Romney on America's uninsured: Let them eat emergency rooms

During an interview with Scott Pelley on the CBS program "60 Minutes" last night, GOP presidential candidate Mitt Romney addressed America's uninsured: "Well, we do provide care for people who don't have insurance. If someone has a heart attack, they don't sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care." Not only is this the douchiest response ever, it's untrue, and it's a reversal of his prior position. FYI, this approach does not work well for a lot of populations: for people who can't afford dental care, for instance, or people like me who have cancer. Without a truly functional health care safety net, many uninsured and under-insured cancer patients in America do, in fact, "sit in their apartment and die."


    1. My first thought as well. Worse, Romney touts himself as the kind of executive who adds value to enterprises by making them more efficient. His “solution” basically formalises a broken system that already exists to the detriment of insured and uninsured alike.

      I suppose Romney would counter the obvious objections by proposing some sort of “first-class/coach-class ER” scheme, which would inspire incredulous laughter from anyone familiar with the day-to-day operations of an ER (not to mention the Hippocratic Oath). Sure, if you’re a multi-millionaire you can use concierge medicine or retain a private physician, but *way* more than 47% of voters don’t enjoy those luxuries. There’s another 52% of non-moochers and non-parasites who use the ER along with everyone else, including those “middle class” folks making $200k a year.

      Although it won’t happen, this twit deserves to lose the election in a massive landslide defeat if only to send a message to the rest of the world that we haven’t completely lost our senses. As it is (see also 2004), there are enough Know-Nothings who’ll accept this mad proposal without so much as a raised eyebrow.

    2. Pish. It’s much more time efficient for me to go to the ER with a heart attack than for me to waste all that time on doctor’s appointment and taking those tests and going to the pharmacy and taking those preventive medications. It’s one-stop shopping.

  1. That is such crap. His statement isn’t even barely correct. “we do provide care for people who don’t have insurance” then he describes a life-threatening situation. He’s completely wrong, not just douchey.

    We don’t provide care; we provide the minimum amount of effort necessary to stabilize and release someone no matter the condition. If it’s chronic, even disabling, you’re screwed. If you need dental care, you’re screwed. If you need very basic medicine to help you stay alive, you’re screwed. It’s only acute care that’s covered.

    He’s either disingenuous or doesn’t get it, which is fascinating given his relatively detailed advocacy of Romneycare.

    Honestly, he reminds me of a stroke victim.

    1. I’d love to see him or Ryan try this line of bullshit in front of an audience of emergency room doctors and nurses. If he’s *lucky* they’ll use fresh scalpels as they take him apart.

    2.  Just so that we’re clear, he is wrong, but also very, very douchey.  Romney is a douche.  Just want to make sure we’re on the same page.

    3. I truly believe it’s a combination of the two. Efficiency Expert Mitt knows this is insane, but Out-of-Touch Mitt rationalises by thinking that middle-class insured people (apparently those making $200-$250k) will use their money just like he does to opt out and find alternatives. Massacheusetts Romneycare Mitt knows there are workable (if deeply flawed) stop-gap solutions, but Politician Mitt rationlises that he has to pretend it never existed if he wants his party’s mouth-breather base to elect him so he can get things done.

      Right up there on the list of the last things I want in Chief Executive of the U.S. is someone who’s so skilled at fooling himself, and whose life experience is so removed from that of most of the population that doing so has only become easier as time goes by.

  2. Yes, Xeni.

    Romney just has no idea how people live in ANY country. His own or others. He has no understanding of people’s income, or their expenses. He has also shown an interesting lack of remorse or compassion. In fact so interesting that it becomes interesting to compare his public behaviour with diagnostic criteria for anti-social personality disorder or psychopathy:

    I’m a foreigner, but Romney’s public blunders have already made him into a cartoonish (but still very frightening) clownish figure over here! 

    1. As governor of Massachusetts, he enacted this:

      …so I’m not sure what to believe. To me, the idea that he’s sociopathic is not as disturbing as the idea that he feels he must pretend to be in order to win the general election.

      1.  Interesting, did not know that.

        But just stuff like the whole “dog on the roof” incident were quite telling. Firstly that putting the dog on the roof was deemed acceptable, and then his response to the media storm which showed an absolute lack of remorse over anything other than getting caught! Finally he also showed that he just didn’t get what people were bothered about, which shows an interesting lack of empathy.
        All those characteristics are quite… well.. unique.. or rather.. well known as a group of characteristics that are not typical of the general population.

