Editore"s Note
Tilting at Windmills

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August 12, 2009

NHS SAVED STEPHEN HAWKING'S LIFE.... Legendary theoretical physicist Stephen Hawking entered the debate over health care reform in an unexpected way recently. The Investor's Business Daily ran a bizarre editorial, arguing that Democratic proposals would punish the elderly and the disabled. "People such as scientist Stephen Hawking wouldn't have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless," the IBD said.

The publication has run a minor correction, noting that Hawking does, in fact, "live in the U.K." That's a start, but it badly misses the point: the IBD's argument is that Britain's socialized system necessarily would have killed Hawking. That's backwards.

Hugh Muir had a great item on this today.

So Barack Obama is facing the fight of his life (another one) as he attempts to reform the US healthcare system. The "special interests" - doctors, healthcare companies - don't like it. The "birthers" - crazy types who hope to prove he is not American - smell blood. The danger, says the Investor's Business Daily, is that he borrows too much from the UK.

"The controlling of medical costs in countries such as Britain through rationing, and the health consequences thereof, are legendary. The stories of people dying on a waiting list or being denied altogether read like a horror script ... People such as scientist Stephen Hawking wouldn't have a chance in the UK, where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless."

We say his life is far from worthless, as they do at Addenbrooke's hospital, Cambridge, where Professor Hawking, who has motor neurone disease, was treated for chest problems in April. As indeed does he. "I wouldn't be here today if it were not for the NHS," he told us. "I have received a large amount of high-quality treatment without which I would not have survived." Something here is worthless. And it's not him.

The Investor's Business Daily, I'm afraid, is going to need a bigger correction.

It's worth emphasizing, for those who remain confused and misled, that Democratic reform proposals would not create a British system. The comparison doesn't even make sense in any substantive way, and the very premise of the IBD attack, which has been widely parroted by the far-right, reflects a fundamental lack of intellectual honesty and seriousness.

But if the right is going to attack the British NHS, it should at least try to be coherent. So far, it's falling far short.

Steve Benen 12:40 PM Permalink | Trackbacks | Comments (30)

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Comments

The bigger issue is what people with ALS go through in the U.S. Essentially, after diagnosis, people have to exhaust themselves and the financial options of their families to finally qualify for limited assistence as they deteriorate. It is horrible.

Posted by: Drew on August 12, 2009 at 12:53 PM | PERMALINK

Breaking (Fox) News:

So-called 'American' President Obama plans to base his new health care policy on the FRENCH system.

-Anyone unable to speak French will be denied coverage. . .

Posted by: DAY on August 12, 2009 at 12:57 PM | PERMALINK

FYI, Stephen Hawking is receiving the Presidential Medal of Freedom at the White House TODAY.

http://www.whitehouse.gov/blog/2009-Medal-of-Freedom-Recipients/

Posted by: cantab on August 12, 2009 at 1:00 PM | PERMALINK

So-called 'American' President Obama plans to base his new health care policy on the FRENCH system.

That would be great! It's even better than the British system, IMO.

But what does Camille Paglia have to say about all this?

Posted by: Allan Snyder on August 12, 2009 at 1:03 PM | PERMALINK

Please read the first and then the revised editorial. They're nearly two different creatures. In addition to their "correction" as a prelude to the editorial the offending paragraphs referencing Hawking have been excised. Down the rabbit hole it goes. Posterity will record the lies were never even told (they hope--or do they care?) Doing battle with this idiocy is truly akin to swinging at ghosts.

Posted by: steve duncan on August 12, 2009 at 1:04 PM | PERMALINK

Boy, I wish that any of this mattered. The astroturf rallies have given the conservadems all the cover they need to say that "real Americans" don't want healthcare reform. They will now join with the GOP and kill it.

I can hear each of them now saying, "I went home and I HEARD you on healthcare. I pledge that I will not let anyone socialize our healthcare system, especially Medicare."

They will then pass something token which will wind up increasing the insurance industries' profits and their chokehold over us all.

Game, set, and match.

Posted by: howie on August 12, 2009 at 1:05 PM | PERMALINK

In other news, America decides that the French were wrong to help them, rejoins England as a colony, gives back Statue of Liberty. Someone get them teabags out of Boston Harbor.

