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Oregon Health Plan has already weighed the cost of life ...

And guess which way the balance tipped:

(July 31, 2008) Barbara Wagner has one wish - for more time. "I'm not ready, I'm not ready to die," the Springfield woman said. "I've got things I'd still like to do."

Her doctor offered hope in the new chemotherapy drug Tarceva, but the Oregon Health Plan sent her a letter telling her the cancer treatment was not approved.

Instead, the letter said, the plan would pay for comfort care, including "physician aid in dying," better known as assisted suicide.

"I told them, I said, 'Who do you guys think you are?' You know, to say that you'll pay for my dying, but you won't pay to help me possibly live longer?' " Wagner said.

Dr. Som Saha, chairman of the commission that sets policy for the Oregon Health Plan, said Wagner is making an "unfortunate interpretation" of the letter and that no one is telling her the health plan will only pay for her to die.

[...]

Saha said state health officials do not consider whether it is cheaper for someone in the health plan to die than live. However, he admitted they must consider the state's limited dollars when dealing with a case such as Wagner's.

"If we invest thousands and thousands of dollars in one person's days to weeks, we are taking away those dollars from someone," Saha said. (emphasis added)

According to Oregon Health and Science University, the Oregon Health Plan (administered by the State of Oregon) "will not cover the cost of surgery, radiotherapy or chemotherapy for patients with a less than 5% expected 5-year-survival. However such patients are eligible to receive comfort/palliative care, which includes 'services under the Oregon Death with Dignity Act' (physician-assisted suicide), 'to include but not be limited to the attending physician visits, consulting physician confirmation, mental health evaluation and counseling, and prescription medications'."

Barbara Wagner had been diagnosed with lung cancer two years earlier, and the cancer had gone into remission after chemotherapy and radiation treatments. When the cancer returned in May 2008, her physician prescribed Tarceva because the drug has been shown to significantly extend the life expectancy of patients with inoperable cancer. It turns out that chemotherapy with Tarceva would have cost the state of Oregon around $4000 a month, while the cost of drugs for "comfort care" would only be around $100 a month. Fortunately for Barbara Wagner, Genentech, the company that markets Tarceva in the United States, agreed to cover the cost of Wagner's medication.

It seems increasingly more clear that under a state-run single-payer health care system, where there are few real choices and no alternative treatment options, we will see an explosion of cost/benefit analysis programs designed solely to put a dollar value on human life. Undoubtedly the government will, in many cases, determine that it will be cheaper to deny treatment and then settle wrongful death claims in court, than to pay for expensive or experimental medical treatments during the last months of a claimant's life. This is essentially the same decision made by Ford Motor Co. when they opted to pay for wrongful death or injury lawsuits, rather than to fix the Ford Pinto's gas tank.

(h/t Protein Wisdom)

...

ADDED: A sobering point made several years ago by Steve Sailer, writing then about the imminent death of Terri Schiavo:

... [M]illions of Blue State Baby Boomers are in line to inherit a bundle ... but not if Mom or Dad lives forever or, especially, if his or her slowly declining health requires a fortune in expensive care. A nice quick fatal heart attack would do the trick, but with Lipitor and the like these days, oldsters are going slower.

So, when you wonder why a lot of people, especially Democrats, are okay with starving Terri Schiavo to death instead of having her kept expensively alive, follow the money.

It's hardly the only reason, but it's out there, and part of a big topic that almost nobody wants to talk about in 21st Century America.



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Comments (41)

Great picture over at Lucia... (Below threshold)
MPR:

Great picture over at Lucianne.com. Obamacare cash floe. Wraps up several of Obamalala's "stupid" pet policies into one. It should go viral like the Obama "joker" picture.

April 27, 2014Am I... (Below threshold)
Upset Old Guy:

April 27, 2014

Am I missing something here? We're all going to die some dau. That is an absolute fact. So what's the big deal now?

There is no reason for anyone to NEED to see a physician. Not ever, under any circumstances, do YOU have to be seen by a doctor.

Just admit to yourself, you're terminal. From the day you're born you are terminal. Embrace reality and you'll feel better.

Have a nice day,

Your ObamaCare Representative

I was going to propose that... (Below threshold)
DaveD:

I was going to propose that since extraordinary care may become a thing of the past there is really no reason not to pare back or eliminate completely the National Institutes of Health and their funding and oversight of biomedical research at universities across the nation. I mean why research sophisicated and heroic biomedical cures if they are too cost prohibitive to implement clinically.