        1. See, the lack of empathy plays well with the Romney supporters that I know.  Even friends and family members that are union.  Just because they have a job and healthcare and have had it for years they think it’s just there.  They haven’t worked for some giant corporations or jobs that can be off shored. 

          I ask them, what if you lost your job, what about this family member that is now going to be better off with affordable healthcare, etc, and they just don’t get it.  They don’t want to get it.  They have no empathy and are really lacking in the ability to see themselves in a time of need. 

        2. Interesting, did not know that.

          That was one of the things that provided a lot of fuel for arguments over here — “Obamacare” was largely modeled on “Romneycare.” And not just arguments over the ACA itself; Romney’s Republican opponents pre-nomination latched on that too.

      2. This has been the most puzzling thing about Romney:  Is he the centrist republican who got elected in Massachusetts?  Or is he the partisan right republican we see now?  Was he deceiving us then or now?  Are either of these his actual values, or is he an empty hat who will just say whatever it takes to get elected?

        Personally, I’m leaning towards “empty hat” at this point, but it’s really disappointing no matter which answer is correct.

      3. Read it critically. The net effect was minimal as it did not move uninsured or underinsured residents away from acute focus care to preventative focus care. No one got doctors as a result, no one got checkups and health advice. 

        What they got was a Peter paying Paul scam to shuffle around the costs of acute care for the uninsured/underinsured and in the end it would have collapsed. 

        Romney did there what he did as head of Bain, he played a shell game with money, this benefitted his desired image as a moderate in a state that typically elects moderates to left-leaning executives, and probably lined the pockets of some friends in insurance and private health care.

        Obamacare has some of the same failings, but is at least partially intended by some of it’s proponents to move toward preventative care and away from solely acute care as the -actual- cost benefit, which handily results in a health benefit for those who manage to get preventative care as a result of being insured. Too bad it is so watered down it will certainly fail without serious upgrades. Poor people don’t co-pay check-ups or visits to doctor’s offices, they just don’t go.

        1. Huh? I was on Romneycare for a year or so (until I got married and went on my wife’s insurance), and I got preventative care, dental, even eye care if I’d needed it. The insurance options are actually quite good.

          1. I had a nominal co-pay (something like $10) and no premiums. (In fact, after I went on my wife’s insurance, I learned that my previous insurer had accidentally kept covering me.) But I went from going without insurance for ten years, and as a result not getting care unless it was an emergency, to having insurance that permitted me to get preventative care. When you say that “No one got doctors as a result, no one got checkups and health advice,” that runs directly counter to my experience. Perhaps you were being hyperbolic?

  3. The fact that he said “apartment” rather than “home” is also a bit telling of how he subconsciously devalues people.

      1. by saying “apartment,” he implies they do not own a home. The word “home” implies a sense of ownership and value. Whereas “apartment” is understood as a type of middle-to-lower-income housing.

      2. “Home” is the word with the pleasant connotations, and so politicians using rhetoric try to invoke it. “Apartment” is more impersonal and assumes the person has failed somehow to get a home; apartments are associated with public housing, instability, low income, etc. Whether those associations are true doesn’t matter. The implication is still there. Choosing to use “apartment” instead of “home” suggests a lack of empathy.

      3. I’m not sure I 100% understand the comment (and I am a native English speaker), but my guess would be that it is in reference to a stereotype that apartment-dwellers are more likely to be poor than those who own their home. Although an apartment is, literally speaking, someone’s home, usually when the word “home” is used, it refers to a free-standing house (vs. a condo or townhome) that one owns instead of rents.

        But I think it’s a stretch to say that Romney is “devaluing people” here. Frankly, I would posit that apartment-dwellers are more likely to be poor than home-owners, and therefore more likely to be without insurance. So he could have just been picking an apt example. But maybe there is a connotation there that I’m missing also.

        1. If you’re not a native American English speaker, you might miss the nuance. “Home” would be the default conversational term for where one lives, regardless of whether it’s a rental apartment or an owned house. Romney was either unconsciously or deliberately identifying uninsured people as being lower or working class people who may be more likely to live in apartments. Regardless of that being true or not, it definitely comes off as condescending.

