mykeystrokes.com

"Do or Do not. There is no try."

“The Death Panels Are Coming”: Conservatives Are Going To Have To Turn Somewhere, And I’m Guessing “Rationing” Will Be On Their Lips

Now that Healthcare.gov seems to be working reasonably well (at least on the consumer end), Republicans are going to have to find something else they can focus on in their endless war against the Affordable Care Act. So get ready for the return of “death panels.”

They never really went away. Those who aren’t immersed in the fantasy world in which conservatives move were reminded of that last week, when chronicler of changed games Mark Halperin, the embodiment of most everything that’s wrong with contemporary political journalism, did an interview with the conservative news organization Newsmax. When the interviewer mentioned “death panels, which will be coming,” Halperin responded, “I agree, it’s going to be a huge issue, and that’s something else about which the President was not fully forthcoming and straightforward.” Halperin didn’t explain what lie he imagines Obama told about death panels (perhaps he thinks that when Obama said the government wouldn’t declare your grandmother unfit to live and have her murdered, he wasn’t telling the truth), but what matters isn’t Halperin’s own ignorance of the law (after all, understanding policy is for nerds, right?), but the fact that it came up in the first place. Which, if you pay attention to places like Newsmax, it still does. A lot.

But wait, you say. Wasn’t this all debunked years ago? Yes, it certainly was. But why should that matter?

It’s important to remember the switcheroo conservatives pulled on the “death panel” issue. They started off complaining that one provision in the law constituted “death panels,” then when their unequivocal lie was exposed and condemned roundly even by neutral observers, they switched to asserting that all along they had been talking about an entirely separate and unrelated provision, and when they say “death panels” they aren’t talking about death, or panels for that matter, but about health care “rationing.”

Here’s how it happened. The ACA originally included a provision allowing doctors to get reimbursed by Medicare for sessions in which they counseled their patients about their end-of-life options and how to make sure their wishes were properly carried out. The problem is that most of the time, when a patient shows up in the hospital in crisis, the staff has no idea what the patient wants if they can’t communicate. Do they want to be resuscitated, or intubated, or have every heroic measure taken until the moment they expire? All of us have different ideas about this, and it’s important that we think about it beforehand. So the ACA said, if a doctor spends a half hour talking to a patient about it, they’ll be paid for their time. It didn’t say what they had to tell them, it just said they could get paid for doing it, because right now if they do that counseling, they’re doing it for free, which makes it much less likely to occur, which is not only bad for the system but bad for individual patients.

So that part of the law said simply that doctors can bill Medicare for the time they spend doing that kind of counseling, just like they do for a physical exam or performing a procedure. To the people who supported it, the idea seemed commonsensical. Wouldn’t you want doctors and patients to have those kinds of conversations? You’d think. But turning that into the “death panel” lie began, as a remarkable number of health care lies have in the last couple of decades, with policy fraudster Betsy McCaughey, who went on Fred Thompson’s radio show in 2009 while the law was being debated and told his listeners, “Congress would make it mandatory—absolutely require—that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner.” That would be terrible! It would also be terrible if our beloved elders were then hurled from hot air balloons hovering over volcanoes, but the law doesn’t require that either.

Unlike most deceptions in politics, which can be justified by pleading that there was some misinterpretation of ambiguous language, or that what the speaker meant just got garbled in the articulation, this was a clear and specific lie—or two lies, in truth—that McCaughey simply made up in her attempt to subvert the law and then repeated multiple times. There was nothing mandatory or required about counseling, every five years or ever, for any patient, and the counseling was not about “how to end their life sooner.”

To continue our story, then Sarah Palin took things the next step, turning a blatant lie (but at least one with some connection to what the law was about) and spinning it out into an extravagant fantasy one can only imagine came from some obscure 1970’s dystopian sci-fi movie she saw at four in the afternoon one day while the snow fell gently in Wasilla. “The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s ‘death panel,'” she wrote on her Facebook page, “so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care. Such a system is downright evil.” 11 The quotation marks were a nice touch, since we in the English-speaking world use them to denote actual quotes from a specific person or document, not just something you make up. For instance, I could write, “I wouldn’t like to go to Sarah Palin’s house, where ‘heroin is given to children’ and ‘homeless men are hunted for sport.'” But that would be extremely misleading, since as far as I know, no one has said those things about Sarah Palin’s house, least of all Palin herself. And thus “death panels” were born.

