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7th March 2017, 08:04 PM | #721 |
Illuminator
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I think the House GOP plan is something like 1) create something that looks like an actual plan and push it through the House as quickly as possible before anyone realizes how much it sucks, 2) hand the stinking thing over to the Senate hoping that the Dems will filibuster it so we don't know how bad it is by practical experimentation, 3) allow it to die in the Senate, 4) loudly denounce the vile and evil Democrats for not caring about the sick, the elderly, America, apple pie, etc. 5) If anyone in the future points out how bad the plan is, scream "GOD BLESS AMERICA!" at them over and over again until they go away...
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The road to Fascism is paved with people saying, "You're overreacting!". |
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7th March 2017, 08:08 PM | #722 |
Penultimate Amazing
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1. He'd never do that. 2. Okay but he's not currently doing it. 3. Okay but he's not currently technically doing it. 4. Okay but everyone does it. 5. He's doing it, we can't stop him, no point in complaining about it. 6. We all knew he was going to do it which... makes it okay somehow. 7. It's perfectly fine that's he's doing it. |
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7th March 2017, 08:11 PM | #723 |
Penultimate Amazing
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That and they never get sick. Or maybe all Republicans are rich. Or they just hate America, or drive to Mexico to buy their prescription meds, or are all secret nihilists and want to die.
It must be something. It can't be they actually think they have a better idea. |
7th March 2017, 08:13 PM | #724 |
Penultimate Amazing
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1. He'd never do that. 2. Okay but he's not currently doing it. 3. Okay but he's not currently technically doing it. 4. Okay but everyone does it. 5. He's doing it, we can't stop him, no point in complaining about it. 6. We all knew he was going to do it which... makes it okay somehow. 7. It's perfectly fine that's he's doing it. |
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7th March 2017, 08:14 PM | #725 |
Philosopher
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7th March 2017, 08:18 PM | #726 |
Poisoned Waffles
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You added nothing to that conversation, Barbara. |
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7th March 2017, 08:25 PM | #727 |
Becoming Beth
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"A great deal of intelligence can be invested in ignorance when the need for illusion is deep." "Ninety percent of the politicians give the other ten percent a bad reputation." |
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7th March 2017, 08:35 PM | #728 |
Graduate Poster
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7th March 2017, 08:39 PM | #729 |
Nasty Woman
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7th March 2017, 08:42 PM | #730 |
Nasty Woman
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7th March 2017, 08:44 PM | #731 |
Penultimate Amazing
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7th March 2017, 08:46 PM | #732 |
Penultimate Amazing
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1. He'd never do that. 2. Okay but he's not currently doing it. 3. Okay but he's not currently technically doing it. 4. Okay but everyone does it. 5. He's doing it, we can't stop him, no point in complaining about it. 6. We all knew he was going to do it which... makes it okay somehow. 7. It's perfectly fine that's he's doing it. |
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7th March 2017, 08:46 PM | #733 |
Penultimate Amazing
Join Date: Apr 2011
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Do you really believe this?? This is so different from my own experiences and those of my family, friends, and acquaintances that you and I must be on different planets! The vast majority of the people I know desperately resist seeing seeking medical help! They hope against hope that they will get better on their own, and only make a doctor's appointment if driven to it by fear or when they become so ill that they come to believe that they have no alternative. Sure- most of their conditions are not "life-threatening" at the time they first see the doctor but they almost always impact significantly on quality of life. And many of even these conditions, if allowed to progress untreated, can worsen into much more serious, and yes, life-threatening diseases. I've had a common cold that, because I resisted seeing a doctor for something so trivial, progressed to pneumonia and came close to killing me. My sister put off a minor surgery because the problem wasn't too serious- until it suddenly impaired her breathing and she was hospitalized close to death for a month! Friends who were saved from blindness because they saw a doctor when their symptoms progressed enough to scare them into doing so when their condition was still reversible. I could name example after example.
