Health Care Reform

[Craig Read]

Imagine the following in YOUR company, in which you are the overpaid, [and fat] CEO and your Personal assistant [young and pretty and female of course], hands you an overview of one of your operation Divisions. What would you do to reform such a system ?:

Dear Mr. Fat CEO,

Here is the summary you requested of our division 'Health Care' Inc.

1. Expenses have increased 30 % per year on average for the past 4 years.

2. Due to government price caps we will never generate enough capital to maintain let alone improve our operations.

3. There is a severe shortage of trained personnel using old outdated technology.

3. Our clients are constantly put on hold, told to wait a very long time to get serviced, and / or do not receive the service that they have Pre-Paid for. Our client complaints department is overwhelmed.

4. Internal audits reveal that this part of your company wastes money, has no accountability and is badly organised. Indeed the various parts of the division do not know what each other is doing. It is estimated that fully 10-20 % of all investment capital goes missing in action.

5. Over half your budget allocated to this division goes to administration expenses.

6. The distribution arms for your services and products have been declared technically bankrupt.

7. Minor setbacks cannot be contained and minor problems escalate to major headaches due to bad management and disorganisation.

We kindly request that you the CEO sell off this division as soon as possible.

Apparently Government's would be interested in the purchase.

Yours sincerely,

Bored Directors.

[RB]

THE HEALTH CALL AGREEMENT

This Health Call Agreement (hereinafter referred to as the Agreement)

is entered into on the _____ day of __________, 2003, by

_______________, between _____________ and ___________.

THIS AGREEMENT SHALL COVER THE FOLLOWING RULES AND PRINCIPLES:

1) Name calling is not tolerated

2) Be diplomatic when addressing our personal assistance, dirty talk is only encouraged with outside engagements

3) Decrease your expense account by reducing number of paper you use in triplicate, eliminate those computer idling, make sure your department act as if they are working, then charge the for all space used by your department. We now request all departments submit a P&L statement

4) Here is the order regarding the price cap: we decided on a tradeoff and to go ahead for payment at election time, the results of this will be forthcoming

5) To solve the long waits to be heard we will introduce: a) panic buttons that will surprise and overwhelm everyone every 2 minute interval, will blasts throughout our buildings and all of us can hear you

6) There is an Request For Proposal (RFP) out for auditing, and the only submission we hope for is Arthur Anderson

7) We have decided to distribute Pfizer products for free to cure you of all your head aches, the consensus went in favor of Viagra

The aforementioned rules may be amended only by the holder of the agreement. We are not convinced selling is a current option. If any other party attempts to change or alter any terms of This agreement, it will automatically become null and void and your departments will then be downsized and deleted from memory and email list, BLOCKED from all communications herewith until your silly ass understands the what is rules.

Participating department:

Signature: ______________________

Date: ______________________

[Craig Read]

RB, rather funny. Well imagine the idiocy of Canadian public health policy.

Bankrupt hospitals.

Shortage of Doctors and Nurses.

Outdated technology.

Long waits.

High debts.

Ever escalating taxes.

All i ever hear from the cry baby left is rhetoric that the old, sick and poor need help.

Yeah no kidding genius, i guess i missed that part.

Does that mean that socialised, rationed, gov't mandated care is the ONLY means available to ensure, timely, accurate, cost effective and technologically advance care ?

What a country !

Health accounts for 10 % of our GNP yet it is off limits to capital accumulation and efficiency.

NONSENSE.

[KrustyKidd]

My time to me is worth $30 an hour. That is the amount I have set to put a value on my leisure time. When I am called from work to take my daughter to a doctor or clinic and have to wait hours to see somebody I am annoyed. Why can I not just pay extra to get prefferential treatment? They call it two tiered health care but why is that like so evil, like "naming HE, that cannot be named?"

Everything I do is two tiered, everything you do is two tiered. You tip a waitress for good service. Hmmmm. Like if you didn't, next time you show up you might not get the "upper tier " service of the two tiered service establishment. My mechanic doesn't want to work on one of my trucks on a sunday. I offer him a $50 bonus for comming in. Did I hurt anyone? No, but I got service and - guess what? On monday some poor shmuck that doesn't have $50 will not have to wait for me to get my stuff done. Privatize it. Health care is too expensive and necessary to leave in the hands of a government that loses FIVE BILLION DOLLARS and never accounts for it. Lord, we could have sent up our own space shuttle for that, not just a mechanical arm that the world calls the "space arm" not the "Canada Arm." (BTW, the fCanadian flag sticker is one inch by two, the photos make it look big.)

