Blogs Are Stupid

Doesn't anyone believe in Dear Diary anymore? What happened to the joy of putting actual pen to paper? And why does every ordinary Jane and John think they can write well enough to burden the world with their scribblings? It’s a mystery that badly needs solving. My first entry contains my thoughts about blogging and will set your expectations. The rest will probably be stream of consciousness garbage, much like you’ll find on any other blog. Perhaps we will both come away enlightened.

Wednesday, October 17, 2007

So About That Health Care Post....

(You know, the one I had planned to post the day of the dog attack?)

Some of you know that the health care crisis here in America is one of my hot button issues. I am fortunate that the drugs my children take are not necessary to sustain life. But they are necessary to maintain a certain quality of life.

At one point, we had to fight our insurance company tooth and nail to cover a twice daily dose of Strattera for our oldest son. This dose was arrived at through much trial and error, which was closely supervised by not one, but two doctors; his pediatrician and his psychiatrist.

And yet, our insurance company denied us coverage because the "standard" dose of Strattera is once daily. They would cover a once daily dose of 80mg, but they would not cover a twice daily dose of 40mg. OR, we could get 60 pills, but we would have to pay two copays. Does this make sense to you?

Well it makes perfect sense if the bottom line is your main priority.

And that's where the problem lies. Capitalism and Health Care are two entities whose interests are at cross purposes, and as such, creates a gross conflict of interest.

When you start talking about socialized medicine, people get nervous. And, you know what? I get that. I understand that people are nervous about putting decisions as personal and far reaching as those regarding our health, maybe our lives, into the hands of bureaurocrats. And I realize that socialized medicine is not the perfect solution to this problem.

But it is a solution.

Right now in the United States the percentage of uninsured Americans is at an all time high. Premiums are climbing and employer sponsored coverage is decreasing along with the number covered procedures, services and pharmaceuticals.

There are chronically ill people who are choosing between food and medicine. There are people with fatal illnesses who are having to choose life saving treatments over providing for their children, or vice versa.

And that is just wrong. That is worse than wrong. That's criminal.

According to this article, 1 in 10 cancer patients is unable to provide basic necessities for their families. 1 in 12 made the decision to delay or forego treatment because it was too costly.

How costly is too costly?

The prescription drug Zofran, which is an antiemetic, and sometimes the only thing that keeps cancer patients from wasting away to nothing during the numerous and brutal rounds of chemotherapy, costs $42 per pill. Per. Pill. Most cancer patients take it at 8 or 12 hour intervals in the days following chemotherapy.

Herceptin, a relatively new drug in the cancer arsenal, and one of the few that is effective against inflammatory breast cancer, costs $48,000 for the recommended year of treatment. Wholesale.

Avastin, which is primarily used to treat colorectal cancer can cost up to $50,000. If used to treat breast and lung cancer, the cost can double because of increased dosing needs.

Why are these drugs so costly??

Drug development is expensive and the companies developing them are not government sponsored. That means that they must foot the bill for development costs, testing, and marketing as well as turn a profit to keep shareholders happy.

See...it's that word "profit" that mucks everything up. It should never be about profit. It should be about keeping healthy people healthy and making sick people well. Period.

Most startling of all, there is currently no accountability holding these drug companies to ethical pricing practices. One company, Genentech, raised the price of their drug Tarceva by 30% when they realized it was more effective than preliminary testing indicated, and thus, more sought after by patients.

That's just one example among many of why healthcare costs are skyrocketing and more and more Americans are going without basic medical care. But it clearly illustrates why Capitalism and Health care should not be joint endeavors.

We won the fight regarding our son's medicine. Now we are fighting a different battle. Our insurance company only wants to cover 12 visits annually to Diminutive One's therapist. But she feels that for now, once weekly is optimum to track his progress, monitor his moods, (which can be affected by his medication) and make sure that he's not experiencing any co-morbid conditions, which are very common with these types of disorders.

So let's recap. Our son's doctor, who has a degree in psychology and who has specialized in this subset of disorders for 25 years, feels he should go weekly. But our insurance company, who has never met Diminutive One, nor reviewed his medical records, feels once a month is adequate.

But we are lucky. We can afford basic health care for our children. Well checks, vaccinations, office visits when they are sick, medicine when they need it and two tonsillectomies for different reasons, but both equally necessary. But they wouldn't have died without the tonsillectomies. They won't die without Strattera or Concerta. They won't get Tuberculosis, Measles, Mumps, Rubella, Whooping Cough, Polio or Scarlet Fever.

