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GOP Issues Part One: Healthcare

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Health care will likely be a contentious issue far beyond 2012, as continued increases in medical care and pharmaceuticals abound, and insurance and Medicare/Medicaid costs continue to rise. The solution to this problem is far from simple, and will have to include changes to all of its various aspects to be acceptable the American people.

For reference, here is the summary of The Patient Protection and Affordable Care Act, useful since it is the focus of most of the candidate’s health care platforms. This site has an overview of the candidate’s stances on health care, although its neutrality may be in question. Below I will define my understanding of the positions of each GOP candidate with regard to health care, Medicare, and Medicaid, and provide links to interesting sites. The mini profiles are in alphabetical order, no bias is implied or intended.

Michele Bachmann claims to have the longest business career, having started at age 5 (see quote here), but that’s not really pertinent to the issues. She has been rather staunch in her opposition to “Obamacare,” claiming that both the Gingrich and Romney plans are too close to the president’s plan. She seems fuzzy on the cost of the president’s plan; although the author of this article may not have realized that it could have been hyperbole, or not. Her proposed H.R. 502, Health Care Freedom of Choice Act, would make premiums 100 percent deductible, expand HAS/FSA, and include allowances for small businesses to band together for better insurance rates. This plan and other topics are discussed on her house.gov page.

If we consider Romney to be a flip-flopper, then Newt Gingrich must look like a Mexican jumping bean. His history of support for a federally mandated plan goes back, at least, to 2005 when he partnered with Hillary Clinton on a bipartisan reform plan, and by 2008 he said that it was, “fundamentally immoral for a person to go without coverage, show up at an emergency room and demand care.” In his 2005 book Winning the Future, Newt said, “You have the right to be part of the lowest-cost insurance pool and you have a responsibility to buy insurance. …a 21st century intelligent system requires everyone to participate in the insurance system.” Gingrich claims that during his term as speaker, major reforms then “saved Medicare from bankruptcy,” but they apparently did not do the job right. When the House voted on the Ryan plan earlier this year all but four Republicans voted in favor of passing it; Newt called this “right-wing social engineering” and denounced it, but at other times he has endorsed at least parts of this plan.

Jon Huntsman Jr. is against having any form of mandated coverage now, in Utah anyway, but apparently did support one in 2007 as part of a United Way plan. At that time he said, “I wouldn’t shy away from mandates. I think if you’re going to get it done and get it done right, a mandate has to be part of it in some way, shape, or form,” especially as pertains to children as noted in this link. Depending on which way he is currently flopped, he wants states to experiment and find the best solution, except probably Utah. Another area in which he differs from the others is in a plan to streamline the FDA to lower drug-to-market costs, which he seems to be working on with the UCSF chancellor. Here is a little more about his plan, which, although light on detail, does give some of his thoughts.

The fact that the U.S. Constitution does not mention Medicare is not lost on Ron Paul, although the comment about general welfare could pertain (or was that the Declaration?). At any rate, he is against federal meddling in state affairs, such as with healthcare. Ron partly blames “government enforced monopolies” (HMOs and Pharmaceutical companies) for much of the problem, followed by the FDA. In his opinion the only solution is to let the free market competition select the best providers. It could be, that as a doctor, he has better insight into this problem than other candidates, but he was an ob-gyn, does that count? Here are some questions answered by Ron, as well as some of his voting record on healthcare.

About One Americans Rant

  • jamminsue

    OAR: You say, “Given the astronomical costs of a major illness, surgery, or extended therapy, it seems reckless to live uninsured; but for those at, or below the poverty line there aren’t many choices”

    This is so very true, and copayments for those with insurance are crippling as well. Thanks for showing some of the difficulty within this issue.

  • http://oneamericansrant.blogspot.com/ One Americans Rant

    Jamminsue,

    No, problemo. Some of the candidate have workable ideas, if they can get past the partisan hurdles, and actually get something done. Others, scare me.

  • Baronius

    “Surely there is a reasonable middle ground where the American public can meet.”

    Why? I have a couple of points of disagreement with you, or at least discussion with you, but the last sentence of the article really stumped me. I think it’s common for people who are first looking into politics to assume that the existence of two sides means that the answer must be in the middle. My advice to you is to challenge that assumption, because it may prevent you from seeing a real solution.