What the hell. I don't think there will be much of a choice in a few years anyhow. So much money is being wasted and if I'm wrong then I'll live for next to nothing in a government retreat somewhere but if I'm right then I'm glad I'm in my own business and don't have to rely on social security. The rest of you keep on writing those subsidized blonde joke books. Good reading in the waiting rooms. Oh, vote Liberal too. Otherwise Cretien won't have the pull to get his stuff done in the States like he always does.

[Craig Read]

KK, good point. An Indian economist - Bhagwati - who is unfortunately at Columbia [not as liberal or stupid as Harvard and Princeton but getting there], has written numerous tracts on the inequality of socialism. He writes that what the 20 something no nothing activists and the grey hairs fail to understand is that under socialism, the rich jump the line anyways. They will get 'serviced' no matter what demagogic ideology is used to control the masses.

Health care is the same. Chretien and the rich Lie-berals head off to the Mayo clinic while telling us that we have the best system in the world.

By any measure Canada ranks near last in many categories within Industrialised nations pertaining to doctors, technology, waiting lists and costs per capita.

Time for change. Yet one can hardly imagine Uncle Ernie or Howdy Doody McGuinty plumping for reform.

Would disturb their poll ratings and actually make them work on important issues as opposed to spending time on photo ops and focus group reports.

Hard to imagine the stupidity of a nation that manages itself by focus groups.

[RB]

privatisation does not work favorably for the average person

you realise you give examples with a provision of something extra, i like the idea of my money I would like to control it but some consideration must be given to the majority of people

i wanted to be fair and add some more examples of traits of those interested in privatisation

so about the importance of being earnest for my own sake about my wants and my money

want a hot rod – purchase a car

Want shelter – purchase a house

Want Entertainment – pay for those

Want ivy School – pay for those

Fix my named brand glasses, those massages etc. – take the green shield

Fix my breast implants – pay for those expensively

My plastic parts – pay for those expensively

Botox or whatever – pay for those expensively

Important about being earnest in health

Wish to live – glad to pay upfront

Wish to prolong life - glad to pay

Death wish – pay for this also

subsequential eventualities to follow:

To avoid those waits – I wish to pay

Non-drudgery – I wish to pay

To access my choice of doctor – I wish to pay

To avoid paying for services I do not use – I only wish to pay

To avoid increase taxes and better distribution of taxes – please let me decide how to use my dollars

Well I have been doing very well making my own decisions and to the goverment i demand service as in privatisation.

Now i have decided to take a head start and tell this to the hell to pay low income canadian, and just remind them of the hard line, but there is good here in the end, no hard feelings now darlings, and of course you are going to give a helping hand, appropriately this is not so hard to believe, less hard to swallow, and in these hard times, your privatisation should’nt be a hard sell.

[Lost in Manitoba]

Really good posts, especially KKid. I'm not so convinced the system is unfixable, though, and needs to be scrapped. It just needs to be run like a private company, in other words, more efficiently. Its not the system itself, its the managers and department heads. Like Craig said, over 50% of expenses goes to the administrators. What the hell? I have the (naive?) belief that we can have healthcare twice as good (or better) without increasing spending. No well run business would not do an overhaul if a department was as inefficient as our healthcare system. To get some answers on how to solve the problems, you just really got to ask the doctors and nurses for advice. They work within the system and see the redtape and waste everyday; chances are they also have ideas on how to fix it.

[Craig Read]

Well most docs and nurses suffer from over work and burn out plus low salaries. The average for a doc after expenses is U$55 K !!! This is less than the line worker at GM !!! Of course union workers are superior - they are the bedrock of society - poor dears have to work 35 hours a week and only get 8 weeks paid holiday, plus fat pensions and a big severance when they get fired for drinking on the job !! Tears flow when i consider their plight.

In Canada government accounts for 70 % of health care spend. In the US it is 45 %. Pierre Lemieux of the Economics and Liberty Research Group in Quebec wrote a good article and stated the following:

"Even in the Brave New World of the public health advocates, Americans still get more [and better] health care after paying their administrative costs. The consumers get more of what they want, which is the ultimate criterion for any economic system."

