What is a Deficit Reduction Worth?

Time for the Grown-Ups to discuss Healthcare Spending…

The basic question posed by the Wall Street Journal headline this morning is really “What’s a free lunch worth?”

They point to a Congressional Budget Office report: “CBO Sees 24 Million More Uninsured, $337 Billion Deficit Cut in Coming Decade With GOP Health Plan.”

Let’s do the math together, shall we?

Let’s take the savings ($337 B) and divided by the uninsured (24-million) see what the answer is and whether the estimate is reasonable since we like that word a lot when comes to spotting holes in our thinking.

So it’s $14,041.67 per person.

Since there are usually 10-years in a decade, the CBO is estimating $1,404 per person per year for healthcare — of the uninsured.

I’m arguing with myself over the “reasonableness” of this number.

Remember, most of the uninsured are not people at retirement age – or older.  These gray folks like us are mostly covered by Medicare.

And it’s axiomatic that your medical spending goes up at a nonlinear rate as you approach the end-of-life.  (It’s OK –EoL brings the end of taxes, too.)

Paul Ryan is quoted over here as saying “If we don’t pass my bill, the system is going to collapse.:”

Und zo?

Ryan, unfortunately, is a typical politician – and not a particularly admirable one so far. 

Worse? Washington is in something of a hostage-taking mode on healthcare since the insurance industry/business model has convinced the weak-minded that giving perhaps 20% of our healthcare budget to overhead and profit of insurance companies is the only way to go.  “Why look at all them health insurance jobs!” they moan.

See “disingenuous.”

The U.S. government spends about $100-million a year on healthcare for active duty military.

There are (about) 1.174 million enlisted plus another 224-thousand active duty officers.  That doesn’t count 580-thousand civilians.

Let’s round it off to 1.4-million.  Then, let’s double it because I think we can assume that there is is a lot of spousal and child healthcare in this – so maybe the figure is closer to 3-million covered active.

But it doesn’t stop there:  We have to toss in a further million, or so who are getting healthcare (Tri-Care) and other V.A. benefits, too.

It might round that off to 4-million.  Pencils out to $25,000 per YEAR per patient.

I’d have to dig a lot more numbers out, but it seems to me that either a) V.A. is spending too much OR b) the CBO numbers could be low, if anything.

Which then circles us back around to the original problem:  How do we do a better job of delivering healthcare to everyone?

As the old saying goes:  We don’t have any problems more revenue won’t fix.  This is a fine example.

I can’t cite current figures, but Canada – often held up as a role model on national healthcare – spent about $11,000 per family – and this was back in 2015.

That pushed pushes out to $2,750 per person.

The REAL problem with Canadian healthcare is at some point, they will have to pay the ACTUAL costs because that’s how budgets work.  So picture basic Canadian income taxes then toss in $11,000 for an average family just to handle healthcare. 

Not exactly a pretty picture.

So Let’s Solve It!

The problem with healthcare, when comes down to it, is something we touched on in the Coping section yesterday when we were talking about Daylight Time.  (We don’t say “savings” with that because no one “saves” time.  It’s just another government over-reach.)

The fundamental question has to do with the 10th and (missing) 16th Amendments.

Did States delegate the power to CentGov to decree everyone MUST buy healthcare to the FedGov?  (Justice Roberts said it’s a tax, remember.)

Sure, if we were loaded (like the State of Alaska was for a while with oil tax revenue) it would be fine to have total healthcare. Toss in a universal gym membership and tanning cards, too.

But the Budget is far from “fine.”  It’s a wreck. 

I think about government healthcare as being something that should be scaled according to the Nation’s financial condition.

We need more money coming in.

If we were to wipe out the Balance of Trade deficit, for example – which runs $40-$50 billion per MONTH, then sure. We would all get healthy.

The ugly fact of Healthcare is that it has been reduced to a single bill that doesn’t look at the entire budget picture and come to realistic answer to the over-all problem.

Remember Rubberstamp Ryan pushed Obama’s globalism plans.

Picture an airline flying along at F?light Level 37 (37,000 feet).  The crew notices a problem with the right wing/.  As the cabin decompresses and people begin to instantly die from cold and a lack of oxygen, the pilot turns to the co-pilot and says “This is just ;like the approach to healthcare reform.”   As the plane crashes toward a very small landing.