        2. Iirc, the census bureau has updated its methodology to include more factors to more accurately measure real poverty for renters vs. owners.  Now I think it’s much closer to even than it used to be, but homeowners still are a bit wealthier than renters overall, that is true.  Of course many renters are actually renting houses too, even in urban areas.

          1. Actual home owners are likely to be substantially wealthier than is typical. 

            People who have signed up to rent their house from the bank for 20-odd years are a lot closer to par, though still likely to be slightly wealthier than people who rent in shorter increments….

          2.  One of many factors taken into consideration.  The other thing though, is that even though many people *own* their home outright, they may still be elderly, unemployed/underemployed, and still have to pay high property taxes etc.  Another thing to consider.

      4. When a guy like him chooses “apartment” instead of “home”, it seems to imply that the kind of people who don’t have insurance are just transient, urban, rootless, no family etc., when really the uninsured are so numerous that they cover all kinds of living situations.  In reality the highest amount of uninsured people are in Southern states like Texas, and Alabama etc. It also shows a complete ignorance to the fact that many of the uninsured are children, people refused because of existing conditions, practically middle class people who just can’t afford it and so on. 

        Most people would get the benefit of the doubt, but when your party is constantly (and wrongly) trying to advance a narrative that urban people (i.e. minorities/democrats) are takers, while bootstrapping white rural/suburban people are makers, it comes across as coded language.

        His 47% comment was similar. Spinning these “takers” as urban democrats and Obama voters, when in reality the top ten states with the highest percentage of “non-payers” are Southern red states.

      5. Thank you all. I was not aware of this distinction, and, I realize now, it is also a cultural thing. Here and in Venezuela, living in an apartment can be quite expensive, depending of the area. 

        Last year, I finally started earning enough to rent my own place, after I moved to another country. An apartment in downtown is huge achievement for me. So, in addition to my ignorance of the subtle connotations, we have a bit of a cultural gap here.

        Again, thank you very much

  4. How is having the hospital and state foot the bill after the fact for the service performed for the uninsured NOT a tax? Certainly, those with insurance pay higher costs on just about everything to cover the losses. AND those with the lower income and worse insurance will pay disproportionately more than say Ex Governor Billionaires and Ex-congressmen. 

    I like how when it is proposed that all people have a MANDATE to be insured that is called a TAX by the GOP. But when they admit that a hospital will not deny service, the make it sound like somebody (the insurance fairy) will pick up the tab in a way that does not drive up the cost of health care overall. 

    1.  Similar to how government subsidies for human beings are “entitlements” while government subsidies for businesses…aren’t mentioned at all.

    2. Yes, not only will his model have cost, it will have the least efficient delivery at the highest possible cost, with the worst results.

      But this is all about maximizing profit, not about lowering the cost of healthcare. Thats what you get when you have profit in healthcare. Imagine what it will be like when you have the profit motive in the presidency. 

        1. Profit motive doesn’t mean what you seem to think it means.

          Profit motive means you’re rewarded for maximizing profit.  This has no connection whatsoever to the cost of campaigning.

          1.  Hmm. gotcha, well in that case how much do Lobbyists affect the President’s decisions?

            Also I was trying to imply that you have to practically be one of the “elite” to run for office (and have a chance).

    3. “Insurance Fairy” – I like that. Most people don’t understand how the economics of hospitals works; many hospitals get huge tax breaks to operate as charitable organizations, but really only provide about 2% of their care for people who are not able to pay, and even then they are often compensated by the state or Fed for that care. So the “taxpayer” ends up really subsidizing both the non-paying emergency cases and the private paying clients as well (through tax breaks). And that’s not even getting in to the funding of local charity clinics that handle non-emergent care, which often also comes largely from the state.

  5. Xeni said “Without a truly functional health care safety net, many uninsured and under-insured cancer patients in America do, in fact, ‘sit in their apartment and die.'”
    True, but Mitt and many conservatives are 100% fine with that statement.  (Remember the “Let him die” shouts at the primary debates?)  Their argument is that if you choose to forgo healthcare insurance, you have assumed the risk of adverse health events in your future.

    Obviously, one of the biggest flaws implicit in their position is that millions of people don’t have that choice.  They don’t have it through work and they can’t afford it without creating more immediate threats to their health like homelessness or starvation.