  • http://oneamericansrant.blogspot.com/ One Americans Rant

    Baronius,

    You believe that the answer lies at one extreme or he other? While likely not exactly in the middle, neither hard left (big brother takes care of everyone) nor hard right (everyone for themselves) seem like the best course. Although given just those two, I would lean more to the right, but some social safety programs can be good. My main concern is that with the constant partisan fighting, nothing ever seems to get done. As an example, Congress has been fighting over healthcare since, at least, 2005, and very few of the basic issues have changed since then. Why haven’t they come to some sort of agreement by now?

    Perhaps if you elaborate on your ideas, or ideals, then I would have a better gist of your points of contention.

  • Igor

    The fact is that we desperately need single-payer UHC. We could save $500billion a year, nationally, in excess insurance costs and enforcement costs.

    We need to get every American into the UHC pool. The logical way to pay for healthcare is from the pool that everyone pays into.

    Nobody can predict what illnesses he will have, so it’s criminal to make him bet a large part of his income on health outcomes.

    The head of a prominent Blue Cross Hospital was astounded to discover that he had an insurance clerk for every bed in his hospital, but he didn’t have a nurse for every bed! What the hell?! Is insurance more important than care? No.

    UHC is used in every other advanced country in the world. I’ve lived abroad and gotten sick and I can attest that healthcare was easy, cheap and effective. Foreigners are astounded at our primitive system, which seems purposed merely to prop up a fantasy of Private Enterprise.

    We can’t afford to indulge that fantasy any more. Not at a cost of $500billion/year, AT LEAST!

  • Baronius

    I think you summed up the contradictions in Newt’s position quite well. If “social engineering” can ever be benign, he’s been a big supporter of benign social engineering his whole career. Cutting capital gains taxes, for example, is a use of a government function for the purpose of changing individual behavior.

    Perry’s “bi-national” insurance isn’t governmentally-run or governmentally-mandated, and he hasn’t talked about it in ten years, the nearest I can tell. It was something he mentioned a while back, that’s all. But your phrasing implies that it’s something on the level of international “Obamacare”.

    I think that Huntsman and Romney both can be viewed as having classical federalist impulses. I don’t think you gave them quite enough credit. You were right to call out Santorum for supporting Medicare Part D, but if you look at your nuggets from Santorum and Paul, they’re basically the same.

    And that’s my real problem with this analysis. Any one of these people, as president, would sign practically the same legislation (except Paul). They all see some level of government intervention as necessary, but less than the current amount, and far less than the Obama package will entail. But just as .001% of Democrats would actually want government making every health care decision for the consumer, .001% of Republicans are calling for a complete hands-off. (It happens that one of that minority is Ron Paul.)

    So my problem is with the spirit of your analysis. We can’t guess what specific items are going to be in the probably-inevitable overhaul of “Obamacare”, whoever wins the White House. The only thing we can do is try to gauge where each candidate lies on the private-public spectrum, and even that’s going to be distorted by their positioning.

    I forget which candidate it was who said that he liked Cain’s 9-9-9. That was probably the truest thing said on stage during the debates. Some advisor is going to have a pet project that’s going to make it into the platform, but his son is entering college next fall and he doesn’t want to have to pay out-of-state tuition, so he’s not going to move to DC. That’s the kind of thing that determines the content of legislation more than what’s being said on stage or probably what’s written on a candidate’s website.

    And as for my comment #3, it just seemed like you threw in the towel at the end of the article. I may be doing the same thing, but it’s because I don’t believe the analysis can be made, not because I think that the answer is necessarily found in the middle.

  • http://oneamericansrant.blogspot.com/ One Americans Rant

    Igor,

    Do you have a cite for the %500B/year?

    Someone said something like,”500 billion here, 500 billion there, and pretty soon were talking about real money.” At that rate the deficit and a balanced budget seem within reach.

    [This is usually attributed to Senator Everett Dirksen, but according to this site there is no record of it.]