Point?  Sure:  You can’t fix one wing at a time.  You need to consider the outgo when trying to spend income that isn’t here. 

If the U.S. were to tax imports at the differential between the cost of such goods being made America and the cheap-o overseas rates, life would be wonderful.

The problem (which no one talks about) is that universal healthcare from some of these Asian countries – and Mexico – is not considered nor required  when tariffs are set on cheap-o goods.

Then – compounding our national stupidity – there’s the World Trade Organization which really benefits the rich One Percenters more than the rest of us.

I would argue – and I think it’s a convincing case – that if we are going to enforce a Healthcare program in these (prior to Obama) United States, then we must simultaneously move to impose a tax on imported goods to level the trade playing field.

Tariffs should be set after adjusting labor both here and abroad for Worker Purchasing Power Parity plus Quality of Life (QOL).

The problem, you see, is bigger than healthcare.

There is the corporate tax angle. 

Here we have major corporations screaming bloody murder about how high the U.S. tax rates are yet IRS has only limited authority to deal with the multinationals that use international tax dodges and havens to avoid (or ridiculously minimize)  corporate taxes in most countries. 

Remember I lived and worked in the Cayman Islands for a couple of years – and I have a pretty good handle on how the International Tax Shuffle is danced.  Really,  do 40 of the 50-largest banks in the world need to be serving a total market of 60-thousand people unless there’s a lot of dodging going on?  Well, there is.

Corporations should all pay the same “end-to-end” tax rates as U.S. domiciled corporations..

Go back to last year and how the E.U. moved against Apple on just this point.  Read “The Inside Story of Apple’s $14 Billion Tax Bill.”  Interesting stuff.

The simple version of this avoidance game works is simple:  Since I will use a couple of dummy shell companies to illustrate, seems only right that they be named  after myself:

Ure Industries buys cell phones from our Ure Industries Ltd in Grand Turk for $100 per phone.  They sell at a small profit (retailing net is $110) so $10 in taxable income in the USA.,

The Foxcommy Division of Ure International, Inc. manufactures the phones in China for $20, sells them to Ure Industries Limited, Grand Turk, for $22 – and thus pays China a corporate tax of 10% ($2) profit from making the phones.

Follow me here:  Did you see the cutout?

Ure Industries Ltd in Grand Turk in the Turks and Caicos made a tax-free bundle. 

They buy the phones all day long from China for $22.  And they resell them to Ure Industries America for $100 and that $78 of pure profit is tax-free since it was “earned” manipulating paper in a tax haven country.

Sweet, huh?

I made it simple because I used Ure throughout.  But in real life no way.  The companies have interlocking directors, perhaps, but the names are varied to hide avoidance.

Sadly, the Fools on the Hill don’t get after end-to-end taxes.  If they did, our foreign goods income might be higher, but so would our consumer prices – so it’s a balance there.  The E.U. has moved against such schemes, though – they need dough to build-their-burgers, so to speak.

But with lobbyists essentially buying votes in D.C.?  Do you really think Washington will land the airplane and look at the whole aerodynamic problem?

N o chance, at least YET.

They’re going to crash the plane.

And as is goes down, the usual pathetic crooks will blame one another (and the president) when the fact is, we need something the Trump Administration has the brainpower and horsepower to do, but are up against the Ryans and butt-kissers/ and coverers on the Hill.

With no Trade Deficit, we could pay $1`,875 per month for each of those 24-million who (wring your hands with me brothers and sisters) wouldn’t be covered.  Yes, PER MONTH!

Revenue is the answer.

We need to sit back, review the Big Picture first, and then fix healthcare to the degree we have money to spend, not to the degree the democrats can subvert Trump via the Obama “second White House” where the leakers might be on speed dial.

Cynical view?  Me?  Oh, hell yeah. GTFU.

We now return you to the usual data with a side order of slime for breakfast.

Data du Jour:  PPI-FD

Producer Prices, Final Demand is where we sometimes get a glimmer of ‘inflation in the pipeline.”

“The Producer Price Index for final demand increased 0.3 percent in February, seasonally adjusted, the U.S. Bureau of Labor Statistics reported today.

Final demand prices rose 0.6 percent in January and 0.2 percent in December. (See table A.)

On an unadjusted basis, the final demand index climbed 2.2 percent for the 12 months ended February 2017, the largest advance since a 2.4-percent increase in the 12 months ended March 2012.