Someone better "break" it to FOX (also that "French" fries are Belgian, and French's is the most popular mustard on hotdogs). and then maybe we can get better health coverage through hthe NHS ;)

Perfect timing on that medal for Hawking.

Posted by: royalblue_tom on August 12, 2009 at 1:08 PM | PERMALINK

I'm sure that Dr Hawking was misquoted.

Hise electronic voice unit was probably supplied by the NHS and hence is poor technology. Plus it's probably programmed to filter out negative comments about the NHS.

Dr Hawking is probably screaming silently for help that only the American medical system can provide.

Posted by: Al on August 12, 2009 at 1:13 PM | PERMALINK

The stories of people dying on a waiting list or being denied altogether read like a horror script ...

Golly, just like the good ol' corporate health insurance plans here in the US!

Posted by: Michigoose on August 12, 2009 at 1:24 PM | PERMALINK
royalblue_tom @ 1:08: ...and French's is the most popular mustard on hotdogs

Too bad I didn't think about that when they were all up in arms over Dijon. Maybe mustard in all its forms is unpatriotic and anti-Christian?

Posted by: JTK on August 12, 2009 at 1:27 PM | PERMALINK
Al @ 1:13: I'm sure that Dr Hawking was misquoted.

Hise electronic voice unit was probably supplied by the NHS and hence is poor technology. Plus it's probably programmed to filter out negative comments about the NHS.

Dr Hawking is probably screaming silently for help that only the American medical system can provide.

Al, you're roots are showing. I've been wondering lately how long a parody troll can resist the dead-giveaway comments like this one. Cute!

Posted by: JTK on August 12, 2009 at 1:31 PM | PERMALINK

Here's hoping he takes the opportunity of to comment again on how the UK's health care system has protected his life.

Posted by: Nothing But the Ruth on August 12, 2009 at 1:35 PM | PERMALINK

On a side note.

Hugh Muir: "The 'special interests' - doctors, healthcare companies - don't like it"

Actually, the legislation that passed the House committees is supported by the American Medical Association, the College of Surgeons, Doctors For America, Physicians for a National Health Program, some of the cardiologist groups, some of the pediatrician groups, as well as a large majority of the nurses.

Posted by: Joe Friday on August 12, 2009 at 1:35 PM | PERMALINK

Anyone care to look up Sarah Palin's record in AK for people dying from lack of funding for medical services in AK? Death Panels, indeed.

Posted by: st john on August 12, 2009 at 1:38 PM | PERMALINK

I commented extensively on the last Stephen Hawking post, so I'll try to keep this focused on the topic (see the comments from a couple of days ago if you want more info on the disease itself). As the primary caregiver for my mother, who has ALS and has been on a ventilator for almost two years, I have dealt extensively with what health care services the US offers to those with the disease. People kept advising my mother to "stay away from Medicare" before she suffered from respiratory failure. An ALS diagnosis (or any of the subsets in the motor neurone disease family) qualifies a person for immediate Medicare, unlike other diseases that require a two-year waiting period after getting on Social Security Disability (end-stage renal failure is the one other disease that I know of where someone can get immediate Medicare). My mother did *not* apply for disability or Medicare because we heard all these horror stories about Medicare. She stuck with her private insurance, which often meant having to call and dispute declined claims or, worse, flat-out not having access to certain services because the insurance wouldn't give a pre-authorization. We worried that Medicare would be worse.

Then when she suffered from respiratory failure and decided to get a tracheotomy, we learned that we would need to get on Medicare immediately because private insurance wouldn't pay for the total amount of time that she needed to spend in a long-term rehabilitation hospital so that we could be trained in her care, allowing her to live at home instead of in a nursing home. In fact, at first they didn't even want to pay for her to go to the hospital at all--they thought she should go straight to a nursing home (where she would have died shortly thereafter due to the fact that nursing homes have a harder time with infection control, plus she wouldn't get the constant attention that she needed).

I set up an appointment at the local Social Security office, and the very kind person who processed my mother's application pushed the app through at lightning speed. Within two weeks, my mother was on disability *and* Medicare (the coverage was provided retroactively to reflect the amount of time that she *should* have been on Medicare due to her deterioration). Medicare has been a blessing for us. It would be nice if Medicare would pay for private-duty nursing (we haven't "spent down" enough to qualify for Medicaid yet), but other than that, everything is covered at 80% (100% for home health scheduled visits).