  • John Lake

    Thanks for a readable and informative article. I look at the issue this way. Healthcare costs will be lowered in one of two ways. If Americans have a personalized account from which they draw for healthcare cost (“with their name on it” as Cain often said) they will spend much less, spending “their own money”. If the system stays as it has been, with government sponsored insurance, or insurance sponsored by private companies, costs of the care and the insurance can be lowered by careful oversight. I visualize an onsite office, in local hospitals, reviewing treatments, tests, and referrals. This government intervention and regulation becomes necessary, and will greatly reduce costs. In cases of healthcare, if individuals and families have the option of being uninsured, there is a prospect of their being denied life-saving treatment in an unexpected emergency. This situation is unacceptable. We don’t allow people to “die in the streets.” This prospect extends; I have used the example of a delivery in a maternity ward going wrong, with an uninsured family not being able to afford the necessary measures. Now what do we do? There is no answer. Or we might consider the plight of a child developing curable blindness. Treatment would have been covered, but the family opted out of insurance; now the family is unable to afford available help. How sad if a family worked all their lives to accumulate a small fortune, only to see it all go to unexpected expenses.
    As our President has said, preventative healthcare averts costly issues from arising. Prostate cancer, caught in an early stage by a regularly scheduled examination responds quickly and easily to treatment. If discovery is delayed, the cancer will spread; treatment becomes expensive, and the matter can be life-threatening.
    Doctors of late have worked at their own volition to reduce costs and end unnecessary measures, but not all doctors are so visionary. It is just and fair to establish national standards.

  • http://oneamericansrant.blogspot.com/ One Americans Rant

    I just ran across this site on the candidates while doing some research, and I wish I had found it before writing this article.

  • Igor

    OA: I can give you other peoples analysis and numbers if need be, but let me propose instead that you do your own analysis, which IMO is easy to do.

    Start with a few simple facts that are easily available, for example:

    -total healthcare costs in the USA are about $2.5trillion per year.

    -the USA spends about 18% of GDP on healthcare, total.

    -most modern western countries spend about 9% of GDP on healthcare, suggesting that we spend twice as much.

    -if we embrace UHC as other western countries do, there is about $1.25trillion/year savings available.

    (There are various mitigating factors that reduce this to about $350B to $600B by various analysts)

    Consider this:

    -Right now the IRS sees about $188billion/yr in lost revenue to health insurance premiums mostly benefitting wealthy people. The other taxpayers are subsidizing rich mans health premiums by that amount, yet the rich object to ACA.

    Etc., etc.

    Explore. Think.

  • Glenn Contrarian

    OAR –

    Would it help the American economy if the single greatest cause of bankruptcy were removed? It’s easy – universal health care, since medical expenses have been for some time now the single biggest cause of bankruptcies.

    The sad thing is that we’re the ONLY first-world nation where medical expenses drive people into bankruptcy – but hey, that’s FREEDOM for ya! (political cartoon)

  • Baronius

    Igor – There are three reasons that the US spends more money on health care than anyone else. One, we’re the fattest (and although we’re not the oldest, we’re old). Two, we’re getting far better health care than others are. Three, we spend a lot of money on unnecessary tests and procedures.

    Yes, you can argue that a public system would cut costs, and it would – mostly by restricting the availability of care, directly or indirectly. The direct way is rationing. The indirect way is by choking off market responsiveness. As I’ve said on this site many a time, if you want universal health care, it’s easy: bone saws and sulfa drugs for everybody.

    To give your comment its due, a public system does have the potential to whittle away at unnecessary tests and procedures. (Oh, and unnecessary drugs. How could I have forgotten about those?) But there are ways of reducing waste without bringing government in further, and let’s face it, government involvement is no sure cure for wasteful spending.

  • http://oneamericansrant.blogspot.com/ One Americans Rant

    Glenn,

    How was your trip?

    Sure, if we could prevent medical bankruptcy that would be great, but talking people into willingly shuffling off the mortal coil, that’s tougher.

    Baronius is right about the unnecessary costs – MRIs, way too expensive and performed too frequently – designer drugs, with ad campaigns, way overdone – too many operations that are likely unneeded. But, some doctors try and keep costs down; do reasonable treatments.

    For example: two years ago I shattered my humerus while snowboarding – three big pieces and some small stuff. The orthopod I went to see decided not to operate – no plate and no pins – he made sure it was set and I wore a brace for six months (I had to sleep sitting up for 2 1/2 months). It healed up fine and I side-stepped a really expensive surgery and a difficult recovery. The surgery would have been easy for the doctor – harder on me in pain, therapy, and cost. While trying to sleep sitting up I thought the surgery would have been better, but in the long run I think he was right.