He is right. Health services =10 % or more of our GNP. There are huge costs in bad technology, waiting lists, and burned out doctors who make little money. Admin costs in Canada to raise the $75 billion for Health speand are over $1 billion. Deadweight loss or economic destruction from state management is estimated by Lemieux to be $20 billion. So in effect Canada spends 25 % or so more than the official numbers indicate PLUS bad technology, under supply of personnel and long waiting lines.

This means that Canadians spend about the same % of GDP on Health Care with less access and poorer technology than Americans.

Welcome to Socialised medicine - the Stalinists that run Canada are very good at hiding real costs. But you can put up with high taxes and high debt for the MotherLand now can't you ?

[theWatcher]

You could always do what our own prime minister does:

From PM proves health care not equal for all Canadians

Calgary Herald

Tuesday, January 15, 2002

Comment

A15

PM proves health care not equal for all Canadians

Ezra Levant

HOW will Jean Chretien respond to Premier Ralph Klein's free market-health care proposals? Will he attack Alberta, as he did in the last federal election campaign, with negative ads on television, accusing Klein of bringing U.S.-style health care to Canada?

Or will he punish Alberta financially, as he did in the mid-1990s, by threatening to fine Alberta, dollar for dollar, for inviting private capital into health care?

Whatever Chretien does to our province, and whatever capitalistic acts he accuses Klein of engaging in, Albertans should know this: Jean Chretien takes his own family to private health clinics. In fact, he doesn't just use U.S.-style private clinics. He actually goes to private clinics in the U.S.

And he flies to those U.S. private clinics on Canadian government jets, paid for by Canadian tax dollars.

According to access-to-information documents obtained by the Canadian Alliance, on Feb. 8, 1999, Chretien and two aides flew from Vancouver to Minnesota, home of the Mayo Clinic. According to air force flight logs, they flew back to Ottawa that afternoon with Chretien's daughter. And on Dec. 11 of the same year, Chretien went back to the clinic, this time just with his wife and his aide.

These trips were courtesy of the Canadian Forces 412th Squadron, which has flown literally thousands of nautical miles taking Chretien back and forth to the clinic.

There is nothing wrong with Chretien wanting the very best in health care for his family -- even better care than he thinks he can get in Canada.

And there is probably nothing wrong with him spending tax dollars to fly to these international clinics. For security reasons alone, the prime minister should not have to fly on regular, commercial flights like the rest of us.

But it is wrong for Chretien to avail his family of private, U.S. health care while condemning Alberta for wanting to provide that same quality of care to all our citizens.

Of course, Chretien is not the first Canadian politician to receive private care.

Robert Bourassa, the late Quebec premier, flew to the U.S. for cancer treatment. Joe Clark, the leader of the federal Progressive Conservatives, paid cash for a suite at Toronto's private Shouldice Hospital, where he had a hernia operation in the late 1980s.

Clark tried to explain that he wasn't guilty of secretly using two-tier health care, which he had publicly campaigned against. "It's not a tier, it's a particular facility," Clark explained to reporters.

Chretien was almost caught by the press, too, on his Feb. 8, 1999, trip.

Normally, no one would have known about Chretien's whereabouts that day. The official line was that Chretien was with his family in British Columbia -- with no mention of the stop-over in the U.S.

But then King Hussein of Jordan died.

Chretien was supposed to be at the funeral, but he didn't go. He wanted to go to the clinic in Minnesota, instead. So he claimed that the air force couldn't get him to Jordan in time.

"I was in British Columbia," he told Parliament. "It was physically impossible for me to get to Amman," he said. "I went skiing with my grandchildren."

It might have been embarrassing to miss a world leader's funeral because of a family vacation.

But Chretien's advisers thought it would be much worse to admit to using a private U.S. clinic. In Chretien style, the decision was made to tough it out, and stand by the Vancouver-skiing-couldn't-make-it excuse.

Under extreme political pressure, the air force released an unsigned press release, saying it had let down Chretien by not being ready.

No mention was made of the Minnesota flight. And the next day, Gen. Maurice Baril, then the Chief of Defence Staff, held a press conference to personally accept the blame. Again, no mention of the Minnesota flight.