Unfortunately, Medicare did not get processed before my mother went into the long-term hospital. She was in limbo in the ICU (taking up a bed that someone else probably needed) for an extra week while we waited for insurance to cave and authorize the long-term facility. Then the insurance said that she had to be discharged the day before Thanksgiving, before we were really "ready" for her to come home (advice: never, never get discharged with a chronic critical condition the day before a major holiday). One of the durable medical equipment items didn't work that night, I couldn't get anyone from the company to come check on it because of the holiday, and our original "nursing" provider turned out to have misrepresented the skill level of the person who served as our overnight caregiver while I was (halfway) sleeping. On Thanksgiving morning, my mother stopped breathing, turned blue, and I performed CPR on her while fielding a 9-11 call (the aide panicked and couldn't do anything to help me, to the point where the dispatcher thought the aide was actually a small child). That was in 2007. We found out the Monday after Thanksgiving that my mother's Medicare had been approved, and since then, she has never been discharged from a hospital prematurely (there is a Medicare provision that prohibits hospitals from discharging before the patient is ready to go home). My mother is still here at home with me today.

OK, I've given enough personal details that if anyone who knows me reads this, my anonymity is shot. But at this point, I am not sure that I care anymore, as much as I value privacy. I'm tired of this twisted debate that misrepresents facts, especially when I can say what is actually going on with health care for the "Stephen Hawkings" in the US. My mother isn't a brilliant scientist or celebrity. She is just a "regular" but extraordinary human being who has been treated in an amazingly dignified manner by our socialized medical system, and everyone who meets her can sense what a special person she is. Obama doesn't want to kill her or anyone else. When a relative who works up in DC called his office last fall to share her story, the result was that we received a personal, caring, encouraging, inspirational letter from him the day after the election. But ultimately, this health care debate isn't about my mother. It's about the millions of people who deserve the same compassion and respect that she has received.

Posted by: Cindy McCant on August 12, 2009 at 1:59 PM | PERMALINK

[T]he IBD attack, which has been widely parroted by the far-right, reflects a fundamental lack of intellectual honesty and seriousness.

As such, it is a perfect example of the US right wing in general.

-Z

Posted by: Zorro on August 12, 2009 at 2:29 PM | PERMALINK

Why are Democrats exploiting this poor crippled man? Why did they drag him into the middle of this health care debate? Stop playing politics!

Posted by: Conservatroll on August 12, 2009 at 2:39 PM | PERMALINK

It would also be useful to point out that Dr Hawkings would be un-insurable in the United States. He developed amyotrophic lateral sclerosis while at University which means he would not have been able to get insurance when and if he entered the workforce.

Posted by: GregR on August 12, 2009 at 3:25 PM | PERMALINK

As someone from the UK, it seems worth pointing out that the NHS is not the only provider of care in the UK and it is in no way perfect.

What it does do is provide a much higher base line service than the current US service. This can be seen in the cost of additional private insurance for health issues. For a family of 4 good insurance in the London area will cost about $1,500 per year, would people in the USA like to comment on the costs of their insurance (paid by them or the company they work for).

Posted by: Roger on August 12, 2009 at 3:26 PM | PERMALINK

Pretty amazing that IBD's correction indicates only that Mr. Hawking lives in the UK , but the piece now has removed any reference to him. This correction, then does not rebut the charge that he would not have been treated in the UK, but lets stand the implication that NHS would deny care for the disabled or elderly which he clearly misproves.

Roger: $1,600 a month family coverage (now through COBRA) = $19,200 a year. New job has no benefits so that's is a direct offset on income.

Posted by: hads on August 12, 2009 at 5:29 PM | PERMALINK

"It would also be useful to point out that Dr Hawkings would be un-insurable in the United States."

Actually, he would be insurable through Medicare. The problem is that ALS patients used to be required to wait 24 months from the date of disability before becoming eligible for Medicare. Congress passed a law in late 2000 to eliminate the waiting period (recognizing that the debilitating disease can progress to end-stage in less than two years, as it did for my mother). Dr. Hawking developed his disease long before 2000, so he would have had to deal with the two-year wait. Medicare pays only 80%, though, so he would have been responsible for the additional 20% out-of-pocket until he "spent down" his assets to qualify for Medicaid.