  • http://oneamericansrant.blogspot.com/ One Americans Rant

    Baronius,

    I agree about the obesity of America – I wrote an article about that on my blog, and may write another for BC. I think that better overall health would cut our medical expenses dramatically. This is similar to the discussion we had about wearing helmets – all of us pay more so that there will be care available for those that have obesity related problems.

  • Glenn Contrarian

    OAR – my trip was one of the times I treasure most in my life – not because of where I was, but because of the time I spent with my son. You know what I mean.

    UHC cannot be had without raising the tax revenue through one means or another…but our economic woes cannot be truly addressed without addressing our growing health care problem. It’s time to have the courage to look at other nations that are doing quite well, thank you very much, with UHC. Of course they do pay higher taxes…and very few of them gripe about it. Canada’s a wonderful example.

  • Igor

    Obesity is a public health problem. we should have public policy to combat it, just as we would if we had an epidemic of cholera or malaria.

    Of course that would upset our politico-industrial complex because it would reduce their profits and power. We’d have to remove all subsidies from things like high fructose corn syrup and industrialized meat. We’d have to stop advertisers on TV from telling lies. We’d have to inspect all the fast food outlets for obesity foods. We’d have to educate children in our schools to demand better foods, and we’d have to present more nutritious foods in the schools.

    We can start by revoking ALL of the existing commercial radio and TV licenses across the country. They are all obviously in violation of the primary FCC rule which is to operate in the public interest.

    But we’re too weak and irresolute to do that. What we say instead is “food makers should be allowed to say what they want, and if people eat unhealthy fattening foods it’s their own fault so they can suffer for it”. We’re bullies. We join the strong and powerful in oppressing the weak.

  • Glenn Contrarian

    And OAR –

    Our refusal to go with UHC is IMO a prime symptom of our national hubris, our rejection of anything that’s “not the American Way” even though in practice that particular something is obviously better for the nation as a whole…and that’s the point of my most recent article.

  • Igor

    There is one reason that the USA has the highest costs: the health system is operated for profits not for good health.

    What would you expect? The system is owned and operated by for-profit organizations. If you were working in any USA health outfit (insurance company, hospital, clinic, whatever) and you were faced by a choice between the most profitable course and the most healthful you MUST choose the most profitable! If you don’t you will be fired! And if your company doesn’t choose profit over health it is in direct conflict with the widely proclaimed Primary Directive of corporation: to produce a profit for shareholders.

    And so we see the result: the health system is operated for profit and the poor patients and clients are just cannon fodder. If they don’t come bearing rich gifts for the companies they are turned out in the streets, or worse, they are condemned to an eternity in the emergency waiting room.

    We need Universal Health Care (UHC) and there are plenty of available models from which to choose.

    It is simply UNTRUE that UHC systems ration care excessively. In fact, European UHCs that I’ve used have less rationing.

    NOBODY else in the world wants to copy the US system.

    Here’s a good FAQ on UHC collected by actual physicians:

    PNHP site FAQ

    Our current system will INEVITABLY result in fewer and fewer people being covered, and more and more people in bankruptcy losing everything to a voracious system that victimizes the most sick and helpless people in the land.

    Do YOU think you will be strong enough, healthy enough, employed enough, insured enough, to survive?

  • http://oneamericansrant.blogspot.com/ One Americans Rant

    Igor,

    I really enjoyed the PNHP FAQ. I apparently had bought the story that “socialized medicine” was bad without really thinking through the arguments. Now, it all seems perfectly reasonable to me.

    Why do you think so many are against moving to a similar system in the US? Is it purely greed on the part of massive insurance and pharmaceutical companies? Are the lobbyists giving so much money to the politicians that their greed is in control?

  • Igor

    Greedy opportunists have bribed our supremely bribable politicians to sustain the old system, and our citizens are too naive to compare systems and make a better decision.

    IMO American citizens have been kept ignorant and naive (it is truly startling to talk to European and Japanese people, even children, and see how much greater their knowledge is of basics like geography, history, music, art, mathematics, science, etc.) We are truly dumb, so it easy for liars to deceive us.

    And as if that weren’t enough, we are relentlessly bullied by a reactionary establishment that doesn’t hesitate to show it’s muscle and violence.