In February, over 80 percent of the advance in the final demand index is attributable to a 0.4- percent increase in prices for final demand services. The index for final demand goods moved up 0.3 percent.

Prices for final demand less foods, energy, and trade services rose 0.3 percent in February, the largest increase since a 0.3-percent advance in April 2016.

For the 12 months ended in February, the index for final demand less foods, energy, and trade services climbed 1.8 percent.

Final Demand Final demand services: The index for final demand services moved up 0.4 percent in February, the largest advance since a 0.4-percent increase in June 2016. Nearly 70 percent of the February rise can be traced to prices for final demand services less trade, transportation, and warehousing, which climbed 0.5 percent.

The indexes for final demand trade services and for final demand transportation and warehousing services advanced 0.4 percent and 0.3 percent, respectively.”

Dow futures are down about 70 as the market dare not rally until after tomorrow’s Fed rate hike decision.

Bitcoins are $40 over gold this morning if you’re among the people trusting your future to a hard drive.

Storm Marketing

31-million people are reminded it is still winter.

One of our cynical readers points out that “named storms” may be a way for insurance outfits to slide on claims.  Tisk, tisk – such cynicism, really!

5,000 flight cancellations so far.

It’s About the Surveillance State

You probably already knew this, b ut when the NY Times says “White House Says Trump’s Wiretap Claim Was Meant More Broadly” you can bet democrats have something to hided or gloss over.

Like the Hillaryites meeting with the Ruskies?  Damn!  There goes the cynicism alarm again!

Big Day Tomorrow

Fed Decision, CPI and a barrel of monkeys (played by the House).  Up for subscribers at 7:55 on www.peoplenomics.com as always.

Wonton soup for breakfast?  Seems like hot soup would be a show of solidarity with the snowed in.  Cold at the ranch overnight, too: 34.

24 thoughts on “What is a Deficit Reduction Worth?”

  1. Trump’s planned increase in defense spending would go a far ways to providing care for folks rather than corporate welfare to the likes of Raytheon, Boeing, Loral, Lockheed.

    I’m not sure how the democrats even get blamed when Spicey gives a conference like this http://www.cnn.com/2017/03/13/politics/sean-spicer-donald-trump-wiretapping/

    It’s insanity – Spicey goes off the rails yet again about literal interpretations and quotation marks, Trump not meeaning what he tweeted, blah, blah, blah and somehow the democrats get blamed rather than the mealy mouthed mouthpiece. Now that’s fakakta in my book.

    • Oddly, I think we agree on this one. While it is true that Obama hollowed out a lot of the US .mils, there is very little public info about how the defense planning process works. To my way of thinking it would start with
      1. Blow up the whole world with nukes 10 timres over.
      2. Have enough cruise missiles to take out an Iran sized opponent X5
      3. Have enough pre-emptives to take out X Y or Z opponents.
      4. Provide NATO up to xxx,000 troops in reserve with yyy days of fighting.

      It seems to me the defense spending bill is always done the other way:

      1. How many people can we employ tomorrow?
      2. Who cares if we can afford it
      3. This is politics not defense.

      This is why I don’t hold public office, W/C I am just too simple minded!

      • Defense is nothing more than how many people can get to work before they bother us (the elites!). When I see ‘so-called’ homeless veterans on the street begging I ask myself what were they trained for? Don’t they know, of all the people, how to get it?

  2. Ryan talks endlessly about health savings plans and buying insurance across state lines, both of which are total BS. My son went into emergency, spent less than 24 hours in the hospital and had a bill for $18000K! No one can save that kind of money – especially for one day’s costs.

    In order to fix the plane, we have to look at the whole picture. Where once we had community not-for-profit hospitals, we now have mega-corporations run by people like Rick Santorum’s family. They run the cost of hospitalization up.

    Doctor’s have mega-student loan debt, so they charge $800 an hour for their services and pimp for the drug companies. The teaching hospitals make sure they only produce small numbers of doctors every year and we make it difficult for doctors from other countries to establish themselves. They also form groups to buy expensive machines that go “ping” and then send their patients to said group.