Most people do not like going to doctors- it makes them nervous, they have to take time off work and/or other obligations, they have to find some way to get to the doctor, they then find themselves waiting and waiting in a room with lots of other sick people, and yes, it does cost them significant money even if they have insurance (if only as a co-pay). Virtually no one I know wouldn't prefer to do almost anything else. You present it as if most people seeking doctors are seeking trivial medical interventions: cosmetic surgery perhaps, or perhaps hand-holding! Or are you setting an amazing high standard for "quality of life?" Are you proposing that kids with serious respiratory infections, adults in real pain, old people with multiple health issues that limit their day to day lives should either be able to fork over the dough or just buck up and suffer in silence if they are anything less than close to death? Apparently only wealthy people are allowed in your world view to "simply feel good" physically whereas poorer people have no such right unless they are actually crippled or dying. This has been tried before- look at Victorian England. I don't think it worked out too well for individuals or for society as a whole. |
7th March 2017, 08:48 PM | #734 |
Penultimate Amazing
Join Date: Feb 2006
Posts: 29,167
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You mean OTCs? Ever wonder what prescription aspirin would cost?
A good reason not to have a "free market" for healthcare isn't because of cost considerations, but because we don't want nefarious doctors having too easy a time stealing from the rest of us. We want them to be licensed and regulated. Oversight means regulation and restricts the market. What isn't obvious is how far the regulations ought to go. |
7th March 2017, 08:55 PM | #735 |
Penultimate Amazing
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We can look at some data: https://www.washingtonpost.com/news/...ription-drugs/
"Nearly 3 in 5 American adults take a prescription drug, up markedly since 2000 because of much higher use of almost every type of medication, including antidepressants and treatments for high cholesterol and diabetes. In a study published Tuesday in the Journal of the American Medical Association, researchers found that the prevalence of prescription drug use among people 20 and older had risen to 59 percent in 2012 from 51 percent just a dozen years earlier. During the same period, the percentage of people taking five or more prescription drugs nearly doubled, to 15 percent from 8 percent." Or this: http://www.cnbc.com/2016/04/27/ameri...id-supply.html "Americans are in more pain than any other population around the world. At least, that's the conclusion that can be drawn from one startling number from recent years: Approximately 80 percent of the global opioid supply is consumed in the United States." How old are your friends and family? Maybe they haven't yet gotten on the healthcare bus - or they don't have the type of insurance that pays for it. ETA: More stats from the CDC: https://www.cdc.gov/nchs/fastats/dru...herapeutic.htm |
7th March 2017, 09:00 PM | #736 |
Philosopher
Join Date: Dec 2007
Location: Colorado
Posts: 6,248
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No. Members of Congress, Senators and their staff are required to have insurance just like most legal US residents. A clause in the ACA requires them to choose from the policies available to any DC resident on the healthcare exchange. The government pays about 80% of the premium and they pay the rest.
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7th March 2017, 09:16 PM | #737 |
Penultimate Amazing
Join Date: Jul 2011
Posts: 12,511
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The GOP plan is a step away from pools, not toward them. Without the individual mandate there is no UHC. The mandate was a conservative idea, but the GOP has been forced to disown it because they could not stand seeing it pressed into service by Democrats. It looks like we're back to a free rider/take your chances system.