There are some people who cannot say the same for their children.

And that's why it makes me so freaking frustrated when people vote down bills like the Children's Health Care Bill.

I know socialized medicine is scary. Socialized anything is scary. And people are afraid bills like these are a foot in the door for governmental micromanaging of our health care choices. They see it as yet another freedom in danger of being curtailed.

But make no mistake...this is not just an issue for the poor or underprivileged. There are lots of families out there who would be devastated if they had to bankroll treatment for a life threatening disease, a debilitating accident, or a chronic illness.

Think about it. That's you and that's me.

But hey...you're doing well, right? You have a nice house, two cars, some luxuries like cable and internet and dinner out a few times a week. And you have some savings right? A couple hundred? One or two thousand? Five? Ten? Twenty?

If you had cancer you could blow through twenty thousand in a month. And then what?

You can't work. How do you pay your mortgage? How do you feed your kids? How do you keep the lights, gas and water turned on?

This is an issue that affects all of us. And it's not about giving up control because we never really had any anyway. It's about taking it away from the insurance and drug companies who are getting rich at our expense and putting it back into the hands of doctors.

Yes, there will be some red tape. There will be some micromanagement. There always is, isn't there? It's just a part of life.

But what's more important? Choice and convenience? Or coverage?

For some, any coverage is better than what they have now, which is, nothing. Maybe you can still afford your premiums and your increasing co-pays. I can, but it's getting harder and harder. Combined, our prescriptions cost around $240 a month. And we don't have many. That's one for each of the boys, Restasis and 2 migraine meds for me. The co-pay on the boys meds and my Restasis is $60.

The median household income in the United States is $46,326. Though we are a one income family, our income is substantially higher. And yet sometimes it's a struggle even for us.

But, we can give up family movie night. We can give up frappucinos and lunch out and lawn care service. We could go without pest control, but here in the South, I'd do almost anything to pay my beloved Orkin man. He's my saviour.

But a lot of people can't. For a lot of people, $240 a month would be simply impossible. And for a lot of people, there's simply nothing left to give up.

So...as I said, it's not a perfect solution, but it is a solution. Or at least, the beginnings of one. It's a foundation, if nothing else. A place to start.

And in the absence of anything else, I think it's our best bet for the 16.5% of Americans who are uninsured. That's roughly 37 million and it doesn't include those who are not naturalized citizens. We can add another 10 million right there.

And a whopping 9% of the uninsured are children.

Is that acceptable to you? Would it be if one of those children were your own?

For me? No contest.

20 Comments:

  • At 7:32 AM, Blogger Mimi aka pz5wjj said…

    I do believe there is room for improvement in the American Health Care system, however, having lived in the UK and with their socialized medicine system -- one that some people want to model after -- I can tell you it's a disaster.

    My FIL had a heart attack and was put on a waiting list for an angio -- one that he will never have as the wait list is years long. He's been taken off as he's now 80 and he will probably die before he gets one.

    When I had my son, I was told, "If you want a healthy meal in the hospital, have someone bring it to you." And then for dinner one night all I got was a small plate of mashed potatoes.

    My SIL's daughter has a chronic illness that has taken years to diagnose as they get shuffled between doctors and specialists with no continutity of care.

    I could go on with more examples. It sucks. However, if you live in the UK and have private insurance you're golden.

    So, is it worse to pay higher taxes for mediocre Health Care that you may never get or higher rates up front for better care?

    Now I realize that some people in the US can't afford Health Care, and the costs are outrageous. And I believe there could be a better way, but not socialized medicine.

    My sister has a medically fragile child who would actually be better off healthcare wise IF my sister could not afford healthcare.

    I think the answer is more to do with regulating health insurance companies that basically steal money from your pocket. Legalized gambling....

    Thank you for sharing -- it is an important issue and I think everyone who reads will have a different opinion! LOL!

     
  • At 7:37 AM, Blogger Terri said…

    A day or two ago I was talking with a Canadian friend of mine who lives here about the whole healthcare issue. Having grown up in Canada under socialized medicine and having lived here for six years without any insurance at all she has been on both sides of this issue. Interestingly, my friend is very opposed to socialized medicine, but did comment that what we had here in America was more like fascist healthcare controlled by private insurance companies.