  • Clavos

    We’re bullies. We join the strong and powerful in oppressing the weak.

    What you propose will oppress the entire population and make a mockery of the Constitution and Bill of Rights.

  • Igor

    The CBO scored the ACA (“Obamacare”) and found that it saves $200billion/year. So, if you vote for a republican who promises to oppose ACA you will be voting to RAISE YOUR taxes $200billion.

    Do not believe the BS that says they are against taxes. They are not. They just want to give the proceeds to their companies instead of the American people.

    Here’s another fact: the US government spends $122billion/year on PRIVATE insurance premiums for public officials.

    Taxes do NOT have to be increased to pay for UHC. The savings from escaping the clutches of the overpriced and uneconomical privatized system will MORE than make up for the cost. That has already been proven in the CBO scoring of the ACA.

  • Baronius

    “Obesity is a public health problem. we should have public policy to combat it, just as we would if we had an epidemic of cholera or malaria.”

    No, they’re nothing alike. No one makes a choice to avoid sanitation or get bitten by mosquitoes. In both those cases, there’s an environmental problem that an individual can’t manage, and it calls for a group effort to intervene. Your comments on this subject seem very doctrinaire, and that one doesn’t even pass the sniff test.

  • http://oneamericansrant.blogspot.com/ One Americans Rant

    Baronius,

    I’m going to lean with Igor on the obesity issue. The primary causes may be ignorance and apathy, but the cure is very similar – knowledge. Whereas we once didn’t know that bacteria and virii caused disease, many now don’t really know much about nutrition and diet. We have raised a generation that only know what they see on television, or in magazine ads, which tells them to eat at McDs. 100 years ago there were still people that didn’t understand the need for clean water and proper sanitation, even though the basics were understood by the Romans. My grandfather died of Typhus in the 1930′s from a contaminated well, even though they must have known about the dangers of contaminated water back then – much like the common awareness of diet and nutrition now, isn’t keeping people from eating the wrong foods and not exercising.

    This seems like a slippery slope – if we aren’t going to worry about people’s weight, and the resulting effect that has on their general health, then why worry about clean water, or sanitation? Surely you don’t mind boiling and treating your own water, or making sure that your waste is taken care of? We don’t really need a government organization to handle those things, do we?

  • Baronius

    “We have raised a generation that only know what they see on television, or in magazine ads, which tells them to eat at McDs.”

    That’s not true. We have more access to information than we ever have. All packaged foods have nutrition labels, and the government has been promoting the food pyramid for at least a generation now. Increasingly, restaurants are being required to post nutritional information. And we have apps for everything. Besides, if you want to eat healthily at McDonald’s, you can do it. (McDonald’s has salads, although personally I’d rather go with a Whopper with cheese no mayo, or a Wendy’s baked potato.)

    The problem is bad parenting early in life and lack of discipline as adults. Granted, that’s a generalization. Some people do have metabolic issues, and some people are unaware of proper nutrition, and “discipline” may be too strong a way to put it, given that there’s psychology involved. But I hope you understand what I mean by it.

    If you look at the history of smoking in the US, there’s a lot of ambiguity. Everyone knew that smoking was bad for you, but it was culturally accepted. The change happened in the 1980′s, when more information was available, but also the culture turned against smoking. In recent years, all the regulations against public smoking have done a little to cut smoking rates, but not as much as the cultural shift of the 1980′s.

    So, how should we reduce overeating? Thinner models? That doesn’t seem to work. Greater information? I haven’t seen any positive results so far. Outright government intervention? I’d hate to see how strong government would have to be to interfere with someone eating a second cheeseburger. And since this is the Politics section of BC, and Igor is casting everything in terms of greedy corporations and wonderful government, you’ve got to wonder if he sees any limits at all in the appropriate use of governmental power.

  • Igor

    Gee, I guess Baronius is right. Anyone who eats American food, watches TV, or even breaths the air or drinks the water, deserves whatever misfortune befalls them.

    Why, I think Tom Lehrer warned us about this 50 years ago:


    If you visit american city,
    You will find it very pretty.
    Just two things of which you must beware:
    Don’t drink the water and don’t breathe the air.

    Pollution, pollution,
    They got smog and sewage and mud.
    Turn on your tap and get hot and cold running crud.