    The drug companies have carte blanche now to charge whatever the traffic will bear for drugs that used to cost pennies. While they claim they spend millions on research, mostly they feed off of discoveries made in our universities, etc. that they pick up for a song from the government. Witness the “orphan drug” system of scooping up a cheap, but necessary drug and raising the prices x $1000’s. They are able to keep patents for ever by tweaking the product every so often and fighting to keep generics off the market. The FDA is complicit with the drug companies in keeping cheap, safe natural drugs off the market. Witness CBD’s and marijuana – they should never be classified next to opiates, but there they are. Jeff Sessions is poised to crack down on their sale so drug companies can continue to hook people on opiates. Seventy percent of the country is on some prescription drug.

    I have been trying to figure out just how much of the country is “uninsured”. We have all the seniors on medicare(approx. 50 million), along with many disabled and a lot of younger people with diabetes and other chronic diseases. Medicaid covers the poor and a whole lot of drug addicts. Many people have employer coverage – for what it is worth today. As you cite, approx. 4 million veterans/military are covered by VA or tricare. So how many people are we really trying to cover with Obamacare or whatever it turns into?

    Whatever that number is, wouldn’t it be possible to cover them through medicare or medicaid in a single-payer system? In fact, we are bearing the cost of that right now. The cost of having a baby these days is insane and many of the people having them are young women with no insurance, at the same time the conservatives are trying to get rid of Planned Parenthood that provides low-cost contraceptives to these same women. Homeless people end up in the hospital at enormous cost because they have multiple health, addiction and mental problems.

    Corporations cry the blues about the cost of health care for their employees, you would think that they would be eager to unload that obligation for a few % points of payroll. With everyone covered in a single system, we could get rid of medical coverage on auto policies, workmen’s comp, and the whole network of piecemeal ways of paying for people who get sick or injured.

    As you point out, we could find another tax base for funding healthcare. We just lack the will because so many are making so much from the idiotic, wasteful system we have now.

    Homemade chicken soup on the stove for breakfast. These cold mornings it hits the spot!

  3. Yesterday on Hannity’s radio show, Newt said Ryan read only the sentence in the CBO report that claimed 14 million uninsured, and not the qualifying sentence that followed. It stated that most of the 14 million would be healthy young folks who chose not to buy insurance. Paints a different picture, doesn’t it?

  4. No one has mentioned Rand Paul’s four page healthcare bill.


    U.S. Senator and physician Rand Paul introduced S. 222, the Obamacare Replacement Act, to provide Congress with a health care plan grounded in broadly supported conservative reforms that is ready for an immediate vote after Obamacare is repealed. Dr. Rand Paul’s proposal would expand access to higher-quality, lower-cost health care for more Americans, regardless of medical history.

  5. George, please do not conflate the terms “health insurance,” “healthcare,” and “taxes.”

    Healthcare is provided by medical professionals, who are paid by health insurance companies, which are deriving part of their revenue from taxes — especially from those who choose to pay the penalty rather than the mandate.

    Proponents of the current system use “healthcare” to mean both treatment of patients and insurance premiums to pay for it. This creates confusion which — sadly — occurred in your post as well.

    • Some of us buy no insurance and pay for our health visits out of our own pocket, thus easily ending the middle trillion dollar man….Insurance… More people need to quit their insurance scamming middle man, go to a health sharing ministry. Get back to the basics, before the trillion dollar insurance man got in the middle to make it a business model. Thanks, George, it all makes sense now.

  6. Present day ‘health care’ (complicated for most of us!), You are describing an excellent case why our representative democracy will never work, unless we’ll have competent and honest people in places that matter. How could we achieve this condition with the way we presently choose our representatives? Getting interested, perhaps. ;-(