    Personally, I think either extreme will inevitably have some dire consequences, but socialization of medicine with all of the red tape seems to be more equitable for all than the continued fascist control by indifferent insurance companies. However, I've always been wary of increasing government control of anything.

    Thanks for the thought provoking post on an important issue.

     
  • At 7:45 AM, Blogger Avalon said…

    BA~~~ Having worked in Healthcare for over 20 years, I also don't think that socialized medicine is the be-all, end-all answer in the US. I think accountability is. Accountability from the Drug companies, from the HMO's, from the *small* percentage of MD's worried about profits and kickbacks.

    However, having been a poor, single, young mother, there have been times that either my daughter or I have been uninsured. The worry consumed me every minute of the day that something devastating would happen and I wouldn't be able to afford the care. I probably would have been very happy to accept a socialized plan over nothing.

    No easy answers.

     
  • At 8:24 AM, Blogger URBAN PEDESTRIAN said…

    Health care is a #1 issue everywhere, even here in Canada. There is nothing scary about socialized health care. It's not the utopia it's made out to be, but it's not as scary as the American Insurance system. Yes, we have incredibly long waiting lists for non-emergency procedures and it's almost impossible to get a GP, let alone get to see a specialist, but if your life is in danger you'll get fixed up and it won't cost you. And, in my experience, for children, they'll bend over backwards. No waiting. Whatever a child needs, he/she will get whether you can afford it or not. Many drugs still have to be paid for unless you're under some medical plan through work or through social services. To me, the issue here is that we keep pumping money into band-aid medicine instead of preventative care. If we could figure a way to improve lifestyles and diets we'd go a long way in preventing many diseases. Also, something needs to be done about pharmaceutical companies -- but that's a whole other rant

     
  • At 8:25 AM, Blogger PunditMom said…

    This is a wonderful post -- not wonderful about the issues getting coverage, but pointing out how much our "system" needs to be fixed. What on earth would trained and experienced doctors the idea that they are more knowledgeable in prescribing treatment than the widgets that answer the phone and push the papers at Blue Cross/Blue Shield?

    I fear nothing will really change until we have leaders who have faced these situations personally.

     
  • At 8:36 AM, Blogger Megan said…

    As a Canadian-American, I can see both sides of this issue. I have to say that our system here in Canada is far from the ideal that many people would make it out to me.

    Doctor visits are free, sort of, if you don't mind waiting. Taxes are sky-high. Drugs are not covered by our national plan, so people need to buy private insurance.

    I really think that our biggest problem comes from the fact that all of this care is "free". When something's free, it has no value to anyone. (I've blogged about this at length, but that's it in a nutshell.)

    However, if you have a real emergency, you get into the ER right away with no waiting or questions.

     
  • At 8:46 AM, Anonymous cerebralmum said…

    I'm in Australia and I have to say, I really don't understand the attitude in the States to "socialised" medicine. Even the term seems like a bizarre hangover from the Cold War. I don't mean that as as a criticism - I mean I genuinely don't get it.

    Our healthcare system, like most countries, is far from perfect, but private healthcare exists alongside Medicare and people who can afford it have a choice but everyone covered.

    Sure, waiting lists for "elective" surgeries can sometimes be long, but surely it's a longer wait when there is no one to pay for it at all? And from what I hear in the news (which could be completely skewed, of course) the HMO's like the health of their bottom line more than the health of their "clients" and restrict access to diagnoses and treatments as much as they can.

    And sure, governments are pretty useless and not very trustworthy, but are corporations any more accountable? Maybe to their stockholders. Everyone is the government's stockholder. That's service for payments rendered, not socialism.

    Personally, I don't know what my situation would be like in the States. Like Avalon has been, I am currently a poor, single mother and my son was born with a cleft palate. That's audiology, and plastic surgeons, and ENT surgeons, and possibly years of speech therapy, and orthodontics, and an unknown number of further surgeries until he's fully grown. In this first year, I have spent 1 day in every 10 in a waiting room. Unlike Avalon, I have not had to worry about it all. And I shouldn't have to. I'm not a charity case. I paid my taxes for this.

    Access to healthcare is considered a human right in the Western world. If governments have a reason to exist at all, I would think meeting basic human rights standards should be at the top of their list. Otherwise, I want my money back.