    This idocy is so pervasive it was presented as the hypothetical  that produce the “Let him die” shouts cited above.  In the Ron Paul hypo, he was asked what should happen to a young, healthy man who, while he could afford it, chose to forgo health insurance and now has a life threatening emergency.  While this does happen, it is intentionally deceptive to presnt it as the norm. (It is akin to the “welfare queens” lie spread by Reagan.)  In reality, large swaths of people in this country can not afford insurance and live shorter lives because of it.

    The best answer a conservative should give tot he hypo is to save his life and then send him a bill that he will have to pay off like a mortgage, not to “LET HIM DIE!!!”

    It is time for the U.S. to jump into the 21st century and provide care its citizens.

    1. And herein lies, as I’ve mentioned previously on Boing Boing, the contradiction of “pro-life.” Life is supposedly sacred if you’re a mother considering abortion, but adult life is disposable if you’re a society full of supposedly self-made, I-built-that!, bootstrap-up-pulling, individualistic patriots who don’t want the government to interfere in your delusional free market utopia. Who would Jesus let die because they lacked health insurance and possibly made poor life decisions? I’m pretty sure it wasn’t the poor or the diseased or the prostitutes, because I recall reading stories about him spending a lot of time with them and healing them (without compensation).

  6. The weird disconnect I’m feeling from his statements is that this sort of bare minimum emergency treatment for uninsured is actually SO costly.  It’s costly for the individual, for the providers, for the city/state, and for the other patients who ultimately pick up the tab, through higher rates.  It’s the worst possible scenario for everyone.  If people could get reliable, affordable wellness checkups and health care, many problems could be caught and managed early. Less cost to everyone, fewer missed work days, more productivity, and lower loads on the emergency service network. Fiscal conservatives should love this idea. Looking at it simply from the numbers, it just makes so much more sense.

    1. Fiscal conservatives did love this idea until Obama advocated it. It was the conservative answer to Hillarycare.

    2. “Looking at it simply from the numbers, it just makes so much more sense.”

      If you’re wondering why the GOP isn’t on-board with that, it’s that last word there that’s critical.

    3. Also, for a political philosophy that claims to worship the entrepreneur, conservatives seem very wedded to the idea of having employees locked into corporate jobs for fear of losing their health insurance.

      1. I’ve never been very long without a job, but I’m frequently in the position of having to scramble for a new one. I’d much rather provide my own healthcare (at the kind of rates corporations can negotiate) and go purely to contract work. In fact, it would make sense for a lot of people in a lot of industries to move to contract work instead of having a new “salaried job” every couple of years. Especially when companies offer so-called benefits that vest after a certain term of employment, when that term is rarely reached.

    4. I was surprised to find out that preventative care is actually more expensive than emergency room visits. 

      But I don’t think that universal healthcare needs to be fiscally justified; rather it should be one of those inalienable rights.  What preventative care does is save lives, and as such accessible preventative health care is simply the moral thing to do.

      1. That article is, according to the article, examining the statement “preventative care saves money” outside the intended context. If all Americans receive health care it is a par conclusion that the amount spent on health care will be more than what is spent with a large number of Americans excluded from all preventative care. The article excludes the societal and economical benefits of preventative care in order to focus solely on the dollar amount spent on health care, in order to draw a conclusion out of context and say that Obama’s claim is false. The article also assumes that all patients will be tested for any disease that there is an instance of in any patient, and preventative care does not actually include testing that is not indicated by the physician. (Just because Joe got pancreatic cancer, I must be tested too = false). The article also relies on costs associated with private for-profit healthcare. Guess what, in universal single payer systems costs drop like a rock because for-profit hospitals cannot justify a $12 aspirin based on how many people don’t ever pay for acute care.

        1. Perhaps I am unclear what the intended context was,as I thought it was in reference to the Healthcare law President Obama helped enact.  But the article never assumes that “all patients will be tested for any disease.”  The article assumes that testing will increase because “To avert one case of acute illness, it is usually necessary to provide preventive care to many patients, most of whom would not have suffered that illness anyway. ”   Which is something that will undoubtedly happen.  In order to be preventative, doctors must first know who is likely to get sick.  To know this, they must perform many tests, the very vast majority of which will come back negative.  If you look at one person, whose illness was avoided through preventative care, then absolutely, it will be much cheaper to prevent that one persons illness than to treat it.  But in order to determine who will have an illness that can be prevented, a large number of tests must be done. 