  7. George if anyone has ever listened to me rant.. it is quite obvious this one hits home with me.. since.. I worked healthcare and can see both sides of this issue.. hospitals were forced to raise costs when one out of three people entering the offices didn’t have insurance.. of those almost ninety percent of them were young family with children.. healthcare started the peak high after companies quit offering insurance.. until this deregulation every company offered health insurance to their employees and low cost insurance for their families.. this change just like auto fuel started during the reagan administration https://inournameblog.wordpress.com/tag/regan-era-deregulation/ . I will never forget during that time Nurses mad five dollars an hour techs made three.. or less.. as insurance companies started to raise the rates to levels that cannot be found anywhere.. did the aca hurt the insurance industry.. Hmm.. in my opinion not at all.. Anthem’s is up 238 percent ,Humana’s 309 percent,United’s astonishing 375 percent,
    I visit with canadians and people from the UK almost daily.. most of them find our predicament a huge joke.. that we would spend 49 mil in mexico,100 mil in honduras,el salvador 85.3 mil, columbia 187.3 mil.. etc etc etc.. yet in the usa.. we gripe about 260 billion and there is a huge percentage of that that doesn’t go for healthcare but other things.. we actually give more to other countries than to our own people we would rather see the average taxpaying citizens squander in the mire and give it away especially to countries that offer the top one percent a higher profit margin..
    the other thing is spending account.. excuse me.. we started the EIC tax credit to stimulate the economy..to give a family with children ten times what they put in just to get them to spend.. Hmm.. so now these same families with children that need the tax stimulus to spur the economy is expected to save for doctors.. a doctors visit here would not cover what an employee making twenty four thousand a year could possibly afford to set aside. Just to walk into an ER is a grand before any services..a doctors visit is a hundred and meds tests etc.. my grandson had strep.. they wanted four hundred before they would even look at him.. a friend had cancer of the thyroid.. they wouldn’t even touch her till she gave them a fifty thousand dollar down payment.. I could go on all day long.
    the only reason that Obama was elected his first term was because he was running on healthcare reform to stop run away healthcare costs.. the only way to do this is to put limits on it.. in the UK and canada.. they are limited on what they can make.. the arguement is made that these same doctors would go elsewhere. let me see where.. the USA is one of the only places that they can make an unlimited amount of money and the health rating of our country is just above Slovenia .. so what they would go sack groceries for eight dollars an hour. or work some other job skilled for thirty grand give me a break… instead of making a quarter mill a year..

  8. George,
    As another date point for you on health care costs, I oversee our self-insured program. Our aggregate population is likely a little bit older than the general population, but it covers employees, spouses and dependents. Our average cost (excluding admin fees, etc) is around $5000 annually per plan participant, and includes a generous (in terms of deductible and co-pay) health care ppo and prescription drug coverage.

  9. the answer to the health care industry can be made in one paragraph..
    1. No discrimination ( anyone can purchase product a at the same price of any other consumer)
    2 No price gouging.. ( price is regulated to cost the same to all consumers that purchase that product.)
    3. Open the borders. ( corporations in other countries or states can sell their products to any area of the United states. in other words. a company in texas can sell in New York )
    4. hospitals and consumers can negotiate for price outside the continental United states..
    there isn’t any reason that a medication or product should cost between five to a hundred times more for an american citizen than it does for someone from another country.
    5. Put a limit on profit.

  10. Obamacare IS the worst government scandal of the century next to the fact of a ILLEGAL president, BUT we will stick with the health care issue, the GOVERNMENT has NO business usiing taxpayer monies for this, Obamacare totaly ruined healthcare costs by removing the compettion and creating a captured market. they said it was to give the poor insurance, what a load of C–P we already had medicaid in place for them, IT IS ALL a SCAM and nothing more!! all this does is send more profits to certain companies!! egt the government OUT of the healthcare business and competition will lower the rates, yes my old rate BEFORE obamacare $150.00 a month for solid insurance!! AFTER obamacare $1200.00 a month and LESS coverage!! wake UP people, it is a scam!!

  11. Being an American in Canada who works in Pharmacy, I can address at least some of this. Currently it is nearly impossible to get a family physician here. We have been here about 18 months and can’t find one, so you depend on walk-in clinics. Fine for most things, but the walk-in Docs, while well-intentioned, do not have your history and do not like to figure out difficult diagnoses–so you tend to see people dying of cancer a lot more due to longer waits to diagnosis and treatment.
    On the Pharmacy end, the acquisition cost of almost every drug in Canada is much lower than the acquisition cost of drugs in the US. That’s the actual price the pharmacy pays to get stuff from the wholesaler. Rx pricing here is transparent, meaning that the customer is given an accounting of what the actual cost price is to the pharmacy, the exact markup and fee.
    In the US by contrast, there is an official wholesale price “AWP” which can be two to ten times the actual acquisition cost. Pricing is secret.
    Monopolies have a role too. Walgreens/Rite Aid with CVS control 99.7% of all the retail pharmacy dollars in the US. No one benefits from these cartels (except the cartels!), and it is impossible for either of them to do anything without the other one knowing all about it. So effectively, monopoly.
    In US Pharmacy, there is a triple-entry bookkeeping system enabled by pricing secrecy. An insurance company may specify that it will pay the pharmacy $2.50 plus AWP. The pharmacy bills AWP+2.50, but pays acquisition, which may be 1/2 to 1/5 the AWP. Do they declare the full income or only the $2.50? Stock prices indicate its mostly the $2.50… Much room for improvement there.