The tax credit does not appear to be broadly means-tested (I could be wrong). Under the ACA subsidies were means-tested by way of federal tax returns. I get back some of what I pay; I think people can also pre-qualify to have it taken off their insurance premium. With most Americans covered through work or by Medicare/Medicaid/VA etc., they are part of pools that can negotiate prices through volume. Will individuals have the same bargaining power? I doubt it. A small thing is bothering me. My mom's provider said a liver enzyme was high and she needed another blood test. If it's still inflated Medicare will pay for an ultrasound. But today, before the 2nd blood draw, the ultrasound clinic was trying to get her scheduled. So it sounds like the clinic is doing it on spec, which it would only be doing if it has surplus imaging capacity (idle machine and/or staff). Meanwhile, also today, my aunt said her husband needs an MRI of his brain and she has to pay $200. I asked what they were going to do with that information and she didn't know. Both my aunt's and my mom's case came up in a single day. Just a coincidence, but imaging has been cited as a major factor driving up U.S. health-care costs. |
7th March 2017, 09:23 PM | #738 |
Graduate Poster
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Posts: 1,657
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Bah, Yelp will keep doctors honest. The modern medical licensing scheme predated the internet. Nowadays, bad actors could be outed and customers could choose the best available fellow in their price range. The only drugs that even need to be prescription-only are antibiotics. Let people buy their Viagra and Oxy at the gas station instead of that gentleman lurking around behind the gas station. Health care costs would plummet in short order. Doctors would compete like fast food stores for customers. Nothing could possibly go wrong.
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7th March 2017, 09:29 PM | #739 |
Penultimate Amazing
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7th March 2017, 09:58 PM | #740 |
Penultimate Amazing
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1. He'd never do that. 2. Okay but he's not currently doing it. 3. Okay but he's not currently technically doing it. 4. Okay but everyone does it. 5. He's doing it, we can't stop him, no point in complaining about it. 6. We all knew he was going to do it which... makes it okay somehow. 7. It's perfectly fine that's he's doing it. |
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7th March 2017, 10:13 PM | #741 |
Nasty Woman
Join Date: Feb 2005
Posts: 96,386
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No not OTCs! Not to mention aspirin is as cheap as dirt and is not a problem that I'm aware of (excluding the years the industry resisted proper hazard labeling so that manufactures could make 5 more years of profit at the cost of hundreds of needless deaths from Reyes Syndrome, but selling science doubt is another issue).
Just as I thought, you prove you don't know what you are talking about nor have you considered actual issues with the free market. Allow me to repost my very simple examples. Maybe this time you'll actually read past the first line in my post. I'm not holding my breath. The uninsured get emergency care and leave the hospital with bad debt that paying consumers end up paying. |
7th March 2017, 10:34 PM | #742 |
Penultimate Amazing
Join Date: Feb 2006
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I am not arguing for a free market solution to healthcare costs in the US. If you think I am, you have misunderstood something.
Quote:
What you are missing is that we can choose those downsides. That's really all I was talking about - the way we run healthcare is a choice, we are not forced to act in some particular way. Here is perhaps a less contentious choice: Allow nurse practitioners and physicians assistants more privileges and allow doctors to supervise more of each in a distributed system to lower labor costs. That's a choice we can make, but only with the condition that the choosers (John Q Public) understand the consequences, both good and bad. |
7th March 2017, 11:01 PM | #743 |
Graduate Poster
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Oh, absolutely. To treat the subject a bit more seriously than I did before, I think we'd see significant levels of self-regulation by the medical service provider community and a quasi-regulatory role for the insurance industry. For health care providers, we'd probably wind up with a multi-tier system. Something like: 1) Accredited - people with some kind of certification very similar to what health care providers have today; 2) Unaccredited - people with widely varying skill sets and education levels who would be able to effectively treat some basic ailments but would be a risky and cheaper choice for people with more serious or less common problems; 3) Wildcats - guy in a van with some gear he bought off eBay who totally doesn't think this looks that hard. The pharmaceutical sales market would just go buckwild and that could create some serious problems.
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7th March 2017, 11:15 PM | #744 |
Nasty Woman
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Let's start here. Cost is only one issue of many. Your tunnel vision is not doing you any favors.