A couple of other things: Once someone goes onto Medicare for disability, private insurance stops paying for services that are not Medicare-eligible. In other words, if your insurance policy offers services that Medicare does *not* cover (i.e., private-duty nurses in the home), they will no longer pay for those services once the policy is a "secondary" insurance (Medicare is always primary). They also pay at the same rate as Medicare. For instance, if a provider bills at a higher rate than Medicare will pay for, Medicare pays 80% of what is considered the "established" amount for the service. Our experience has been that Medicare does not always make a cost adjustment--for instance, one of our durable medical equipment companies was reimbursed for 80% of the actual fee that they billed (for a power wheelchair). We saw a hospital bill for more than $135k one time, and I can't imagine a billing agency would seriously expect to get 80% of that amount as payment from any insurance company, "public" or private. Then after Medicare has paid 80% of whatever it thinks is "reasonable," the private (secondary) insurance will pay 20% of the rate that Medicare established. In other words, insurance companies are profiting off of Medicare's negotiated pay scales (except for prescription drugs, as has been noted in this ongoing debate), without actually having to do any legwork on the claims adjustments. Medicare indirectly provides this service to the private insurance industry. Of course, Medicare isn't really "government" insurance--where we live, it's run by Cigna.

But back to ALS today, Medicare is available immediately, unlike when Hawking became ill. The problem is when you don't have secondary insurance before you get sick, or if your insurance drops you. And where we live, Medicare Supplemental policies aren't available (state regulation) to those who are under 65 and on Medicare due to disability. So if you don't have secondary insurance, you either pay the 20% yourself or try to qualify for Medicaid. Plus, the system varies among the states.

Posted by: Cindy McCant on August 12, 2009 at 7:22 PM | PERMALINK

Are you all delluded? Americas health care system is one of the worst in the developed world and whilst the NHS is not great....it's a MILLION times better than the disgusting way people are treated in America.

You insure your bodies like you'd insure a car.

And for you uneducated lot it's worth pointing out the French (alongside Norway) have one of the best health systems in the world.

Crawl back under your rock America and get back to us when you can label more than 2 countries on a map.

Posted by: Richard on August 13, 2009 at 4:19 AM | PERMALINK

I am British and would like to point out some facts that some of you nieve people in the USA might not know.

1, We can get to see a Doctor 24 hours a day 7 days a week and it's Free.

2, Our NHS hospitals are just as good if not a better standard than the ones in the USA, and we don't have to pay big insurance premiums, or put it simple if you lose your job you can still get medical treatment. In the good old USA, if you lose your job: OH DEAR

3, Where I live you don't have to pay for prescriptions, medcation is FREE.

4, If you have cancer or any serious illness, you can get life saving treatment free on the NHS, and usualy will get to see a Consultant very quickly.

5, Did you know you can even get IVF treatement on the NHS, oh and by the way it's FREE.

Oh and if your thinking that we pay any more tax to pay for the NHS than you do in the US, it might just be worth mentioning that the standard rate of tax on income in the United Kingdom is 20 percent.

In short I think the system we have in the United Kingdon I LIGHT YEARS ahead of what you lot have!!

Posted by: Jonathan Mills on August 13, 2009 at 3:46 PM | PERMALINK

Truth
Day 1
Tripped and Fell
Ambulance called and prioritized to our remote rural home in evening
Ambulatory staff competently checked patent in home
Ambulatory staff competently checked patent in Ambulance on way to our preferred hospital
Hospital Staff immediately received patient and competently checked patent including a vast number of blood checks
Pain killers administered to appropriate levels
X-Rays undertaken
Diagnosis made
Patent given bed in ward
Day 2
Anaesthetist checks patent
Anesthetic given
Surgery undertaken
….morning over
So in the space of 12-18 hours the patent was collected from rural home and underwent Hip Replacement
Her age 85
Did her age affect the British West Suffolk Hospital’s decision making
Yes
The effect was to prioritize her attention from the medical staff
The NHS - far from perfect but
did she have to undergo wealth checks? No
was payment needed? no
- it’s the National Health Service
I think that the slogan was “Cradle to Grave” when introduced
well she’s to old for the Cradle part - I got that part as her son - but she is getting the “to Grave “ bit
an 85 year old injured woman got all the required attention from the NHS - doesn’t make a good headline but it happens every day ….