    • unfortunately.. in the US.. we have the walk in clinics to.. unless you can afford a family doctor. I have a friend that had a huge lump on her throat.. went into the ER because they didn’t have insurance they of course diagnosed her.. she had cancer.. the good news it was a common cancer that almost has a 99 percent cure if it is caught and treated in time.. she asked them when would they begin.. she was told not until you bring us fifty thousand dollars down payment..
      the same thing has happened to my children as well.. for one grand child no insurance.. there was a three week waiting period before they could see the grand child for strep throat.. if she went to the clinic other clinic they needed four hundred dollars before they would see him plus the medications..
      I had a medication in a local pharmacy where the cost was 1250.00 for a months supply and I could purchase it at the canadian pharmacy where they would fax the prescription to canada have it filled and mailed for 250.00 a thousand dollar difference.. and if I was a canadian resident I could have gotten a generic for 75.00..
      for a specialist in the us there is a six month or longer waiting period to get a visit.. if you have obama care lower end insurance.. a daughter had a ceserian section baby.. the doctor that took care of her under the lower end insurance of the aca.. went on vacation.. while he was gone the stitches came out and the wound opened.. the other doctors in his clinic would not close it by the time the doctor came back it was infected .. that was last may.. now it is march and is just starting to heal shut.. brain cancer.. I just had a friend pass away because they could not get treatment.. I could go on all day long. I worked in Healthcare field all my adult life in one level or another.. America isn’t any better than Canada.. in fact we are one of the worst countries for taking care of the health of our working class people.. we have the best healthcare that money can buy but if you can’t you don’t have access to it at all.( the us is above slovenia though). that is why the ER’s are overrun with people.

      • It angers me every time I hear a right-wing radio talker claim that the emergency room is “free”. They wax endlessly about how you can just walk in and get treated – so why is everybody complaining. It may be “free” if you are here illegally and can leave the country, or if you have absolutely no assets. Even if you qualify for Medicaid there is a proviso that if you ever HAVE anything, they can come after it. So it ain’t exactly free, the bills will hound you forever.

        You walk in to ANY care facility and the first thing they want to know is how you’re going to pay for it and if you want to use your credit card!

  12. The simple reason the plane is crashing is the government and lobbyist of health care are sitting on the wings.

  13. “…Obamacare totally ruined healthcare costs by removing the competition and creating a captured market…

    While I’m not advocating for Obamacare which it turns out is just another way to destroy the middle class, health care will never be a completely competitive market. When you’re throwing up and think you may die or your kid has been hit by a car you’re hardly going to check hospital prices. People don’t usually go to the Doctor when they’re in good shape.

    • what ruined healthcare what during the reagan administration when they deregulated it.. and the insurance industry.. insurance industry got greedy and seen a way to make more money.
      Healthcare costs started to increase because they had to be able to supply equipment and material.. as the ratio of paying customers to non paying customers rose they had to offset the loses by charging more. because of the deregulations.. doctors started to get greedy to.. at first to pay off outrageous school loans that were eating them alive.. it is all a business .. what company can survive with non paying customers.. clinics pushed the non paying to the hospitals where they have to diagnose them.. they don’t have to treat them .. but they have to see them.. so you end up with an over worked ER where just to walk in the door is a grand.. As for the ACA.. what did anyone expect to see when one the bill was written by the lobbyists for the Medical insurance industry.. the big boys.. ( with congress only working three days a month who do you thing wrote a four thousand page bill that with all the offshoots could easily hit fifty thousand pages.. )

    • If Obamacare removed the competition, why wasn’t I getting the benefit of lowering rates before Obamacare went into effect? Im self employed. All I encountered before Obamacare was escalating premiums. every year, where my only recourse was to increase my deductible, eventually up to $10,000 to keep my rate affordable. Tell me where the competition was then, that you claim Obamacare destroyed?

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