payer" simply means "universal". To others, Single payer is a lot more focused: it means no private insurance at all; everything is covered by the government program. (This appears to be what Sander's plan is. I'd have to look at Warren's plan in more detail to see if it is the same.) I think the U.S. system needs to be reformed. But I think going to a true 'single user' system is a mistake. The best health care systems are the ones that merge private and public systems. If you tell people who do have coverage "Your own health care and that of your family will get worse, so that some unnamed person might be better off", you might have a hard time getting broad public support.
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The fact that the government finally adopted it doesn't change the fact that there was a time period when it didn't cover the treatments.
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Again we have to deal with what exactly 'single payer' means. Universal coverage but with private options for better service? A public option to cover those that private health care missed? True single payer with no private options at all? The only western country that has adopted a 'no private insurance' scheme (like the one pushed by Sanders) is Canada, and we generally rank near the bottom of various health care rankings. The better options mix private and public in various ways, and usually end up better off for it.
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Strangely enough, I have no problem getting fast treatment for vision or dental. But then those are paid for by private insurance. What are the odds?
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From: https://www.cnn.com/2019/07/03/polit...ity/index.html Under the Sanders proposal, private health insurance companies would be eliminated. Every resident would be covered by a single government insurance program that would pay the entire cost of almost every health care service and product... Its a plan that goes beyond even what Canada offers. And then there is Warren's plan: From: https://www.businessinsider.com/what...dustry-2019-11 Private insurance would be eliminated. Warren argues that would save hundreds of billions of dollars in administrative spending, and relieve patients of the hassle of dealing with their insurer.
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5th November 2019, 04:34 PM | #145 |
Illuminator
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As long as the healthcare is being paid by insurance, what difference would it make whether Medicare or private insurance pays for it? Would it not cost roughly the same, no matter what?
If you were adding say 30% more patients, then costs would go up. |
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5th November 2019, 05:27 PM | #146 |
Penultimate Amazing
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I understand. In Australia we "copied" the Canadian model because it was a good fit. But it is not pure single-payer for everything. Ours is a single-payer for basic coverage grafted to optional private coverage for the rest.
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...our governments are just trying to protect us from terror. In the same way that someone banging a hornets’ nest with a stick is trying to protect us from hornets. Frankie Boyle, Guardian, July 2015 |
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5th November 2019, 05:58 PM | #147 |
Penultimate Amazing
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I have no doubt that a national health insurance program similar to most of Europe could work. I just don't see it as politically feasible right now. The winning health care plan would be, bring back he ACA to include mandate and offer Medicare as a plan option in those markets where there are few or no private options. You offset some of the cost by having the customer pay the means tested premium that they would have paid for a commercial plan.
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5th November 2019, 06:27 PM | #148 |
Illuminator
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Most of Europe is not all. Germany has private insurance. It is more like a co-op, with members employing the minimal crew to process the claims. If enough patients pool together they can become the insurance company. They take it out the paycheck I think, except for disabled etc.
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5th November 2019, 06:42 PM | #149 |
Penultimate Amazing
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5th November 2019, 07:27 PM | #150 |
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Because both sides of the equation are best guesses. And being optimistic for the lowest cost and highest revenue to make a plan work seems like a bad recipe. Do you think a backup funding plan is necessary? And at what point should it be implemented?
If after the change is made, deficits become apparent that run large but decreasing yearly, should that burden simply be added to the national debt for however long it takes? So funding lacks 800b first year, 700b second, 600b third, 575b fourth, the trajectory is right but the timeframe until even is troublesome and would reflect a need for some modifications to the funding. When you run on 'no middle class tax increase', the political ramifications for fixing it become a deterant. How many of those examples we can draw from finance in the same way as Warren's plan? Since we are discussing a specific plan, we should focus on that I would think. |
5th November 2019, 09:02 PM | #151 |
Penultimate Amazing
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"We are enjoined, no matter how uncomfortable it might be, to consider ourselves and our cultural institutions scientifically — not to accept uncritically whatever we’re told; to surmount as best we can our hopes, conceits, and unexamined beliefs; to view ourselves as we really are." - Carl Sagan |
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5th November 2019, 10:29 PM | #152 |
Penultimate Amazing
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The thing is that there is no need for that to happen even with a single payer.
The US system has privately run hospitals and doctors. All that really has to happen is to change who the payer is. Heck, under a single payer system it should be possible to prefund hospitals based on their population and the number of cases they are seeing every year. If they have a situation that would cause them to over run the projected costs, then that case can go to a board of doctors who can work with the doctors of the hospital to determine the best course of treatment for the patient(s), and then either approve the cost overrun if that is considered the best, or follow another path is there is a better option for the patient. There is no need to make the service worse just because there is a single payer. In fact, just to put a level between the politicians and the hospitals, having a Federal Health Board who would act like an insurance company in that it negotiates costs, lobbies to get the money from Congress, does the paying, and works to organise specialists to help with any special cases. |
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6th November 2019, 04:11 AM | #153 |
Orthogonal Vector
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6th November 2019, 04:14 AM | #154 |
Orthogonal Vector
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Well for starters the overhead in medicare is 6% of costs as opposed to 30% when the efficiency of private coverage comes into the game. Then there is the simplification of medical billing and hopefully less "reject everything twice to make it go away before paying" make work positions in insurance.
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Sufficiently advanced Woo is indistinguishable from Parody "There shall be no *poofing* in science" Paul C. Anagnostopoulos Force ***** on reasons back" Ben Franklin |
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6th November 2019, 04:34 AM | #155 |
Illuminator
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My point was more to do with the fact that they throw up 52 trillion and say "too expensive" when medicare is involved. Yet the same amount is paid if you use private insurance. And it also ends up as "bad healthcare" if the government is paying and good if you pay thru the nose to insurance. Yet the doctor gets the same amount of income.
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6th November 2019, 05:20 AM | #156 |
Penultimate Amazing
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Let me tell you how it works in Japan in my experience. When you arrive at a doctor's office you are asked for your insurance card, not cash up front. That happens only after you've seen the doctor. So medical care is provided before they ask for payment every time I've ever encountered the system.
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6th November 2019, 09:13 AM | #157 |
Penultimate Amazing
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A thoughtful critique of the Warren plan:
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6th November 2019, 09:15 AM | #158 |
Fiend God
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6th November 2019, 10:20 AM | #159 |
Penultimate Amazing
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Canada has been attempting to deal with the issue of how to allocate health care resources in a 'single payer' system (for basic medical services) for decades, and yet we are stuck with long waiting lists.
Why exactly do you think the U.S. will somehow be magically different? That somehow the U.S. will be able to somehow solve the problems that Canada (a pretty normal western country with no major corruption issues) has been unable to?
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Governments will have to budget for whatever health care costs are expected, and plan for any expected infrastructure upgrades that are needed. (After all, you probably don't want to give private hospitals and clinics free reign to decide "We want to buy X and the government will pay".) That means health care will be subject to the actions of a government that will have multiple competing priorities.
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Would you really feel confident putting complete control of your health care funding in the hands of a President Paul Ryan a decade from now? I can just imagine the conversation at the GOP headquarters: "We need to give the rich another tax cut" "But that will increase the deficit" "Maybe we can cut down on defense spending." "Ha ha! good joke" "I thought you would think that was funny" "Lets just cut a few extra billion out of health care. After all, by the time waiting lists get too long the Democrats will be back in power." |
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6th November 2019, 10:49 AM | #160 |
Orthogonal Vector
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