I don't think I buy that th... (Below threshold)
James H:

I don't think I buy that the Oregon situation automatically means single payer is evil. If that woman were on a private plan, then there's a good chance that private plan would also choose not to pay for her care.

hmm, maybe 6 kids ar... (Below threshold)
macofromoc:


hmm, maybe 6 kids are to expensive on the plan. 2 children per household? one? far fetched?? who can say

...also what if ever... (Below threshold)
macofromoc:


...also what if ever a treatment is ever covered.. Democrats basline everthing to race and or gender. Will there be quotas for treatments. Are we ready for that?

If that woman were on a ... (Below threshold)
iwogisdead:

If that woman were on a private plan, then there's a good chance that private plan would also choose not to pay for her care.

In which case she could file a lawsuit, win, and get the treatment she needs. I've never heard of a "5 % expected 5-year-survival" exclusion in a health policy, and even there were such a thing, it would be unenforceable as against public policy.

Unfortunately, she apparently does not have a private plan, so she's SOL.

Re: "Fortunately for Barbar... (Below threshold)
Hank:

Re: "Fortunately for Barbara Wagner, Genentech, the company that markets Tarceva in the United States, agreed to cover the cost of Wagner's medication."

I doubt this will be allowed when the govt completely controls health care; can't have bureaucratic decisions undermined this way.

Every legislator who voted ... (Below threshold)
btenney:

Every legislator who voted for this abomination should be stoned to death by the citizenry.

Wagner should offer an OHP ... (Below threshold)
Les Nessman:

Wagner should offer an OHP official if she could assist in their suicide. Nothing wrong or illegal with making the same friendly suggestion back at them, right? You know, return the favor. She could even offer to do it for free, as opposed to Wagner paying taxes for the 'privelege' of OHP helping to bump her off.

And if it is illegal for her to offer her 'help', what are they gonna do to her? Give her a death sentence? har-de-har

/some sarcasm

In which case she ... (Below threshold)
James H:
In which case she could file a lawsuit, win, and get the treatment she needs. I've never heard of a "5 % expected 5-year-survival" exclusion in a health policy, and even there were such a thing, it would be unenforceable as against public policy.

Well, no, a private insurer would offer scenarios only somewhat more appetizing:

1) She could bump up against her lifetime maximum or annual maximum benefits.

2) The insurer could refuse payment if a proposed cancer treatment is classified as experimental. Or, if she's on an HMO, the HMO may not have the drug on the list of drugs it covers.

3) The insurer rescinds her policy because she forgot to disclose a bad case of acne from when she was 28.

Thing is, any public payer plan worth its salt is going to have an appeals process. And if Oregon's plan lacks that process, it needs to institute it.

Perhaps Ms Wagner should ma... (Below threshold)
Zelsdorf Ragshaft III:

Perhaps Ms Wagner should make a personal visit to the offices of the good Dr. Saha, bringing with her close friends Mr. Smith and Mr. Wesson to help her in negotiations with the Dr. I have heard that Smith & Wesson can make a powerful arguement or even settle one. I am positive the good Doctor would gladly revise his thinking on the matter when presented with the logic Smith & Wesson provide. Also helpful is that Italian fellow, Berretta or that German, Glock. I know this is a contradiction in terms however an old colt, say one born about 1911 can be influential. Some folk believe snakes can help make decisions. Pythons in particular. Citizens have the right to defend their own lives. Sometimes the threat is insideous as a single payer healthcare system would be.

James H., these three scena... (Below threshold)
iwogisdead:

James H., these three scenarios you have made up miss the point of my post and this thread. Besides, I've seen no indication that Tarceva is an experimental drug, and the Oregon health official did not claim that it was.

The point of my earlier post and of this thread is that Oregon has denied this woman the treatment she should get for the worst of possible reasons--she's just not worth it. No court would let a private insurer get away with that.

This is a glimpse of our future under the government option. Treatment by actuarial table.

My 10 year old was diagnose... (Below threshold)
Tom Kelly:

My 10 year old was diagnosed with a less than 5% chance of surviving 5 years with a brain tumor. Estimates were about 6 months to live.