But air force log books aren't subject to political cleanups: they show that Chretien wasn't in Vancouver on Feb. 8, 1999. At 7:55 a.m., he flew to Minnesota, and stayed there until 4:50 p.m., when he returned to Ottawa.

So the next time Chretien accuses Klein of promoting U.S.-style health care, the premier shouldn't get angry. In fact, he should look at the Chretien family as a customer, and try to get the Chretien family's health-care business.

After all, clinics in Calgary are a lot closer to the ski hills than the Mayo Clinic -- and we accept payment in Canadian dollars.

[Lost in Manitoba]

That's funny, never heard it before. Curious what they went for....

Craig, Their is no reason Canada's social healthcare cannot adopt the management and administrative practices of the American system, their just isn't the political will or the constituent pressure to do it.

BTW, wondering where you got the $55k salary for doctors? This past year the local paper released the top 10 doctors and salaries in town. They ranged from about $150k to $300k. There's only about 50 doctors or so in town.

[RB]

you know its a very sad day when you enter into public life unless you are an exhibitionist, but you are under major scrunity.

most folks like their personal health PRIVATE.

i see nothing wrong with trust-patient relationship, like go for treatment/diagnosis etc with those you believe regardless of geography.

we are very concern and serious about health, thats for sure. goofing around my sister discovered my daughter's PDA (PATENT DUCTUS ARTERIOSUS-occurs in 3 or 4 of every 8 North American children) - and we flew her out to the UK for further examination. mostly for answers and a piece of mind. but her operation is done in canada and we now know of a risk factor, not that the folks here could not answer our questions, there is a closer relationship with those you know and trust.

that 55k US is after your good goverment took what is considered fair share taxes - do the calculation 150K @47% taxes

[theWatcher]

you know its a very sad day when you enter into public life unless you are an exhibitionist, but you are under major scrunity.

most folks like their personal health PRIVATE.

I think there is a difference between public and private life. I think it is a very sad day right now because our leader is a liar and a hypocrit.

Our health care system has been dismantled and tiered long ago. We don't have to worry about the Alliance destroying health care as the Liberals have done quite a nice job already.

[Lost in Manitoba]

I don't think it's as bad as all that, but I am definitely for reform. I worry about those who seem to think privatization is a cure-all, just as much as I worry about those who think everything is jim-dandy.

[Craig Read]

The Politico's lie about the sytem's costs [25 % understated], have no plans to curtail rising expenditiure [10 % per year in Ontario], have no plans to upgrade technology [not a part of the increased spend], have no ideas about retaining personnel [who flee to the States, where they get their asses sued by Democratic trial lawyers], and moan about access for the poor and old [to buy votes and cry on TV].

Farcical. Since when is it good governance to allow one budget item to eat up 50 % of the total government spend ? Since when it is good governance to allow billions to be wasted each year in bad management and overlapping organisational entities ?

All to buy votes and cry and weep that we care.

Care about buying votes you mean. And the sick fact is that the majority of Canadians have bought into the myth that socialised health care is noble.

Even the Brits are reforming their NHS - a loathsome inefficient and unsightly spectacle.

Inter-generational transfers are in general, immoral.

[Lost in Manitoba]

About the last part of you post Craig. Benifits for the elderly are one of the only fair and legitimate special privelages a society can give. With luck, everyone in our society (rich or poor, black or white) will someday obtain that special status. You can look at them as a burden because they use more of our social net, but have they not paid taxes all their lives?

[RB]

show me an honest politician ever, they are all liars and crooks, trying always to sway votes, and some like our good leader is a professional law'er, watch his lips move, but he is a good one, well that much term in office must tell you something of the kind of characteristic needed to become a leader in this land.

at election time i have always voted for the chretien of my choice - well the point is if i didn't vote i er would have been more actively criticizing

but check the amount of immigrants (older ones) that enter this land and did not contribute to the system

i have a problem with this

[Craig Read]

RB, i have nothing against immigrants that is for sure, and welcome ones that work hard and want to be Canadian ie. not a hyphenated African-Italian-Somalian-French-Tamil-Hindu-Sino Canadian but a Canadian. Period.

I don't mind paying for the public costs to make sure people have adequate care.

What I do mind are two things: 1. People abusing the system. and 2. Politicians and bureacrats mismanaging the system.

Health Care without reform is doomed. It is simple demographics and economics.