          I agree that a universal single payer system will save money, and is the way to go, but that is not what the President’s Healthcare act created.  A single payer system has been shown by the CBO to save money, but again, is not what the healthcare act created.  We do have 2 single payer systems in the U.S., Medicare and the Veterans Administration, and those function (reasonably) well, and save money.

          The NEJM report (upon which the politifact article is partially based) does take into account the societal and economic benefits of preventative care.  It is still not enough to offset the cost increases associated with many more people seeking preventative care.

      2. Amusingly enough, one reason universal preventative care costs can exceed those of a system like the US’s today (awkward phrase there) is that people live significantly longer with preventative care. So while those regular ER visits add up, enough of the non-affluent* chronically ill are dying in their 50s and 60s, instead of passing a couple decades later as is the norm in civilized societies, moving in and out of the hospital before their death.

        *Well, in the US you don’t have to be poor at all to not be able to afford care, especially if you’ve got an expensive illness OR if you’re self-employed. When I was a kid in an average lower-middle to regular-middle class neighborhood, plenty of my classmates never got dental care or glasses, or other basic medical care (still remember one kid with nasty eczema), mostly because appointments were too expensive.

    1.  Fortunately, it’ll be less than the amount he needs to win the presidency.

      Oh, but then we’ll all be in Obama breadlines in a socialist dystopia, just like we were for the last 3+ years since he got elected the first time…

      1. You were doing so well until you added that second paragraph! It’s possible for Romney to be bad without that making Obama good. This isn’t Star Wars.

        1. I didn’t say anything about Obama being good or bad. I was just referencing the fact that Republican scare-mongering from the last election didn’t come true, just like he’s not going to send in UN troops to subdue Texan uprisings if he gets re-elected.

          It’s possible to point out that some Republicans try to scare-monger without implying that their opponent is a saint.

  7. Someone so out of touch with the experiences of the average American citizen is completely unqualified to be president of the U.S.  It would be one thing if he were rich and had some type of understanding and empathy for people who were not rich but he is clueless.

    He thinks going to the emergency room is the same as health care.  That is not health care, it is a minimal amount of sick care.

    He tells college students to borrow money from their parents if they need help.  I guess if your parents aren’t rich like Romney’s you are out of luck.

    He or Ann talk about being poor in college and how they had to sell some stocks or bonds to get cash.  Right, you are not poor if you have investments and trust funds to fall back on.

    He thinks 250,000 per year or less is middle class.  That is 5 times more than the average income of 50,000.

    He simply doesn’t care about anyone who isn’t rich.  If you are rich, he will take care of you.  If you are the 47% of bums who don’t pay income tax, he will not worry about you.  It’s beyond amazing that someone who can’t even bother to pay lip service to the middle class is running for president.  He’s like the real life satire of a rich presidential candidate.  You couldn’t create a character who better epitomizes the greedy 1%.

  8. This reminds me of the infamous Barbara Bush comment about people housed in the Astrodome during Huricane Katrina:  “And so many of the people in the arena here, you know, were underprivileged anyway, so this is working very well for them.” Same kind of attitude; they have nothing so they should be happy with any level of care that they get. Never mind that 60 percent of bankruptcies are the result of medical bills, or that tens of thousands of people die every year because of the lack of medical insurance… 

  9. Xeni, you’re spot-on with the “douchiest response ever” bit.  Wow, he points to one of the most broken/flawed parts of the medical system as to why the system “works”.

    Beyond the fact that there’s plenty of people in need of health care who the ER can’t/won’t help, there’s also the fact that this system results in frequent 8-12 hour waits for people waiting for “emergency” care, and the fact that this drives up the cost of the health care system for all the paying people.

  10. This kind of thinking almost killed me in 2007. I had, unknown to me, Graves Disease, and was actively going through a thyroid storm. I presented without the involvement of “Marty Feldman” eyes, but had the typical shakes, resting heart rate of 148-160, and puking on a massive scale. The ER couldn’t help me because the ER is not really good for extended diagnosis processes. What I needed was an endocrinologist, who would have known what I had the minute I walked into the office, but couldn’t get that because even though I was a nurse, I had no insurance. Instead, I got too sick to work, thus losing my insurance, and nearly died in my apartment as my resting heart rate went critical risking heart attack. It might not be as fast as dying from an actual heart attack, that Romney used in his example, but I went from 160 pounds to 106 pounds in less than a few months, and was dying. My endocrinologist says I was closer to death than any other patient she’s ever seen, and I have some irreversible damage due to not being able to treat my disease in a timely fashion. Thanks American healthcare system for leaving me to suffer agony in my home without care for long enough to screw me for the rest of my life. Despite being totally preventable if I had access to the healthcare system. 