He died in 4 years rather than 6 months due to multiple surgeries, radiation, and an experimental treatment.

Those four years represent 30% of his lifespan. Whatever the cost, they were worth it.

Back in the 80's, my sister... (Below threshold)
SCSIwuzzy:

Back in the 80's, my sister had a cerebral hemorrhage. Luckily she was in Pittsburgh at the time, which had one of the worlds only (and the only other 2 were also in the USA)laser brain surgery units. She had a 15% chance of survival, 0% if she were at home in NJ.

Would govt funded care spend the money to create a program that would only provide 15% chance of survival, and only if the patient was treated within hours of the injury? Esp since it took years and millions of dollars to even get to that 15%?

She's alive today, with a loss of vision, celebrating her daughter's 8th month. If she didn't tell you, or wasn't wearing her glasses with a Fresnel lens, you'd never know she was ill 24 years ago.

The private sector will spe... (Below threshold)
JLawson:

The private sector will spend millions on health care research. Why? Because of the potential of making much more from selling the results.

Public sector health care? No research, no innovation, and the cheapest ways of doing things will become the standard.

A good parallel might be how the USSR and the US developed PCs. There wasn't a monolithic government agency directing through 5-year plans how software and hardware were developed in the US - instead you had massive numbers of companies (lots of whom failed in their attempts to grab market share - anyone else remember Everex? Or the Samsung PCs in the late '80s? AST PCs?) chasing what they thought would be most profitable. And after economic evolution - look at what we've got today.

(As a side benefit - the Internet came about. Mixed blessing, eh?)

The Soviet PC market? They had to reverse engineer items bought in the free world. They simply couldn't match the speed of innovation in an unrestricted economy.

Take a look at cell phones - think there'd be so many makes and models of them if there were only one carrier? Or that the cost would be so low, features so numerous, with coverage so complete?

Now - just why again is it that it's supposedly 'better' for health care to be handled by the government?

And of course Big Brother c... (Below threshold)
OLDPUPPYMAX:

And of course Big Brother can't get his hands on any of that inheritance unless mums and daddums DO die. Can't be an estate tax until there's an estate!

James H in #4 above is righ... (Below threshold)
The Obvious One:

James H in #4 above is right. HMO and health insurance firms weigh these kinds of decisions all the time.

No difference - no wait -- the difference is that under a government-run plan you eliminate the profit motive of the decision-maker.

How many people will die because of the delay tactics and foot-dragging by Republicans doing the bidding of the HMOs and Pharmaceutical giants who oppose this plan?

ObamaCare will reduce health care costs and cut profits for these giants -- but more importantly it'll save lives.

Oblivious One, If ... (Below threshold)
Upset Old Guy:

Oblivious One,

If my health care insurer refuses me I have the State Insurance Commissioner to whom I can make an appeal. I also have the ability to bring a law suit against the insurer.

Under ObamaCare? Hell, you can't even sue the Federal Government without first getting their permission.

Upset Old Guy --If... (Below threshold)
James H:

Upset Old Guy --

If you're concerned about a government-run public option denying you care, then why don't you call your congressman and ask him to ensure that the legislation includes a robust appeals process?

ObviousOne --

No difference - no wait -- the difference is that under a government-run plan you eliminate the profit motive of the decision-maker.

That's a little obtuse. Whether you're talking about a rescission-happy private insurer or a federal health-care regime (think the VA), there's a large amount of pressure to ensure that claims are not granted, thus saving the insurer (or the government) money.

I'm actually not in favor of a pure public payer system, or even a pure private industry system. I don't think either one is optimal.

I'm tired of people implying that either a single-payer system or private insurers deliver results that are totally positive or totally negative. Neither one will.

And I continue to believe there is little practical difference between an insurance bureaucrat and a government bureaucrat.

If isurers were encouraged ... (Below threshold)
Zelsdorf Ragshaft III:

If isurers were encouraged to offer their services across state lines competition would increase and people would get the benefit. The government has ruined everything it has taken charge of. There is no constitutional right to healthcare.

First, we get rid of privat... (Below threshold)
bobdog:

First, we get rid of private insurance plans. Read the law before you go denying it.