Gov't is not much good at anything. Except building swivel servant empires that greedily feed off of the body politic.

The great battle in Canada is over its soul. What type of nation should be created in which all have a voice. Today it is the lie-beral socialists that are winning this war.

[theWatcher]

but check the amount of immigrants (older ones) that enter this land and did not contribute to the system

i have a problem with this

Denying an immigrant healthcare services based on age is just adding another tier to the system, as well as being discriminatory. Who would decide what age would be the cut off point? It's not fair to let them into the country then deny them access to a universal system. Might as well cut off smokers, and overweight people too, or mountain climbers....

If the politicans were forced to use the same system we were and wait in the same lines as the common person you would see very rapid reform of the system.

[RB]

the intension is not to treat people unfairly, or descrimate or deny rights. the social safety nets intended to help in times of transitional worry is a haven for immigrants and gets abused classic example there are E.I. programs in place to return workers to employment in the shortest turn around time possible, yesterday, one chap revealed secretly to me that his EI ends in about 3 weeks and even though he was offered a position of similar job that which he was downsize to start Tuesday, he won't take the opportunity - [the goverment is giving him money to be at home]

those who have contributed all their lives are being pushed to the extreme just to access some type of assistance because the system are forced to create new rules and procedures on based those "rip-off" feeders.

all i am say is in the selection process of accepting new people there must be some criterion for selection so that there are greater contribute to the economy and than there are more buden upon the systems. the ontario region population is growing with immigrants and i feel very distressed that these folks live in a house on welfare and shares it with 4 different families

the canadian arm forces recuit employees up to an age limit so that they can train the folks not because they are descrimating but the incumbents have to be able to contribute and defend themselves and their land..i would like to see the same idea for immigration, the folks must be able to contribute for a number of years, or they pay for the services themselves.

whats so wrong with this

[Craig Read]

RB, you are right. The immigration system is a failure an utter contemptible mess. The quota is 310.000 per year - we don't need this many people and it burdens the health system. 60 % are not screened and over 50 % enter on 'family programs' - another Lie-beral invention [at least its increased quota is], to buy votes. So we can assume that since 40 % of the immigrants don't speak our 2 national languages and since over 50 % are on the family program that 150.000 people per year more or less are accessing our programs without having paid a dime. I hired a Colombian woman who immediately had her husband, 2 kids and herself access health care. This was before she had paid a dime in tax.

Now in her case she is paying taxes albeit not that much. But the burden on the system is palpable. If I did not hire her, she would be EI and welfare and still accessing the system. She is in high tech - in sales - good education good background, but in Toronto there are few jobs for her given her lack of fluency in English and knowlege of the local market. She was unemployed 9 months before i hired her.

Technically family program members are to be sponsored for 3 years by someone, but the gov't rarely checks the sponsor's ability to pay so many of these people within 3 years are accessing the system. There are lots of examples of Tamil taxi drivers earning $30 k per year sponsoring 10 people in Toronto.

Lie-berals will prattle about 'diversity', that Toronto is 'the world's greatest city' [if you think SARS and dirty streets are great], that we are the post modern multi-cultural nation par excellence.

More likely Canada is a convenient, easy to access and improbably naive little nation state in which immigrants, refugees, terrorist cells, criminals and people who have no intention to be Canadian, use for their own purposes.

Immigration reform and Health care reform plus a host of economic reforms are needed here.

Will it happen ? Hell no. More CBC documentaries will be shown on Canada's greatness outlining the need for more of the same.

[theWatcher]

The entire premise of the last 40 years of our government is that the population must continue to expand to create more taxpayers to pay for all of the programs that have been created. We have created a behemoth that must be continually fed.

Since our population is not increasing quickly enough we are forced to increase immigration levels to accomplish this.

Since all of our social programs are being treated as sacred and untouchable, we are not even allowed to reform them.

The only way I can think of to handle the situation fairly would be to scale health care fees based on the numbers of years you have paid into the system. So the first year of fees would have a high cost, and every year after would have a discounted rate.

A senior who has paid into the system for their entire life would have to pay no fees at all after say, 40 years (working years), whereas a 60 year old immigrant entering Canada for the first time would start right at the beginning and pay the full rate.

But even this theory is flawed as it would be hard to sustain with an aging population.

I have been involved with the immigration process lately and it is very rigid in terms of the requirements needed to immigrate here. One important distinction to keep in mind is the difference between immigration and refugees.