  11. Have you ever gone to an emergency room without health insurance? The government doesn’t automatically pick up the tab. If you aren’t eligible for Medicaid (for example, if you don’t have kids), they expect you to pay your bill. The first thing they want after you say you have no insurance is a credit card number. Or you can sign a payment plan agreement. Or the hospital will sue you or turn you over to a collection agency. If all else fails, they’ll write off your bill -after years of collection attempts and your bankruptcy case.

    1. I took a friend to ER in LA about 13 years ago, she was only 30 but thought she was having a heart attack (it wasn’t, it was a panic attack). We’re Canadian, and she had travel insurance through her work. They took her info, took her in, called her (American) travel health insurance provider, who declined to cover the expenses because we took a taxi instead of calling 911. The ER didn’t want to discharge her before someone gave them a credit card, which we wouldn’t, eventually they let her go with a $3000 invoice. Such a fun vacation that trip.

      And this is how I learned to always call 911 if you have a medical emergency in the USA. Weird.

    2. Have you ever gone to an emergency room without health insurance? The government doesn’t automatically pick up the tab. 

      And in the cases where the hospital and/or government do pick up the tab it’s usually a much, much bigger tab than preventative care would have cost.
      Even if you’re a stone-cold sociopath who doesn’t give two shits about poor people, it just makes more financial sense to provide free basic medical care and treatment services to your local hobo than to pick up the bill every time he lands in the ER.

    1.  Romney wouldn’t have any knowledge about that, you know being rich and having top notch care for himself…

    2. In my area, if you believe you’re having a heart attack and drive yourself to the local hospital, thus avoiding the cost of an ambulance, you’re still stuck with a $3,145 bill.  You may be lucky enough to have insurance that covers such a visit, otherwise you’ll have to find a way to pay.

  12. In July, I left a job for one closer to home (80 miles, one way, is a looooong commute). 2 days later, I found out I have cervical pre-cancer. Then the new job fell through before I started. It was a shit deal all around, and I was scared and angry and feeling incredibly lost. Several tears and deep breaths later, I found that PA has the Breast and Cervical Cancer Treatment and Prevention Program. I got enrolled easily, saw a new GYN, and found a little ray of hope. In a couple of weeks, I’ll have the procedure to get rid of the lesions, and (hopefully) all will be well. Thank the Universe and all the gods that the safety net is still there. If it weren’t, I’d be screwed. There aren’t words to adequately describe how grateful I am.

  13. I have good friends who live without the benefit of insurance.  I’ve noticed that they receive a different tier of emergency service than I do.  For instance, if I break a bone, I will receive the luxury of an anesthetic before the bone is reset.

    All I can say for Romney is that it’s a fine thing that the diseases that frolic amidst poverty have an abiding respect for the borders of a wealthy gated community.

  14. I’ve had two stays in the hospital in the last year and a half, after spending most of my life not needing to go there.  Once for a nasty internal infection which required an extreme regimen of expensive antibiotics, and again for a broken femur that required immediate surgery.

    Thankfully I have what is considered a ‘decent’ salaried job (which still puts me WELL below what Romney considers middle class – I can only afford a small apartment!) and my health coverage is good.  I got away both times only paying a relatively small co-pay, and got lots of good drugs and aftercare. If I happened to be between jobs I’d probably be homeless now, or at least in debt for the rest of my life.

    I consider myself to be one of the fortunate (lucky) ones, but man our system is *fucked*. 

  15. Let’s also note this:

    When people wait to stagger into an emergency room on death’s door…

    Aside from the pain and human tragedy, it actually costs (the hospital/bills to patients/the state) much MORE than if they’d been able to see the doctor for free before it got that bad.  The phrase “An ounce of prevention is worth a pound of cure” isn’t just a dry old expression.

  16. At least we have a complete system of mental health care available for the poor and middle classes. We call the facilities “homeless”, “jail”, and “prison”.

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