     
  • At 8:48 AM, Blogger Amy York said…

    I agree.
    Why in the world... does health care need to be a "for profit" industry? Why? Who was smoking crack when they decided on that? Crazy, just crazy.

    I recently had a conversation with a Canadian doctor who is now working here as a doctor... and he was very adament... it's better there (re: the health care system). How could it not be?

    How do the proverbial "they" convince people that it is??

    So so frustrating to me...
    And like you, we are lucky. We have coverage... decently good coverage... and so far *(knock on wood)* no health problems.

     
  • At 8:59 AM, Anonymous Doug said…

    I too am fortunate enough to have decent insurance and the financial means to deal with the unexpected (for now anyway).

    There were several comments stating "why" the drug makers insurance providers need to be for profit. The bottom line, whether you like it or not is that these are businesses and the push for profits is at an all time high. It's all about the buck.

    If there weren't the incentives for large profits do you really think drug companies would do all the research, development and trials (all of which are risky ventures if they don't work)? Hey I'd do something much less risky myself, but then I'm not a big gambling man.

     
  • At 9:33 AM, Anonymous Anonymous said…

    It sucks. And as embarrassed as I am to admit it, following divorce, I let my health insurance lapse because I couldn't afford it. Most people would say "how can you afford NOT to have it?" but when money is tight, it's tight. I never would have imagined my princess life collapsing into financial despair in so little time. I hope that I don't get sick before I can get coverage again. My kids, thank God, are taken care of, but who takes care of Mom?

     
  • At 10:06 AM, Blogger Beth said…

    I agree with you - as a cancer survivor who made over $100,000 a year - I almost had to declare bankruptcy after my treatment because my portion of the bill left over was 285,000. I guess my life was worth that - but why was it so much? Wasn't I under enough strain without worrying about how I was going to pay to stay alive?

     
  • At 10:30 AM, Blogger Natalie said…

    I think there should be some kind of middle ground. I think that it is inexcusable that people are out there without health care. At the same time, if you can afford to have private insurance or can get it through work I think you should. However, there needs to be an option.

    During the three months after I graduated from college and was off my parents insurance and the time i got a job and had my own I broke my elbow. It should have gotten surgery and pins but because I didn't have insurance and the break was set well the Dr. wouldn't do it. It is pretty normal at this point (after physical therapy that we had to pay for out of pocket) but I only have about 90% range of motion in the joint. If I had the surgery I would probably be able to touch my hand to my shoulder.

     
  • At 12:49 PM, Blogger margalit said…

    I totally agree with you. I've got a lot of points to add, too. I've lived in the UK, and have dealt extensively with the healthcare system there. When my ex-stepson was born, he was 3.5 months premature, and spent many months in Westminster Children's Hospital in London, where he got magnificent care, all of it under NHS. I also used NHS for my chronic heart disease and never had a problem. I made appointments, I saw doctors, I got treatment. No waiting.

    However, in Boston right now, 20,000 women share ONE mammogram machine, and the wait time can be MONTHS for a mammogram, even if you have a suspicious lump. That's RIDICULOUS. We have more hospitals than anywhere in this country and yet women can't get proper health care right here in Boston.

    Because of my heart disease, I had to stop working. My 160K/year job disappeared, I blew through my full year of savings, my 401K and my kid's college funds just trying to make it day to day. I live on SSDI. Did you know that when you go on SSDI, you are REQUIRED by law to go without health insurance for a year? From the day you file for SSDI till a year later, you are required to be uninsured. Had I not have had free care at the hospital I frequent, I would have about $5K/month in medication costs, plus two hospital stays at $28K and $15K. What sense does this make, requiring a DISABLED person to go without insurance for a year? It's insane. And yes, I called my congressional reps, who did research and yes, that's the law.

    The dirty secret in the US is that our health care is inadequate even for people WITH health ins. The insurers can change their formularies monthly, so that a medication you have been on for years may no longer be covered. They cover procedures and then refuse them. They decide ONLY on the bottom line and how they can make as much money as possible without allowing their clients to get medical intervention. They are the most crooked companies in the US, and yet they are allowed to continue to screw their clients and make exhorbinent profits because people are so afraid of government intervention in health care.