Next, when costs explode to the point where not even Democrats can print money fast enough, health care rationing will follow just as certainly as the sun will come up tomorrow. Just like it did in this case in Oregon, just as it has in the UK, Canada, and everywhere else it has been tried. Old people account for a large portion of medical care, and they have the poorest chances for recovery. Besides, they're worn out anyway, like unused cell phone minutes.

If you can't grasp that simple fact of life, Oblivious One, you've been spending way to much time at the Hope and Change concession. You're either pathetically stupid or a willful liar.

Health policy excluded cove... (Below threshold)
ch:

Health policy excluded coverage if less than 5% chance of living more than 5 years? That would exclude all coverage for pancreatic cancer.

Tarceva (used among other things as a second-line drug for chemotherapy for pancreatic cancer) is extraordinarily expensive, list price is about $6,000/month. But health plans often negotiate much lower rates, e.g., less than $2,000/month.

#20. James H"Upse... (Below threshold)
Upset Old Guy:

#20. James H

"Upset Old Guy -- If you're concerned about a government-run public option denying you care, then why don't you call your congressman and ask him to ensure that the legislation includes a robust appeals process?"

James, you're question/statement assumes (a) I haven't already done that and (b) that my Congress Critters would ensure it's inclusion if I were only to ask. Bad assumptions in both cases I fear.

I, on the other hand, assume that "a robust appeals process" isn't already in there simply because they don't want it there (Occam's Razor).

James H. wrote, "Thing is, ... (Below threshold)

James H. wrote, "Thing is, any public payer plan worth its salt is going to have an appeals process."

Yes, but how long is an appeal in Federal court, with the Federal government as the defendant, going to take? For rapidly advancing diseases like cancer, the window for medical decision-making can be as short as 6 to 8 weeks. A two month wait can mean the difference between an operable and inoperable tumor, or a tumor that responds to chemotherapy vs. one that doesn't.

I can't imagine a Federal appeals process shorter than six months, with probably 12 to 18 months being the average (this is the Federal government we're talking about, remember).

For people like Barbara Wagner, such an appeals process would be too little, too late.

#21: There is no constit... (Below threshold)
hyperbolist:

#21: There is no constitutional right to healthcare.

Are the only things worth pursuing those which are explicitly laid out in the Constitution? And is it totally beyond the pale to suggest that perhaps some things which are not enshrined in the Constitution ought to be?

. . . why don't you call... (Below threshold)
iwogisdead:

. . . why don't you call your congressman and ask him to ensure that the legislation includes a robust appeals process . . .

Maybe because it would do no good. Appellate review of administrative action within an agency, and in the courts outside the agency, is very limited. The National Medical Review Board (I just made that up), as an administrative agency, would simply follow its own rules. If there is something akin to the "5 % expected 5-year-survival" standard--and you can bet the ranch that there will be sooner or later--the National Medical Review Board would have no power (or motivation) to say that the standard is unfair or unfairly applied.

With an insurance policy, at least the parties are protected by their ability to contract and the law of contracts. The patient has the option of seeking a different carrier or treatment outside of insurance. And policies don't exclude coverage on the basis of life expectancy, and even they tried, it wouldn't be enforceable.

We citizens will have as much input into the regulations dictating our healthcare under the government option as we do now for regulations promulgated by the Atomic Energy Commission and the EPA--in other words, none.

Even more painful will be that, once our health regulations have been decreed by a bunch of political hacks, the government will make any treatment not authorized by the government illegal. No doctor would offer unauthorized treatment, because to do so would put her license at risk.

Better get those knee replacements while you can folks! This offer won't be open too much longer!

Hyperbolist, you raise a go... (Below threshold)
DJ Drummond:

Hyperbolist, you raise a good and important question. The short answer is 'no, the Constitution is not a wishlist' but the question deserves a better discussion on its own. I will work up a post on that shortly.

Are the only thing... (Below threshold)
James H:
Are the only things worth pursuing those which are explicitly laid out in the Constitution? And is it totally beyond the pale to suggest that perhaps some things which are not enshrined in the Constitution ought to be?