And of course, the charge was picked up by Fox News, and Rush Limbaugh, and all the other far-flung outlets of the conservative media universe. But then the existence of any such panel was debunked and debunked and debunked again. The fact that the evocative phrase originated with Palin probably made it more difficult for conservatives to make it stick beyond their own self-contained world, since Palin is widely understood to be one of America’s most celebrated nincompoops. In addition, cowardly Democrats removed the provision on end-of-life counseling from the bill (to their unending shame) so even the entirely worthy provision of the law was gone. In response, conservatives cast about, and decided that the “death panels” they so feverishly warned of never referred to end-of-life counseling, but to the Independent Payment Advisory Board (IPAB), which did end up in the final bill and which has the benefit of resembling an actual panel.

In brief: the IPAB is a group of 15 health-care experts appointed by the president and confirmed by the Senate who will make recommendations on how Medicare could save money. Those recommendations are due at the beginning of each year, and Congress has until August to overrule them. If Congress doesn’t, the Secretary of Health and Human Services will implement the recommendations. But the IPAB only makes the recommendations if Medicare’s growth exceeds certain target rates.

Now listen to this part carefully: the text of the ACA prohibits the IPAB from recommending that care be rationed. It also prohibits them from recommending other things, like increasing premiums or cutting benefits. And perhaps most importantly, if Medicare’s growth is modest, IPAB won’t make any recommendations at all. And if things go the way they’ve been going and the way they will if many of the other reforms contained within the ACA succeed (including steps to transition from a purely fee-for-service model in which sicker patients means more revenue for providers to one in which they have incentives to keep people healthy), the IPAB might never have to make cost-cutting recommendations. Although things could change of course, the Congressional Budget Office believes that for the next decade Medicare’s growth is unlikely to be large enough to trigger any IPAB recommendations.

You may wonder why conservatives, who are constantly saying we need to control the cost of Medicare, are so vehemently opposed to the existence of a panel of experts whose job it is to come up with ways to control the cost of Medicare. That just shows how little you understand. IPAB, they will tell you, will ration care, which will kill your grandmother, no matter what the law says. 22These kinds of claims, and a general feeling of hysteria around end-of-life issues, circulates relentlessly throughout the conservative world. You may remember that during the 2012 presidential primaries, Rick Santorum told an audience that in the Netherlands, which has a tightly regulated system of physician-assisted suicide, “people wear different bracelets if they are elderly. And the bracelet is: ‘Do not euthanize me.’ Because they have voluntary euthanasia in the Netherlands but half of the people who are euthanized—ten percent of all deaths in the Netherlands—half of those people are euthanized involuntarily at hospitals because they are older and sick.” This was about as true as if he had said that all Portugese people have ESP or that Mongolia is ruled by a parliament made up of dogs and cats. But he didn’t get his fantasy bracelets and fantasy statistics from nowhere—the idea surely arrived to him via the cretinous version of the “telephone” game that is the conservative information bubble, where such things circulate and mutate until they come out the mouths of candidates for president. Just as a for instance, go on over to National Review and search for IPAB, and you come up with articles with titles like, “AARP Betrays Seniors By Supporting IPAB,” and “IPAB, Obama, and Socialism,” and “New England Journal of Medicine Supports Unamerican Expansion of IPAB.” As I said, once they can no longer complain about healthcare.gov, and once those people who had their junk insurance cancelled turn out to be getting much better insurance, conservatives are going to have to turn somewhere, and I’m guessing “rationing” will be on all their lips.

So what started as “Obama is forcing doctors to encourage their patients to die,” then became “Obama’s death panel will assess individuals one by one and withhold treatment from those they find unworthy, leaving people like Sarah Palin’s kid to plead for their very lives,” ends up as “Obama’s IPAB death panel will force health-care rationing on us.”

I do think that the chances that renewing the “death panel” scare will successfully undermine the ACA are slim. The fact that they don’t exist does matter. If you’re a reporter wanting to write a story about someone who lost their junk insurance and will have to buy real coverage, at least there are individuals you can focus on, even if you do a poor job of telling their stories. But there’s no one you can interview who went before a death panel, or whose relative went before a death panel. Because, to repeat myself, they don’t exist. So this whole discussion is likely to remain very abstract. Eventually, conservatives will find something else to cry wolf about. Did you know that under Obamacare, if you kiss a person with herpes, you could get herpes? That’s right: Obamacare will give you herpes. Pass it on.