    Well, I live in Massachusetts, and we are required to have health care coverage now. As of Nov 1, anyone without health care coverage is breaking the law. I don't particularly love dealing with the agency that provides health care for children in MA, MassHealth, as they hire the most dimwitted morons ever, but the fact is, my kid's prescriptions are FREE, their health care is FREE, and our premium is $24/month per kid. For me, that's a LOT of money, but so worth it. All hospitalizations are covered. All therapy is covered. All psychiatric visits covered. All PT and OT covered. This is the RIGHT way to deal with health care. But unless people in the US stop listening to the grumbling Canadians who just DO NOT GET what it means to lose your home over health care costs, we're all going to be stuck in the same uninsured or underinsured bucket. And it sucks.

     
  • At 12:49 PM, Anonymous Anonymous said…

    I agree with the comment made by cerebalmom. I think the term 'socialised' medicine is a hangover from the Cold War and used to terrify Americans that there are bogeymen under the bed, just waiting to steal away their rights.

    Every civilized country has some form of national health care. Forget about thinking in terms of socialism - what is worse? Health care capitalism, whereby life is determined to have a dollar value, and if you can't pay, tough luck?

    For a supposedly classless society, you then get classes of people by virtue of money, which makes it no less a social class, then the Old World notion of lords, ladies and the rest of us peasants.

    There are many different types of national health care throughout the world - one doesn't have to look at say, the Canadian model, and go tsk, tsk, that's not for us, or the UK model. You can find a model good for you and learn from our mistakes.

    I also noticed comments on Canada's health care by Canadians, and one thing is missing in the information, which is that health care can vary from one province of Canada to another.

    Some provinces, like Alberta, get in so many new people every day, that all systems fall behind. They can't keep up.

    Since I have never lived in the US and haven't experienced the health care there directly, I will only speak about my situation with my husband.

    5 years ago he had a spinal tumour. Benign as it turned out. He was operated on immediately by a neurosurgeon. Cost? Nothing.

    He also has high blood pressure and has for many years. He has had several family doctors during that time, as the previous ones he had retired and had no trouble getting a family doctor. When I make an appointment for him, I may have to wait for that appointment up to 4 weeks, for a non-emergency.

    If it is an emergency situation, I talk to the doctor's nurse who talks to the doctor and get a call back within the day, and he sees the doctor usually on that day or the day after.

    If not, there is a doctor on call at the clinic where anyone without an appointment can be seen. It wouldn't necessarily be the family doctor, just whatever doctor is on call that day. For an emergency, of course, that would be the emergency room at the hospital.

    Around two years ago, my husband had an emergency quadruple by-pass. He was first sent in for an angioplasty, they then realised how severe his condition was, and was scheduled for the by-pass immediately.

    One year ago, he had a stroke and a heart event, which is sort of below a heart attack, but his enzyme levels were high and he spent 10 days in the hospital. His blood pressure was also out of control.

    Cost? Nothing but the prescription medication, which, even without private insurance, is less because the Canadian government negotiated it that way with drug companies, so that we can have cheaper generic drugs. We don't have private drug insurance. The drugs, mostly for my husband, have cost us about $5000 a year for the last two years but we actually pay about $2300 of that.

    It used to be that everything over $100 was covered by the health plan here, but they then based the deductible on a percentage of your salary.

    When I have taken my husband to emergency, we have never had to wait. You have to wait if you take in your kid for an earache, or have something that is not life-threatening, which only makes sense.

    For something life-threatening or potentially so, like a heart issue, you are seen immediately.

    Our system is not perfect but it doesn't bankrupt anyone. Yes, there are waiting lists for specialists, I am on one now for herniated discs and find it extremely aggravating. The reason I am waiting, is that while painful and annoying and disrupting my quality of life, I am not in danger of death.

    Another reason that our health care costs are lower, and why we have waiting lists to begin with, is that there are a lot of doctors and nurses who leave Canada to go to the US because of better pay.

    Our doctors don't make millions. They don't make anywhere near what US doctors make. In my opinion, as a socialized Canadian, people who enter certain professions, should be well paid for their work, but they should also be going into a profession, not because of the money, but because they have a calling.

    Yes, we pay high taxes because generally, we believe in the human rights of a society taking precedence in some areas over that of the individual. I am more than happy to pay higher taxes, knowing that that means that everyone can see the doctor, regardless of their ability to pay.