The choice you are stuck on has already been made. Nurse practitioners fought that battle in the 70s and 80s. I know, I am a nurse practitioner. As for, 'always been run that way', we used to take lots of tonsils out until we discovered evidence based medicine. Take a breath, forget market driven costs and either look again at the issues I pointed out, or stop wasting my time with your tunnel vision. |
7th March 2017, 11:15 PM | #745 |
Penultimate Amazing
Join Date: Apr 2011
Posts: 17,646
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And what is your evidence that this prescription drug use is mostly inconsequential and of no significant benefit to most of the users. One reason for increased drug use is that there are more drugs that can help people. Or even more important what is your evidence that imposing a financial test is the best way to differentiate between those obtaining important benefits versus those not? That how much money one has is more important than the judgement of the FDA and the practicing physicians in terms of who can benefit from a prescription drug?
Sure I see the TV ads too and there are efforts by drug companies to increase the use of their drugs even when not necessary. But shouldn't that logically be dealt with by increased oversight and regulation, rather than "free market? ". Why assume that the ability to afford a drug reflects the need for it? Is that legal opioid use? And if so, just how much of the total cost of health care does that represent? In terms of age, the people I refer to do have good health insurance and are mostly middle age to seniors. The young people I know use health care even less. |
7th March 2017, 11:51 PM | #746 |
Lackey
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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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8th March 2017, 12:00 AM | #747 |
Penultimate Amazing
Join Date: Feb 2006
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My contention was that decoupling payment from services in a consumer-driven environment leads to increased use, in contrast to your experience where people avoided going to the doctor. The data I had handy was about increased consumption in the US - that's all.
I think the disconnect came because either the people you knew were exceptions to the general trend, or because you were thinking by "healthcare" I only meant time spent at the doctor's office or hospital. But I am also including the continuing use of prescription medications, for which I think the US does have an appetite. None of this has to do with whether or not we are taking the "right" number of pills. That would require demonstrating an outcome that differs based on how much medication we (as a society) take. What I don't think is disputed is that the cost of pharmaceuticals (and hence treatment with pharmaceuticals) has, and continues, to rise - sometimes dramatically. |
8th March 2017, 12:20 AM | #748 |
Penultimate Amazing
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The main choice is whether or not to pay for healthcare or forego it and keep the money. In the US, we pay part of the cost (co-pays/deductables) even though having insurance is mandatory. I believe the NHS in the UK is funded by tax dollars whether or not someone uses it and they don't recover costs by not seeking treatment. (I'm not under the NHS and don't know it very well.)
Here's an example of how it might differ. There is some dispute about whether or not senior citizens should take cholesterol reducing drugs. If you only have a few years to live, why bother? So I'm 70, 75, or 80... If I pay, I probably would rather not and stop taking the drugs. If I pay partially, it might depend on the cost and my income. If I pay nothing, I might take them "just in case." That's the choice matrix - the idea that healthcare decisions, and the associated costs, don't happen in a vacuum and aren't so easy to put on the better-to-best scale. |
8th March 2017, 01:06 AM | #749 |
Lackey
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But you have never had that choice (at least in recent times) since you have your various "medi-" systems and such areas as emergency healthcare has always been provided to everyone even those that can't pay for it. And as far as I understand it the new system will not remove all that "free" healthcare so those costs will still have to be paid.
Because evidence based medicine has made huge strides in the last couple of decades it is rather a straightforward matter of evidence sifting (granted often that isn't easy) - to put treatments on the "better-to-best" scale. The UK only has one "better than most" feature left as part of its healthcare systems and that is NICE. |
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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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8th March 2017, 01:09 AM | #750 |
Non credunt, semper verificare
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Firstly this is an aggregate and tells nothing about the situation of various "class" of people.