Suggesting something should be in the Constitution is not "totally beyond the pale." But that doesn't mean it's a good idea. If you slap into the Constitution a social obligations amendment -- something like "The Federal Government or the States shall guarantee to each citizen therein care for their health, a quality education, and a lollipop" -- then you place on the federal government a crippling constitutional obligation to spend money on social programs. Appropriate money to inspect food at the ports? Nope. Rita Mae Jennings in Butte, Montana, just filed a lawsuit because her school is falling down. And she has a right to a quality education. Funding for a new generation of unmanned areal vehicles? Uh-uh. Bart Briggs of Minnesota just filed a suit alleging that he has been denied sufficient care for his arthritis. And did I mention that his case has implications for arthritis sufferers across the country?

And don't forget the lollipop!

Health care, since it's a f... (Below threshold)
Joe Miller:

Health care, since it's a finite resource, will always be limited. The question becomes who decides when those limited resources will be used and when they will not be used. If Grandma Jones is 90 and would benefit from a heart bypass that costs, say, $25,000, who decides if that makes sense? The family, of course, will probably want it. Grandma Jones herself may want it. If they had to remortgage a home to do it, would they still want it? If they have insurance, they expect the insurance company to pony up. If the insurance company says No, they get offended and take the company to court. The upshot of this is that someone has to be in the position to say No and make it stick. And that someone will be universally reviled, whether it's the insurance company or the government. There are many reasons to oppose this healthcare reform, but I'm afraid this isn't one of them.

Tarceva is FDA approved for... (Below threshold)
epador:

Tarceva is FDA approved for second-line treatment (recurrence after initial remission after chemotherapy) for non-small cell lung cancer. Most drug companies, including the anti-cancer makers, have patient assistance programs that provide free drugs to those who meet financial standards for poverty IF the patient is uninsured. It is very rare indeed for them to offer the drug to a patient on Medicaid when Medicaid has denied the drug. I suspect that the Tarceva makers had both empathy for the patient, AND saw a chance to show the State up and encourage them to pay for this for others.

That being said,if it takes 20 patients receiving the treatment to get one who responds (and lives 6-12 months longer except in very exceptional cases) those 19 patients treated for say, 6 months each at 4k a month equals about 450,000 dollars spent with no benefit. In a State that is running out of money to pay vaccinations, and is already refusing Physical Therapy treatments for common complaints, you do realize that they are forced to make some sort of rationing decisions? It is sad, but unless someone comes up with a better funding method for Medicaid, that is the scenario. They have to make some tough calls.

Just imagine if it were a FEDERALLY administered program. Ooops, it is a Federal mandate that States have the major burden to pay for. Hmmmmm.

I'm gonna be brutal here. I... (Below threshold)
Hamish:

I'm gonna be brutal here. In fact, I already hate myself.

Tom Kelly said:

Those four years represent 30% of his lifespan. Whatever the cost, they were worth it.

Tom, my sympathies for your loss. You feel a pain I never will.

But we gotta inject a bit of cold, dispassionate reason here.

From your words, it's pretty clear that 1) your son's care cost a lot of money, and 2) you didn't personally pay for it, because you don't know the total.

That money had to come from somewhere. And because it went to your son, it didn't go somewhere else.

Pretty much everything tangible is finite. In your case, money and medical resources were finite. The person or people who decided your son was worth those resources, and someone else wasn't as worthy, had a very hard choice to make.

I'm going to speculate here and say that "public relations" was a factor in that decision. "The people will freak if we get depicted as letting a little boy die" must have been at least in the backs of their minds. Because insurance companies have to, at some point, answer to the public -- stockholders, corporate officers who decide whether or not to sign on to their plans, and the like.

Government regulators and bureaucrats? Not so much. Try to think of the last time one of them made a decision with "sympathy" or "the public will hate it" as a determining factor.

That's the future, folks. Get used to it.

Again, Tom, my sympathies and apologies for using your tragedy as a jumping-off point.

'No difference - no wait... (Below threshold)
Oyster:

'No difference - no wait -- the difference is that under a government-run plan you eliminate the profit motive of the decision-maker."

Right. The profit motive is removed and is replaced by a bureaucracy, red tape, and decision making based on rules written on paper which were derived from statistics. Even though individuals are different. What if you're that five percent?

Doesn't it stand to reason that if there is a five percent chance of survival if a procedure or drug is used, and people are denied based on that statistic, that five percent more people can die?