By: Paul Waldman, Contributing Editor, The American Prospect, December 2, 2013

December 3, 2013 Posted by | Affordable Care Act, Obamacare, Republicans | , , , , , , | Leave a comment

“No, The World Didn’t End”: Maybe We’ll All Survive After All

I’m a bit amused at some of the articles dribbling out of Washington at present that find various silver linings for the demise of the filibuster against executive-branch and lower-court-judicial appointments. I mean, we all know it Killed the Senate As We Know It, at which act the angels are still weeping, and it spoiled the great and dignified work of the “gangs” cutting ad hoc deals to avoid this or that filibuster. I know it’s hard to imagine anything that would significantly offset such terrible damage–what will Lindsey Graham do between primary challenges?–but The Hill‘s Elise Viebeck finds one that has the added bonus of giving Republicans a trophy to mount on its wall:

Kathleen Sebelius may become the biggest loser in the Senate’s approval of filibuster reform.

The Health and Human Services (HHS) secretary has kept her job despite the botched rollout of ObamaCare’s insurance exchanges, but it will now be easier for Obama to replace her.

After the Senate’s vote, confirming an executive-branch nominee now takes just 51 Senate votes. Some think that raises the likelihood Sebelius will soon be a former Cabinet member.

“The president’s hands were previously tied,” said John Hudak, a fellow in governance studies at the Brookings Institution, who wrote a piece on the topic Thursday.

“Now, he has more breathing room and he is able to fire whoever he wants at HHS. That’s a very, very appealing approach, whether it fixes the problems with ObamaCare’s rollout or not.”

Better yet, Democrats can approve appointments to the Obamacare Death Panel without Republicans getting their hands dirty with complicity in genocide.

The filibuster vote could also make it easier for Obama to fill the healthcare law’s controversial cost-cutting board, another big advantage for the president.

Known as IPAB, the panel has no members yet is meant to submit its first proposed cuts in January. Any nominees from Obama require Senate confirmation, which is now an easier prospect.

Before Thursday’s vote, Obama’s nominees needed 60 votes to survive procedural motions. Now they need 51.

And hey, maybe the nuclear option shattered the deal-making dreams of “moderate” Republicans, but it might help keep some Democratic “centrists” in the Senate:

Beyond helping Obama, the change could make life easier for some of the Senate Democrats who face tough reelection contests in 2014. The chamber is controlled by 53 Democrats and two Independents who caucus with the majority party.

“Obama now has breathing room among Democrats,” Hudak said.

“He can actually let some of the Democrats who are in tough races off the hook, which has some real electoral implications for those members.”

So see? Maybe we’ll all survive after all.

 

By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, November 25, 2013

November 26, 2013 Posted by | Filibuster, Senate | , , , , , , , | Leave a comment

“The Myth Of Obamacare’s Bad Sales Job”: The Complexity Makes It Easy For Republicans To Lie To The Public

When they went forward with their plan to shut down the government in order to undo, defund, or otherwise undermine the Affordable Care Act (ACA), conservatives convinced themselves that their plan was going to work because Americans hate Obamacare. If you look at it in an extremely narrow, context-free way, that’s sort of true. If you just ask people whether they approve of the ACA, you get between 35 percent and 45 percent approval. But the closer you look, the more complicated it gets. Some people disapprove of it because they feel it didn’t go far enough; add them with those who say they approve, and you’ll get a majority. Furthermore, and most critical for what I’d like to discuss, the actual components of the law, like giving people subsidies to buy insurance, outlawing denials for pre-existing conditions, and so on, are extremely popular (the one exception is the individual mandate).

One thing’s for sure, though: You can’t say that the ACA as an abstract entity is overwhelmingly popular. That has led a lot of liberals to blame Barack Obama for doing a bad job selling the law. I must have heard or read this from a hundred liberals over the last couple of years. If only he had sold it better! Then we wouldn’t be in this mess. Sometimes, I’ve actually heard people say that he never really tried to sell it.

This argument is complete bunk. Here’s why.