And it here clearly spells out that in some case insurance status PLAY a role into getting a prescription
Quote:
Thirdly note this is about prescription drug, not visit to the hospital or visit to a specialist. When my US friends complain about healthcare cost, it is usually not about most prescription drugs, but rather treatment to real illness or accident which are extremely costly with often a high copay. Hospital being the number one culprit. And then there is stuff like heart operation and similar. How many people do you think would not be bankrupted by one if they had to pay the real cost ? |
8th March 2017, 01:28 AM | #751 |
post-pre-born
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I agree that giving PAs more initial screening and assessment responsibilities is a good idea. However, your last point is unrealistic. Fully 20% of adult Americans think the sun revolves around the Earth. 40% think angels are real beings. At one point more than 50% of Republicans believed that global warming was a hoax. These, and countless other statistics, indicate that for good health care outcomes as a nation, we cannot assume John Q. can understand the consequences of their decisions.
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8th March 2017, 01:34 AM | #752 |
Penultimate Amazing
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I have that choice now. I think we must be talking about two different things. Right now, under Obamacare, I can get my toenail fungus treated by seeing a podiatrist (free) and getting two prescriptions ($8 each copay x 3 months supply = ~$32) and the travel costs. OR, I can buy an OTC treatment for about $14. OR I can just live with fungus and some homecare until it eventually goes away (hopefully). So there's a choice element and a price coercion, coupled with my beliefs about which is the best treatment in my situation.
Quote:
http://www.donaldmiller.com/Real_Wor...d_Medicine.pdf http://www.cmaj.ca/content/163/7/837.full.pdf |
8th March 2017, 01:35 AM | #753 |
post-pre-born
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That highlight part says increased drug use went up less than 1% per year. Zowie! Katy, bar the door.
I'd guess that in an aging population like in the USA going through the latter stages of a baby boom, the percentage of old people went up more than 1%. That statistic you cited is underwhelming, to say the least. |
8th March 2017, 01:43 AM | #754 |
Penultimate Amazing
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8th March 2017, 01:48 AM | #755 |
Penultimate Amazing
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Are you assuming that older people should be taking more medication as a matter of course? Why?
But to your point, here is a graph showing the median age in the us. Look at the years from 2000 to 2015 to see if your point stands: https://www.statista.com/statistics/...us-population/ |
8th March 2017, 01:57 AM | #756 |
Lackey
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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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8th March 2017, 02:44 AM | #757 |
Penultimate Amazing
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Posts: 29,167
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The incentives are different. Under the NHS and free care, it costs me the same amount whether I get professional care or not. Under Obamacare, some options cost me more than others. Under the newly proposed system (Trumpcare?) the costs may be hugely different.
So yes, in a sense I have the same options, but there are different incentives pushing me toward one option over another. Income also has an influence - I might not see much difference between spending $32 and $14, or that may be meaningful if I'm poor enough. (Also, I'm assuming the NHS is free, but I'm not very familiar with it.) |
8th March 2017, 03:45 AM | #758 |
Muse
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Treatment under the NHS is pretty much free at the point of demand. No one with a debilitating condition or suddenly suffering a major accident would be faced with a sudden crippling demand for money at a crisis point in their lives. In Scotland and Wales even prescription drugs are free, the logic being that it costs more to have a bureaucratic system in place to administer the payments for drugs than to allow free access to necessary medicines. It is far from a prefect system, but it works for the most part and is something the vast majority of people in the UK feel strongly about protecting.
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I was not; I have been; I am not; I am content - Epicurus When you're dead you don't know that you're dead, all the pain is felt by others....................the same thing happens when you're stupid. |
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8th March 2017, 04:46 AM | #759 |
Orthogonal Vector
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Exactly the poor need to be left to die from easily treated issues. When will people learn that important foundation of libertain health care and when will our politicians just answer with "well in that situation if you can not afford the $1500 a month medication you die".
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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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8th March 2017, 04:48 AM | #760 |
Orthogonal Vector
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Posts: 53,184
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No it will not apply to the elected officials. Trump voters many of them felt that he couldn't possibly do anything to remove their health care no matter how much he campaigned on it.
The people actually voting on it are safe, the people who voted for them will by what ever propaganda blames the democrats for their loss of coverage. |
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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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