The NHS - far from perfect but, far better than most

Posted by: ynotoman on August 14, 2009 at 2:29 AM | PERMALINK

I am British.

I and my family have always used the NHS and have never been treated privately, contrary to the rumours spread by republicans and conservatives we are still all alive and doing well.

The NHS has provided treatments for my family relating to cancer, asthma and heart disease to name but a few, none of them were refused because of cost or age.

It is the greatest testement to the UK that there is.

Posted by: James Warrington on August 14, 2009 at 3:48 AM | PERMALINK

Having read some of the comments by conservative american politicians i think they all miss the point and that is the NHS delivers health care from conception to death and the founding principle of the NHS is that it is free at the point of delivery irrespective of religion,colour,or ability to pay.
Yes we do pay through our taxes,but at least we do not face any bills when we need the service.
I also speak as somebody whose wife has undergone exstensive treatment for cancer in the last 18 months,no waiting ,no rationing just top qualitiy care given by first rate staff.Like any system it is not perfect no system has yet been devised that is perfect but it suits the UK.
Rebudlcans i suggest that you are not qualified to comment on our system of health care as i am equally unqualified to comment on yours.If you want to pass judgement on our system then i suggest that you have to experiance it first but do not tell lies about our system.
I believe that the NHS is a great health care system it is worth fighting for and defending from ill informed comments from any politicianin any party in any country

Posted by: dave smith on August 14, 2009 at 4:06 PM | PERMALINK

Having read some of the comments by conservative american politicians i think they all miss the point and that is the NHS delivers health care from conception to death and the founding principle of the NHS is that it is free at the point of delivery irrespective of religion,colour,or ability to pay.
Yes we do pay through our taxes,but at least we do not face any bills when we need the service.
I also speak as somebody whose wife has undergone exstensive treatment for cancer in the last 18 months,no waiting ,no rationing just top qualitiy care given by first rate staff.Like any system it is not perfect no system has yet been devised that is perfect but it suits the UK.
Rebudlcans i suggest that you are not qualified to comment on our system of health care as i am equally unqualified to comment on yours.If you want to pass judgement on our system then i suggest that you have to experiance it first but do not tell lies about our system.
I believe that the NHS is a great health care system it is worth fighting for and defending from ill informed comments from any politician in any party in any country

Posted by: dave smith on August 14, 2009 at 4:08 PM | PERMALINK

I would indeed like to comment on this current story of Obama and The NHS.
"I wish we had Obama running this country"
I have spent the past year emailing, writing, preaching, web building, making a Documentary and very shortly up and down the country showing a self made amateur Doc of my story.
The NHS would be a great system if it wasnt run like a business and depended on Statistics to meet requirements, Oh sounds like the Police Force, seem to be growing a pattern.
In brief:
My mum who was only 50 and was the heart of my family and grandchildren was let down very badly and treated like a hypochondriac. She was deceived by her GP who was only interested in getting her in and out as quick as possible, of whom she saw for 20 years very regularly. She was also in and out of The Haemotology Dept at the Hospital every couple of months for 10 years or so.
Yet they all seem to ignore the fact that mum had several Cancers growig inside of her and was slowly killing her. She commonly asked if there was anything bad to worry about and mentioned Cancer on many occasions, but they disregarded it and said there is nothing wrong "stress related". They even caused my mum to have a massive Heart Attack when swapping a drug she was on to something else. On top of that the stress being caused in her personal life, of which was a truth in this matter caused her to have a stroke! A migraine they said!!!!
The last two weeks of her life in August 2008 she bloated, became Jaundice, Delirious and bleeding from every orifice she was kicked out of A&E dept at the Hospital Three times! Stress Related!
when finally listened to, her GP was no where to be seen and she was told on her own very incoherant she is dying of Lung Cancer and has days to live. We then rushed to get a second opinion and before we even breathed she was rushed off to a Hospice without our knowledge and died that night!
The GP even turned up at her funeral!
I have been through complaints and all sorts of meetings and met with nothig but Incompetence and disregard for human life. The Medical Dircetor even tried to convince me my mum was lieing and knew what was happening to her and chose to keep it to her self.
I have the med records and that shows a very different picture, besides they never had my mum crying in their arms wondering why they and the GP will not listen to her!!!
Sadly I am not the only one in this case, this is happenig all the time and to thousands of people, most people are not prepared to come forward or complain because there isn't any point. Nothing will bring their loved one's back so why go on about it?
Well I will not let my mum die in vein and let the people involved get away with treating her like a piece of meat when she has paid into a system that is supposed to protect her.
The NHS is filled with money Grabbing Buearocrats and many many Inexperienced Foreign Doctors and Nurses. Doctors and Nurses that are brought in from other countries because they are cheaper than our own specialists. Some of the Foreign Docs are fantastic and do a great job and some of the Hospitals do a wonderful job but sadly 70 percent of the NHS is the bad sector and is killing most of us unnecessarily.
So Obama good luck and maybe we can learn from what he comes up with!
yours Sincerely
Dean Rees
Son of Susan Rees

www.myspace.com/nhspatientsvoice


Posted by: dean rees on August 15, 2009 at 9:10 AM | PERMALINK

QUOTE: "Actually, he would be insurable through Medicare."

Stephen Hawking was diagnosed with the disease when he was 21 and has lived with the disease for 46 years. He is now 67 and would have, theoretically, qualified for Medicare 2 years ago. What about the previous 44 years? He has stated that he credits the NHS for the fact that he is still alive.

Brits like to complain. They complain about the government, the weather, the fact that they only get 6 weeks vacation a year. They also like to complain about the NHS. But, if you were to tell any one of them that their NHS would be taken away and replaced with an American-style system they would be horrified (and terrified).

Posted by: Nan on August 15, 2009 at 11:35 AM | PERMALINK

I don't want to presume what is right for Americans (I love the USA), but I'd like to set the record straight from this side of the Atlantic

I know about the National Health Service in the UK because it has kept me alive after fifteen years of living (sometimes struggling) with HIV, and after countless illnesses and plenty of scares, I am now thriving. It is also delivering for my mother, for my family and for friends.

There are three principles that guide our approach here in the UK that I think are misunderstood or misrepresented in your debates.

First is respect for the Hippocratic Oath: Here in the UK the relationship between primary care provider (General Practitioner) is continuous and ongoing (though you can change doctors if you want and when you move locality), and specialists treat you according to need. We have continual gripes about "zip-code lotteries" for access to local or specialist services, but the care is nationwide, universal, from the cradle to the grave, and our system encourages patient empowerment. I have just changed my HIV consultant and clinic after ten years, and my old file was on a new desk, no questions asked, at my appointment date, with no loss of continuity of care or concern.

Second is that money never changes hands, and ability to pay is simply not a factor in our health care. It doesn't matter whether you are in work or not, an impoverished elderly person or a high-flying executive, care is (by and large) appropriate to need. This is a benefit of a single-payer universal system, which for all its faults spreads risks (and costs) to make health care attainable for all. We pay half of the US in GDP on health and have better results. And we don't ever have to worry about ourselves or our families affording to be ill. Never � money is not an issue. I say this as a high-earning taxpayer. I appreciate our system, and am happy to pay for it, not just for myself but also for the health of my community. If you�re in a job and not in one of the exempted groups (unemployed, incapacitated, elderly, juvenile etc) we pay for prescriptions, but for those who need a lot of medication we have a system of a �104( that�s US $172)single payment all-in annual fee for all prescriptions.

And it is the recognition that one persons� ill health may affect others� well-being that is the third tier, I think, in the UK integrated approach. Our health service aims to protect seriously mentally ill people here from harm to themselves or to others; we immunise all � free or charge � to protect against disease where appropriate [The UK has a national plan against pandemic flu, which will roll out in the autumn]. Our NHS runs quit smoking and drug dependency and mental health services, and family counselling efforts: Our health service aims to keep us (and our community) well - healthy, sane, productive - without needing to check the fine print on an insurance contract.

To counter the myths: here in the UK doctor and patient relationships are at the heart of our health service; our system aims to make you well and keep you healthy irrespective of age or ability to pay; it also aims to protect and defend the health of the community...we have our imperfections, nonetheless, but please don�t misrepresent, or underestimate, the esteem the we have for our National Health Service.

Posted by: Shane in London on August 16, 2009 at 5:22 PM | PERMALINK




 

 

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