1. Obama did sell it. When somebody says that Obama should have sold the ACA better, you should ask them what, specifically, they think he should have done. I can offer you a stone-cold guarantee that whatever they suggest is something that the administration and its allies did, in fact, do. Take polls to figure out what appeals would be effective? Check. Distribute talking points to their allies to get everyone repeating the same message? Check. Make one speech after another on health care? Check. Run ads touting reform? Check. They did it all. So why didn’t it work?

2. Health insurance is inherently complicated. See if you can answer these questions about your own health insurance. What’s your co-pay for office visits? What’s your deductible? What about cost-sharing for hospital admissions? Your yearly out-of-pocket maximum? Does your policy have a lifetime limit? My guess is you couldn’t answer some or all of these questions, and that only scratches the surface of the contract you signed when you got insurance. Did you read it? You probably skimmed it but didn’t bother to go through it line by line, just like you did the last time you downloaded a piece of software. Health insurance is incredibly complicated. Even people whose job it is to deal with health policy don’t always understand their own insurance.

That means that any comprehensive reform that tried to address the pathologies of the system was going to have a hard time even explaining to people what was wrong with that system. And those pathologies are so numerous that the administration had to discuss multiple things, while the opposition only had to say that Obamacare sucks. We’ll get to that opposition in a moment, but first:

3. The Affordable Care Act was an extremely complicated bill. I discussed this in my column last week, but the ACA is a gigantic kludge, a cobbled-together jumble of features each meant to solve a practical or political problem. The administration decided that the simple thing—Medicare for all—couldn’t succeed politically. They also decided that it was vital to be able to tell people, “If you like your current insurance, you can keep it.” They also had to keep conservative Democrats on board to get above the 60 votes necessary to defeat a Republican filibuster in the Senate. They also decided to co-opt the various interest groups like insurance companies, doctors, and hospitals that benefit from the current system, which required more complexity. They also decided that every penny of it was going to be paid for, which required new taxes and spending cuts. In and of themselves each of those decisions may have been reasonable, but they added up to a complex bill that was going to be difficult to explain, no matter how good their pollsters were and how effective a speaker the President is.

4. The American public is not particularly well informed or sophisticated when it comes to understanding policy. We don’t have to go into all the details here, but anybody who sets out on a project to explain something both new and complex to a public that doesn’t understand these things very well to begin with and doesn’t much care is going to be fighting an uphill battle.

5. They were facing an extraordinarily well-financed, united opposition that would say or do pretty much anything. All that complexity made it easy to just lie to the public about what the ACA does. When people hear about some new horror the ACA allegedly includes, many are ready to believe it, since it contains so many different things they already don’t understand. So conservatives could tell them that there are death panels, or that Obamacare forces doctors to collect information on your sex life, or that the IRS is going to have your medical records, or that Congress “exempted itself from Obamacare,” or whatever else they were able to dream up.

The opposition also had the benefit of being against something, which is always easier than being for something. We’re naturally more attuned to negative information than positive information, which is why it’s so easy to use fear to create opposition to a new policy, and change is always frightening. “You’re going to love this change!” is an inherently more difficult case to make than “Be afraid!”

Furthermore, the alliance opposing the law has virtually limitless resources at its disposal. Yesterday The New York Times published a revealing story on the network of conservative funders and activists that have made it their mission to destroy the ACA, including masterminding the current shutdown. Just one Koch brothers-linked organization no one has ever heard of called Freedom Partners Chamber of Commerce distributed an incredible $200 million last year alone to various groups fighting the ACA.

Let me close this discussion with a little historical reminder. In March of 1994, when the Clinton health-care reform was being debated, The Wall Street Journal published an article about polls and focus groups it had conducted on the plan. The article was titled “Many Don’t Realize It’s the Clinton Plan They Like,” and it detailed how, while majorities of the public expressed disapproval of Bill Clinton’s health-care plan, when its features were described to them without saying whose plan it was, majorities expressed approval of it. That’s exactly the same thing we find now with the ACA. The problem wasn’t that Barack Obama didn’t try hard enough to sell it.

Fortunately, the success of the law won’t depend on whether you can get a majority of the public to tell pollsters, “I approve of Obamacare.” Once it’s fully implemented, the only thing that will matter will be whether, in all its different component parts, it works.