    See the halibuts and the sturgeons
    Being wiped out by detergents.
    Fish gotta swim and birds gotta fly,
    But they don’t last long if they try.

    Pollution, pollution,
    You can use the latest toothpaste,
    And then rinse your mouth with industrial waste.

    Just go out for a breath of air,
    And you’ll be ready for medicare.
    The city streets are really quite a thrill.
    If the hoods don’t get you, the monoxide will.

    Pollution, pollution,
    Wear a gas mask and a veil.
    Then you can breathe, long as you don’t inhale.

    Lots of things there that you can drink,
    But stay away from the kitchen sink.
    The breakfast garbage that you throw in to the bay,
    They drink at lunch in san jose.

    So go to the city, see the crazy people there.

    Like lambs to the slaughter,
    They’re drinking the water
    And breathing the air.

    But for the full orgasmic audio thrill you’ve got to hear Lehrer perform it. Try youtube: “Tom Lehrer Pollution”, or go buy his CD’s (after all his recording income allowed him to pursue his hobby: teaching mathematics) full of good parodies of modern life, by the guy who was the best, and finally quit satire when Kissinger was awarded the Nobel Peace Prize, saying that he just couldn’t top that!

  • Costello

    Haven’t thought about Lehrer in a while. That guy is a riot. Thanks for the reminder

  • Baronius

    Igor – What?

  • http://oneamericansrant.blogspot.com/ One Americans Rant

    Baronius @25,

    It’s certainly not cut and dried (what does that mean anyway), but I think that it’s more like a disease that you give it credit for.

    “There’s no question that obesity is a disease,” said Arthur Frank, medical director of George Washington University’s Weight Management Program. “Obesity is a disease where there’s a disregulation of eating – just like diabetes is a disease where the system of controlling blood sugar is not functioning properly.” Read the rest here.

    Here is a site showing both sides, but as a conclusion it states, “Opponents argue that classifying obesity as a disease would scare overweight or obese people who are healthy into seeking unnecessary medical treatments, divert public funds to treat a preventable condition, and be discriminatory towards people who choose a different body type. They say that categorizing obesity as a disease would not address the underlying problems causing it, such as poverty, the prevalence of unhealthy processed foods, lack of public policies encouraging exercise, and other environmental factors.”, which is what I was trying to get at before – there are things that a governmental agency such as the NIH could do to help, regardless of whether it is a disease or a lifestyle choice.

  • Clavos

    According to the site, World Wide Words, “cut and dried:”

    Though we can’t prove it, the saying is almost certainly from the cutting and drying of herbs for sale.

    The first known use of the expression is in a letter to a clergyman in 1710 in which the writer commented that a sermon was “ready cut and dried”, meaning it had been prepared in advance, so lacking freshness and spontaneity. The next recorded use is in a poem by Jonathan Swift in 1730 which speaks of “Sets of Phrases, cut and dry, / Evermore thy Tongue supply” — clichés, in other words.

  • Igor

    I can see that none of you guys ever worked on a farm.

    “Cut and dried” simply refers to crops being harvested (“cut”) and dehydrated (“dried”) to retard spoilage so they can be stored for future sale and use.

    It’s used to express completeness of the growing, harvesting and storing period of farming.

    The same is used for all crops, whether hay for the livestock (which is usually siloed for winter use) or corn (bet you didn’t know that most corn is dried until the kernels are hard like the leftovers at the bottom of the popcorn kettle!)

    “Cut and dried” goes back 5000-10000 years to the ancient sumerians and the fertile triangle in mesopotamia, regardless of what your dictionaries from city boys say. It expresses completeness and satisfaction. Harvest season is the happiest part of farming, and when the crops are cut and dried the partying and dancing begin!

  • One Americans Rant

    Damn,

    I keep forgetting to use the switches!!!

    This is now an official switch
    Tongue-in-Cheek [TiC] [/TiC]

  • Glenn Contrarian

    OAR –

    You’re twitching – do you have a TiC?

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    Well, the idiom apparently took a life all it’s own, Igor, divorced from the original meaning.

    Shit happens.

  • Clavos

    Well, the idiom apparently took a life all it’s own, Igor, divorced from the original meaning.

    Doesn’t matter, Roger. Whatever he says is gospel.

    He’s da man.

    Ask him.