    And many doctors are more than happy to work for less money than they could, for instance, get in the US, because they see their job as a calling, because they believe that all life is equal, not just those with the cash. It's not like doctors here are living in poverty. They simply aren't as rich as many US doctors.

    I also agree with whoever it was that said that when things are free, they aren't valued as they should be. One of the downsides to national health care is that since no one pays, every time some people get a sniffle, they go to see the doctor. There is no thought behind it. That is a sure way to bankrupt any system. One analogy would be likening our health care system to an all-you-can-eat buffet.

    They can make money only if people eat 'normally.' If their entire clientele consisted of sumo wrestlers, the 'all-you-can-eat' part would quickly go away, or the restaurant would go bankrupt.

    And for many years that is how Canadians used the health care system. They didn't stop to think what it would mean further down the line. I for one, would be in favour of user fees. If Canadians paid even $5 whenever they saw the doctor, they would at least think about whether that cold really is that bad and learn to use free health care more responsibly.

    And I think that if my husband had all those conditions in the US, we would long be bankrupt if not dead.

     
  • At 3:48 PM, Blogger Cathy said…

    Am having link issues, but if you go to www.mysanantonio.com and look on the left rail, under a header called "Special Sections" you'll find a link to "Special Reports."

    Click it and scroll down until you get to the photo of an angel statue. The story is called "Life, death and the bottom line."

    It will disturb and anger you. And it's a great example of how badly our system needs fixing.

    Here's the summary: "Bonnie Terry had a virulent form of cancer, but the doctor said he wouldn't treat her anymore. Like millions of other Americans without health insurance, she had to figure out how to get medical care."

     
  • At 9:47 PM, Blogger slouching mom said…

    Excellent post, BA, and fascinating, thoughtful comments.

    Health care in the US has become completely morally bankrupt. Something must be done -- I wish I were sure about WHAT.

     
  • At 11:44 PM, Blogger painted maypole said…

    excellent post. when we saw Sicko my husband pointed out that the one thing it didn't mention at all is that america is the only country that really makes advances in new medicines, and that part of our perscription costs cover that. but there HAS to be a better way, and we should not be picking up the tab for that for the rest of the world. I'm glad you mentioned the development of drugs, and the unethical raising of costs.

     
  • At 12:14 AM, Blogger Christine said…

    BA, I've touched on this point in your comments before, and I can't begin to do thoughts justice (mostly because I am eight minutes away from my bedtime ;).

    I'll leave it at this...whenever you have a party taking absolute control of the the doctor-patient relationship you are asking for trouble. That third party could be an insurance company, or it could be the government, or whatever. As someone who nearly practiced medicine I can tell you that NONE of my attending physicians didn't express dismay at the control the insurance companies had over their practice. I can guarantee that physicians in socialist systems feel the same way.

    As an extern I studied with and worked for a rural physician. About 60% of his patient population had insurance; the rest were cash. What did he accept as 'cash?' Chickens, quilts, haircuts for his family, babysitting for his children, birthday cakes for his family, etc.

    I won't go into too much detail here, but I voted for Bill Clinton because for most of my twenties I didn't have health insurance and I loved the idea of a national healthcare system. Little did I know that the Clinton 1993 health care plan would have made the physician I spoke of above a felon (because he wasn't paying taxes on the quilt, the chicken, the haircut...the fine was five years in prison and/or five thousand dollars for both the doc and the patient)

    Oh, and I must say...the Clinton plan of 1993 wasn't free healthcare, it was mandatory healthcare, like auto insurance. If the feds found out you didn't have health insurance they reserved the right to take your home to cover health insurance costs. Just always read the fine print.

     
  • At 7:01 AM, Blogger Pendullum said…

    I am just an observer...
    I love to visit the States... It is a wonderfuil country...
    But your argument is so strong....
    I do not understand why all Americans standby as insurance companies dictate medical care...
    Why are these comments notan election platform I have to ask...

     
  • At 8:04 AM, Blogger URBAN PEDESTRIAN said…

    I agree with cerebalmum and anonymous who agreed with her and went on to make some very good points -- as long as they keep you scared of socialized health care, nothing is going to change. Essential health care is a basic human right and ya'll have to fight for it. Socialized health care isn't perfect, but it's the best thing we've got so far. Canada is looking at and/or slowly implementing a two-tiered system which hopes to take the pressure off the free resources. I don't know how this will play out.

     

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