 

By: Paul Waldman, Contributing Editor, The American Prospect, October 7, 2013

October 8, 2013 Posted by | Affordable Care Act, Health Reform | , , , , , , , | Leave a comment

“The MarcoPhone”: Marco Rubio’s Life Is About To Get Complicated

Marco Rubio has had a pretty charmed political life. He rose quickly through the ranks in the Florida legislature, won a Senate seat without too much trouble at the tender age of 39, then suddenly found himself the “Republican savior” a mere two years after arriving in Washington. At a time when the GOP is desperate to appeal to Latinos, he’s a young, smart, dynamic Latino who could be their presidential nominee in 2016. What could go wrong?

Immigration reform, that’s what. Many elite Republicans feel, and not without reason, that while supporting comprehensive reform might not win them the votes of Latinos, opposing it will pretty much guarantee that those votes will be lost to them. And Rubio almost has no choice but to be one of the leaders, if not the leader, of the party in that effort. He can’t be the Great Latino Hope if he isn’t. Trouble is, lots and lots of rank-and-file Republicans, particularly the kind who vote in presidential primaries, don’t much like reform the way it’s shaping up. Sure, under the “Gang of 8” plan in the Senate it’ll take 13 years for a current undocumented immigrant to become an American citizen. But for many in the party’s base, that’s about 113 years too quick. Enter the MarcoPhone. Wait, what? Get a load of this:

Conservative bloggers immediately seized on portions of the bill funding expanded cell phone access along the border as evidence Rubio was supplying free phones to undocumented immigrants. Some commentators connected it to the “Obama phone,” a popular meme on the right last year about a program that provides discounts on phone service to the poor. Despite the moniker, it predated the current administration by decades and rose to prominence last year mostly due to a viral video of a female black Obama supporter talking about the program.

Rubio himself was confronted with the claim on Wednesday in an interview with conservative talk show host Laura Ingraham, who quoted from a blog post that read “Move over Obama phone, this is the amnesty phone.”

The provision in question doesn’t give phones to undocumented immigrants, it gives phones to people who live on the border so they can call the Border Patrol if they see people crossing from Mexico. But as Ed Kilgore says, “I’m having trouble feeling bad for Rubio getting a taste of what it’s like to be on the receiving end of a Tea Party delusion.” It’ll certainly be an interesting test of Rubio’s and his team’s communication skills to see if they can squash this (they’re already trying).

What folks like Ingraham understand is that when you’re trying to gin up outrage about a big, complex piece of legislation, the way to do it is to find some component of the bill that is weighted with symbolic value and will hit directly on your target audience’s resentments and fears. It doesn’t matter how minor the provision is, or how much you need to distort its actual function and intent. All that matters is that it’ll get people pissed off.

“Death panels” was the prototypical example. It told people who feared increased government power and control that the Affordable Care Act would literally give heartless Washington bureaucrats the power to decide who lives and dies. It was not just a lie but an absurd lie, an insane lie. But it worked, at least well enough. Gun advocates who wanted to defeat the Manchin-Toomey background check proposal went around saying it included a “national gun registry,” despite the fact that the bill prohibited the government from ever making such a registry, because they knew that would play on the most paranoid fears of gun nuts who think that any moment the jackbooted AFT thugs are going to come busting down their door to confiscate their AR-15s. The MarcoPhone can function the same way. What does it tell people in the anti-immigrant portion of the GOP base? That a bunch if illegals aren’t just getting amnesty, they’re going to be getting freebies, paid for with your tax dollars!

If it isn’t nipped in the bud, this could be deadly for Rubio. His Tea Party credentials may be impeccable, but if he starts looking soft on the foreign horde to the south, a lot of Republican primary voters will start getting suspicious of him. It’s possible that now that it has been explained to them, people like Ingraham will back off, especially since the guy they’re attacking is one of their own. As long as they still consider him one of their own.

 

By: Paul Waldman, Contributing Editor, The American Prospect, April 18, 2013

 

April 19, 2013 Posted by | Politics | , , , , , , , , | Leave a comment

Medicare Saves Money: Ensuring Health Care At A Cost The Nation Can Afford

Every once in a while a politician comes up with an idea that’s so bad, so wrongheaded, that you’re almost grateful. For really bad ideas can help illustrate the extent to which policy discourse has gone off the rails.