You are hard pressed to immigrate into canada without a lot of education and/or work experience. Bringing in an immediate family member is easier though.

I do agree it should be tightened up with perhaps some form of "points" system to make sure we have people entering the country who are better qualified.

I feel that the government wastes our money much more though. A billion dollar gun registry, HRDC mismanagement, Advertising scandals, etc would buy an aweful lot of healthcare for everybody.

The immigration paperwork i looked at last year required the family member to sponsor the immigrant for a ten year period, and the sponsor is forced to sign a contract. The contract states that the government can go after EVERYTHING, including CPP, paychecks, savings accounts, it looked very ominous.

You alos had to fill out tables listing your income and expenses with calculations that determined if you were financially able to support the person. These were quite detailed and factored in child support, alimony, and even the relationship of the potential immigrant. Spouses were given a bonus for costing less than other family members for example.

According to the paperwork, there is no way someone making 30K could support 10 people, something else must have been involved. Maybe they made 10 separate applications listing only 1 person on each, who knows.

The total immigration paperwork was 80 pages long and ended up costing almost $2,000 dollars in government fees.

Refugee's of course, have much lower eduction and work ability (in general). I am not sure of how many refugee's we take in per year compared to immigrants.

[Craig Read]

There is some good threads on immigration elsewhere on the site. 310.000 is the quota. 60 % are not screened. 40 % don't speak english or french. 2/3 or more do not have skills that our job market demands. For family programs the sponsor period is 3 yrs though in reality most access welfare programs long before this, in fact under the Charter any immigrant can demand access.

Health care is the classic socialist wage and price control monstrosity. Hold down wages for doctors and nurses, ensure no investments in technology and infrastructure are made, import drugs from the States and hold down prices to buy senior votes, ensure equal access regardless of what you have paid, ensure long line ups to services and importantly ensure that no costs are contained or rationalised.

It is the worst possible combination of wage and price controls and free riding.

NO one has made a credible case as to why the current Health Care system should not be changed.

Emotional arguments do not suffice, the system has to be economically viable.

[RB]

i don't have a problem with family bonding, but its stressing our healthcare. my street is full of multi-family such as one family owns the home and mostly both spouses parents are also there. thats good for me - disconnected our alarm system as the folks are always home but at least 30% of those parents are in the country 3 years or less and judging from their appearance i don't think they were able to contribute to any net system - and more good news there are others in my street awaiting their parents to arrive - and i am told they can access the health care system within 3 months of arrival and they don't even have to work - such good canadians we are.

but here is my take on the new immigrant, i think the immigrants need to be “Canadians” first when they arrive. this is to create some national bonding, identity and belonging.

Currently they are unprepared for the immigrant experience that includes culture shock, dismayed at the land of opportunities, dejected at what is Canada they turn inward to what they always know “homeland” somewhere else – I don’t see a country prospering when ½ of the population is bearing their souls elsewhere.

recognising immigration is very important to our economy, i like that the immigrants should speak at least at some grade level either official languages, have employable education and skills and we should have some system in place to direct folks on employment matters, or how to start up new business etc. in the quickest turn around time in order for them to contribute immediately, and in additon to other requirement, NOW they must also play one national sport such as hockey...like own some hockey items, like know what is a puck to what is power play, and also have some pride and root for a hockey team in order to become Canadian

[Craig Read]

Well having pride in a country with Post Modern PC nonsense is very difficult.

Hard to have pride in your country when your PM can't talk properly or is a crook with 11 RCMP investigations going on in his riding.

Or when your military breaks down after a troop deployment of 4000 soldiers to corral goats in Kabul.

Or when socialised health care is your defining identity - a bankrupt idea taken from Europe.

Or when your income levels are 30 % below your major trading partner.

Health Care is the epitome of a poorly run, thought out and inefficient wage and price control system.

Wage and price controls ALWAYS fail. There is not one example of such policies ever once having worked.

So where is Uncle Ernie on Health reform ???

[westcoast99]

I believe the Eves has stated that he is in favour of some privatization (though he won't say that during the campaign as it will immediately cost him the election).

I'm not aware of the specifics but if I remember correctly he was with Klein in lobbying the federal government to allow individual provinces to decide how to deliver their health care services.

Gugsy