And if the answer is that one can always go outside the government plan for 'extraordinary' care, wouldn't this show that we will STILL be faced with the claim that only those with enough money can afford good health care? And doesn't it also stand to reason that if we're all paying higher income taxes to fund the government plan AND paying more for energy AND paying more for everything else that will increase in price due to higher energy prices, that fewer people will be able to afford to go outside the government plan?

The fact is even if the cost of health care does go down, everything else is going up.

I think Joe Miller raises a... (Below threshold)
James H:

I think Joe Miller raises an excellent point above. When it comes to providing health care, somebody does indeed have to be Dr. No and deny treatments. But what should be the grounds of that denial?

In the situation cited in the original blog post, coverage was denied because the money could be better spent on a child's health care.

A private insurer will deny you coverage because your plan does not provide for it. For example, if your plan has a maximum annual benefit of $250,000 and your course of treatment puts you over that, then your insurer doesn't provide it.

Discounting such practices as rescission, which of these is a better model?

And to add to James' point,... (Below threshold)
Hamish:

And to add to James' point, those limitations in the policy are spelled out for the holder -- by law.

Every year, my employer offers me several plans to choose from. Last year, it was four tiers of coverage, and each had a single, couple, and a family option -- meaning twelve different levels of coverage. Dental and vision were additional choices. I could have really, really good coverage if I chose to -- and paid for it.

In his post #4, "James H" s... (Below threshold)

In his post #4, "James H" says he doesn't feel (no thought was involved) that he "buys" that the Oregon situation automatically means single payer is Evil.

"James H" offers the if the woman in the example was on a private plan, there is what "James H" calls a "good chance" the private plan would also choose to refuse to pay for her care.

So far so "good."

But with a private plan and free choice there is a 100% certainty that the woman and all who learn of her case will opt out of that plan and for another PRIVATE plan. And that that "private plan" (or, rather, absence of any planning) will soon go broke.

But with a bunch of mindless bloody activist-"Democrat" bureaucrats in charge of the machinery of what fascists like them and like 0'Zero, like to call "health care," that 100% certainty becomes that she will die in a manner and at a time of the fascists' choosing.

While every mindless bloody bureaucrat is covered, meanwhile, at our expense, by a plan that would make the Good King Midas jealous!

Brian Richard Allen
Lost Angels - Califobambicated 90028
And the Far Abroad

Tom Kelly, I'm going to be ... (Below threshold)
Angie:

Tom Kelly, I'm going to be a little less kind than Hamish and point out that you put your son through literal hell with repeated surgeries and long-term suffering from cancer before finally mercifully being laid to rest. Radiation is the PUREST hell. It's sickening and agonizing to watch innocent children go through it.

Clearly, along with the cost you didn't bear, you also didn't state what his chances were. If there was a chance of recovery and full, long life, then yes, it was worth it. But if it wasn't, you tortured your child needlessly and selfishly.

Wait a second.If s... (Below threshold)
TR:

Wait a second.

If she wants that treatment so bad, why doesn't she use the system currently in place and pay for it out of pocket?

What about this: How many health insurance policies would cover such a treatment? My guess: none but the most unaffordable ones.

This one sad story pales in comparison to what happens daily as a result of our current system. It is past time that we try something new. Thank goodness the new administration has the stones to try it.

She wouldn't have gotten th... (Below threshold)
John:

She wouldn't have gotten the chemo under a private health plan you clowns, and also wouldn't have gotten the perks she was awarded. I noticed the idiot author never proposed the likelihood of a corporation doling out 200,000 to add 3 days the her life. You all have no clue, come to Canada and figure it out for yourselves.

Hi:I just now beca... (Below threshold)
Odowndenlooth:

Hi:

I just now became a member of wizbangblog.com.
I'm planning to look round a lttle bit and make contact with fascinating individuals and discover several alternate viewpoints.


Hopefully this isn't in a bad place. I'm sorry if it does.

--------------------

ALEC NICHOLSON
Survey Researchers

No one needs to be in compa... (Below threshold)
sincerely:

No one needs to be in compassionate. The entire matter of compassion changes when it's one's own family. Fact is, regardless of cost, Life should be priority for a world that's trying to claim that Life is important. If a government wants to control costs, and that's the only priority, maybe that government has no real valuable priorities pertaining to Living. I personally don't agree with a government run system that uses power to cut off the Living to save costs. When budgeting includes omitting the living, the persons in charge obviously don't even have the capacity to budget to begin with.




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