And so it was with Senator Joseph Lieberman’s proposal, released last week, to raise the age for Medicare eligibility from 65 to 67.

Like Republicans who want to end Medicare as we know it and replace it with (grossly inadequate) insurance vouchers, Mr. Lieberman describes his proposal as a way to save Medicare. It wouldn’t actually do that. But more to the point, our goal shouldn’t be to “save Medicare,” whatever that means. It should be to ensure that Americans get the health care they need, at a cost the nation can afford.

And here’s what you need to know: Medicare actually saves money — a lot of money — compared with relying on private insurance companies. And this in turn means that pushing people out of Medicare, in addition to depriving many Americans of needed care, would almost surely end up increasing total health care costs.

The idea of Medicare as a money-saving program may seem hard to grasp. After all, hasn’t Medicare spending risen dramatically over time? Yes, it has: adjusting for overall inflation, Medicare spending per beneficiary rose more than 400 percent from 1969 to 2009.

But inflation-adjusted premiums on private health insurance rose more than 700 percent over the same period. So while it’s true that Medicare has done an inadequate job of controlling costs, the private sector has done much worse. And if we deny Medicare to 65- and 66-year-olds, we’ll be forcing them to get private insurance — if they can — that will cost much more than it would have cost to provide the same coverage through Medicare.

By the way, we have direct evidence about the higher costs of private insurance via the Medicare Advantage program, which allows Medicare beneficiaries to get their coverage through the private sector. This was supposed to save money; in fact, the program costs taxpayers substantially more per beneficiary than traditional Medicare.

And then there’s the international evidence. The United States has the most privatized health care system in the advanced world; it also has, by far, the most expensive care, without gaining any clear advantage in quality for all that spending. Health is one area in which the public sector consistently does a better job than the private sector at controlling costs.

Indeed, as the economist (and former Reagan adviser) Bruce Bartlett points out, high U.S. private spending on health care, compared with spending in other advanced countries, just about wipes out any benefit we might receive from our relatively low tax burden. So where’s the gain from pushing seniors out of an admittedly expensive system, Medicare, into even more expensive private health insurance?

Wait, it gets worse. Not every 65- or 66-year-old denied Medicare would be able to get private coverage — in fact, many would find themselves uninsured. So what would these seniors do?

Well, as the health economists Austin Frakt and Aaron Carroll document, right now Americans in their early 60s without health insurance routinely delay needed care, only to become very expensive Medicare recipients once they reach 65. This pattern would be even stronger and more destructive if Medicare eligibility were delayed. As a result, Mr. Frakt and Mr. Carroll suggest, Medicare spending might actually go up, not down, under Mr. Lieberman’s proposal.

O.K., the obvious question: If Medicare is so much better than private insurance, why didn’t the Affordable Care Act simply extend Medicare to cover everyone? The answer, of course, was interest-group politics: realistically, given the insurance industry’s power, Medicare for all wasn’t going to pass, so advocates of universal coverage, myself included, were willing to settle for half a loaf. But the fact that it seemed politically necessary to accept a second-best solution for younger Americans is no reason to start dismantling the superior system we already have for those 65 and over.

Now, none of what I have said should be taken as a reason to be complacent about rising health care costs. Both Medicare and private insurance will be unsustainable unless there are major cost-control efforts — the kind of efforts that are actually in the Affordable Care Act, and which Republicans demagogued with cries of “death panels.”

The point, however, is that privatizing health insurance for seniors, which is what Mr. Lieberman is in effect proposing — and which is the essence of the G.O.P. plan — hurts rather than helps the cause of cost control. If we really want to hold down costs, we should be seeking to offer Medicare-type programs to as many Americans as possible.

By: Paul Krugman, Op-Ed Columnist, The New York Times, June 12, 2011

June 13, 2011 Posted by | Affordable Care Act, Congress, Conservatives, Consumers, Economy, GOP, Government, Health Care, Health Care Costs, Health Reform, Ideologues, Ideology, Insurance Companies, Lawmakers, Medicare, Politics, Public Health, Republicans, Right Wing, Seniors, Single Payer, Under Insured, Uninsured | , , , , , , , , , , , , , | 1 Comment

%d bloggers like this: