A Line in the Shifting Sands of Health Insurance
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I would like to see the US have universal health care. Short of that, I’m willing to bargain down to a public option. But the public option is gone.
Without, at minimum, the public option I no longer support this bill.
On Countdown with Keith Olbermann yesterday (Tuesday, December 15, 2009), Howard Dean spoke with Lawrence O’Donnell about health insurance reform. “This is not real reform,” Dean begins. He goes on to sum up my position much better than I myself could. If you have five and a half minutes, this is an important interview well worth listening to.
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In fact, President Obama needs to watch this interview. I don’t know what he’s referring to when he expresses confidence in the bill as it stands. I’m guessing he’s just worried that if this doesn’t pass, he’ll be a lame duck. And he might. But he’s defied conventional wisdom before, and he should attempt to do so here as well.
Obama should let the bill fail if it doesn’t have what it should have. He should veto it if it passes and but doesn’t contain what it should. That would show courage. Saying that we have to pass it because, in effect, it’s better than nothing (especially when it’s not even clear that it is better than nothing) does not show courage. It just shows him to be stubborn. It becomes one more way that he has rushed to continue in the footsteps of George W. Bush rather than bringing change we can believe in.
Frankly, this interview makes me again wish that Howard Dean were President. But he can’t be, of course. After all, he said “Yee haw.” And one can’t say “Yee haw” and still expect to be President. That, too, is conventional wisdom. And, having seen him violate conventional wisdom, we, the public, removed him from consideration. Stupid us.
Dean’s Remarks, Abridged
“... This is not real reform. It’s not health care reform. There are no choices.
“But the decision has been made, without really thinking about it. It’s been made because people are exhausted and they want to pass a bill so desperately they’re not thinking about what they’re doing here. ... It’s been made to commit the United States to health care reform through the private sector.
“Now I don’t think that decision should be made lightly. In the previous bills—the medicare buy-in, the public option—had the choice of mixtures, of giving americans the opportunity to make their own choices. Those choices have been taken away by the pro-insurance folks in the Senate. I think that’s a mistake.
“Are there some good things in this bill? Yes. This is basically the Mitt Romney bill in Massachusetts, except it doesn’t insure as high a percentage of people. The exchanges work well, although there’s no cost control of any substance.
“You’re going to be forced to buy health insurance from a company that’s going to take on average 27% of your money so they can pay CEOs 20 million dollars a year, and so they can have return on equity in their share holders and there’s no choice about that. If you don’t buy that insurance, you’re going to get a fine.
“So this is a bill that was fundamentally written by staffers who were friendly to the insurance industry, held up so that it was friendly to the insurance industry by Senators who take a lot of money from the insurance industry. And it is not health care reform. ...
“You can’t vote for a bill like this in good conscience. It costs too much money. It isn’t health care reform. It’s not even insurance reform.
“Take for example there’s a lot of talk about people who have pre-existing conditions can get health insurance. Well, not exactly. The fine print in the Senate says the health care gets to charge you three times as much if you’re older than if you’re younger. They get to write the rules. This bill is no longer reform. ...
“We could come back with a new Congress, which unfortunately as a result of all of this would have fewer Democrats, but we’ll still have Democratic majorities, and we could pass a bill which we had on the Senate floor last week that would insure people faster even though it’s delayed by a year and a half than the bill that’s going to be passed in the Senate. ...”
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Comments
More insurance or better insurance won't do a damn thing. Insurance is a scam that should be illegal. Single payer or bust.
And Obama won't do a damn thing to fix it. He telegraphed his real intentions his first month in office when he made that deal with phrma.
Still, I'm with passing the bill, though I'm totally against the mandates. I think it is a starting point regardless of how watered down it has become (and I really hate saying that). Hopefully this can get revisited in a couple years and get "reformed" some more.
The way the Senate operates is a sham and a shame (just like insurance). How 41 trumps 59 is more BS. The filibuster has morphed into a roadblock, not the detour or check and balance it was intended to be. It is now used as a weapon to block any type of progress and is at the root of this bill getting diluted beyond recognition.
People like Joe Lieberman obviously don't care about that, but responsible politicians should. And I don't see any reason to think that it will be easier to pass a bill with a public option after the midterm elections, where Dems are likely to lose ground. It could easily be another decade before you get another chance to reform the system.
Anyway, there is something called reconciliation. Harry Reid should study it. In fact, it's hard to imagine a better time to declare war on the whole 60 vote supermajority nonsense. Clear the Senate's schedule and let the opponents of the bill filibuster til they drop!
Trash it all you like (and well it should be trashed)...it is a start that is much needed...and it forms a foundation upon which something of substance will eventually be built.
We are going to wake up...the people are going to demand that this absurd problem finally be addressed in full measure. But it will have to be done incrementally...and I think that what we have left of this fractured bill is probably more than many of us expected as a start.
Say "We want a full Rome or nothing at all" if you want...but that can be as dangerous to our overall purpose as many of the things you warn about.
Michael, you say “Hopefully this can get revisited in a couple years” but I think the passing is what will assure that will not happen. Congress will leave well enough alone and/or will say “let someone else try” not wanting to re-engage it. But if they fail, they'll have to try again. They talk like they can leave it be, but if they do nothing, they'll have to try again.
Norwonk, more access to health care may be in name only. What it really does is lock more people into profiting the health care companies and that will backfire, making the companies more powerful monetarily and giving them the right to say “close enough” leaving out the others. This will sell out everyone else for the sake of a few fixing nothing, I fear. Plus, as Dean says, the phase-in times are such that a better bill, done later, would overtake this. Whereas if this passes, I think there will be no impetus to do a better bill.
Frank, I'm not saying perfection or nothing. I'm saying the public option is already a serious compromise. Removing that middle as if it were nothing is not compromise. The motivation for locking everyone in is the promise of fairness; a bill that does a lock-in without at least some promise of price control is a lock-in to slavery. I don't buy that.
But I think we all will be the worse for that happening.
I see this as analogous to the people who are so enraged by what they perceive to be Obama’s spurning of “the people who elected him”…that they savage him. They may end up succeeding…and crippling him to the point where he cannot get re-elected…and we will end up with what the Republicans and conservatives choose as an alternative…Sarah Palin or a Dick Cheney clone.
I see that as being to our detriment.
You may not agree. They may not agree.
We all have to speak our piece…and we all have to fight for what we think will best help humanity.
I say: Pass this bill no matter how defective it is…and let it be the foundation for what absolutely has to follow…universal health care. I do not really give a rat’s ass who gets credit!
Norwonk says "Keep in mind that it will still give 30+ million uninsured Americans better access to healthcare."
Give? Give? Uhhh no. You didn't listen. People who don't have health insurance now because they can't afford it like ME will essentially be taxed 27% of their income. This to the delight of the same thieves that essentially wrote the bill in the form it is now. the fucking insurance industry.
If this travesty does pass then I will become an outlaw because I will NOT participate. Go ahead and "fine me". No blood in a turnip and all that.
On the upside, if jail time is involved for those like ME who refuse to participate (and there will be plenty) then there will be a new boom in prison building. That's the ticket. Build jails for the poor.
Highly rated.
I can only hope the powers that be think differently.
But if you don't want to pass these things now, in the shape of this bill, when will it happen? Remember: When HillaryCare failed, the Clinton administration did not spend the rest of its time in office fighting for a better reform. They buried it. It was dead for 16 years. Would you risk that again - all to save a public option that is already so hopelessly compromised it might actually end up charging higher premiums than the private companies, because it has been deliberately designed to fail?
If it was up to me, the solution would be simple: Open Medicare to anyone who wants to sign on, and let the people vote with their feet on whether they want private or public insurance. The Dems have more than 50 votes in the Senate. If they want to, they can pass whatever they like. But then many of them don't really like the public option. And while I wouldn't mind giving Ben Nelson a hiding with the party whip, I'm not Harry Reid, and Harry Reid is not me...
I suggest you take the crumbs they offer you, and elect some better Democrats next time around.
Good point about HillaryCare and the fact that the situation wasn't addressed again for 16 years.
How long do you think it will take for them to readress it if they actually pass something?
And those like me who never use the American medical establishment will be fined if we don't have health insurance? If I have no job and no money, how can I buy insurance, even if I wanted it? If I can't pay for insurance, how can I pay fines? Will I be arrested? I would imagine there are many in this Depression who will gladly go to prison if it means three meals a day, dental care, etc.
What a country!! Makes me so proud!!
As you're probably well aware, I have a slightly different take on this one, which I've elaborated on in my blog. Would love for you or anyone else to take a look at a different point of view
As much as the entire debate has been contrived, I think your sense of negotiation is correct in regards to demotivation to improve later.
Nobody buys half a horse. And this is the wrong end anyway. There's no way to ride it.
I concur with your viewpoint.
We rely on government to do what the free market cannot. There is no profit is K-12 education. There is no profit in a library, or a fire district, or in the military. There SHOULD be no profit in health care either. But because there is, the people writing the bills are more worried about preserving that ill-gotten profit than about people's lives.
But that's just the thing: Most Americans would not be able to choose the public option anyway. It's not a real public option anymore, just a rickety skeleton of a program which could well end up discrediting the idea of public insurance for years to come.
And whether you like it or not, the Senate you elected is the Senate you have. Who do you think will magically pass a better bill? I like Howard Dean as much as you do, but he can't do this on his own. And Obama is hardly lifting a finger to defend the substance of this reform as it is now. Do you think he will do so after being handed a humiliating defeat by the left wing of his own party? After all, it's the people on the right he has to woo. Liberals won't support Sarah Palin in 2012 because healthcare reform failed to live up to their expectations.
As for the mandate, it is both necessary and a political benefit. Once Congress forces their voters to buy insurance, politicians will be under constant pressure to make affordable insurance available. That is what will drive reform in the future. Without that mandate, they can pretend they are innocent bystanders.
I hear you saying, “Once people voluntarily enter the prison, the wardens will have a lot more reasons to be merciful.”
I don't think so. The insurance companies are simply extorting the American people for maximum benefit to them and minimum benefit to other people. I absolutely do not buy your argument that if we just give them more money and create a legal obligation for us to continue to do so, Congress will somehow magically find the will to stand up to them.
What we will instead hear is public outcry that we have to toss the bums out, and that means less Democrats, more Republicans.
Then the Republicans will say “the country has moved to the right and seen sense at last.” They won't lift a finger to change the obligation of people to buy private insurance because their pals will be making a fortune on it. They will tell us that health care is fine for those people who aren't freeloaders.
What the Republicans will do is turn their attention to tort reform, eliminating the last avenue of the common man to ever get satisfaction. This will be done on the excuse that it will lower prices. But insurance companies won't lower prices any more than banks did when they implemented ATMs (claiming that would lower prices). They'll know a good thing when they see it and report record profits on their legalized extortion. A few people will benefit hugely and the ordinary person will see a few extra pennies in their 401K (which will be mostly empty having been pilfered to pay for unexpected expenses). But the Republicans will continue to use the phrase “this benefits everyone.” because any payoff that pays millions to a few and pennies to everyone else technically benefits everyone.
Not buying it. Not for a minute.
it's always " i'm mad as hell, i do wish you'd stop screwing me or at least use a bit of lubricant, please. please, please...
"What we will instead hear is public outcry that we have to toss the bums out, and that means less Democrats, more Republicans."
You may be right here. But if so, voters have only themselves to blame, don't they? You can throw politicians out of Congress, but you can't vote the American people off the island.
Conventional wisdom is we won't have the will to revisit this if it fails. I think it's the other way around. If we pass this, we're on to the issue of Climate Change. If we don't pass this, we're still at the drawing board solving this must-fix issue.
I stand with Howard Dean, Bernie Sanders, Dennis Kucinich and Wendell Potter in telling the world what a sham of bill this is, that it is little more than the health insurance industry's equivalent of Wall Street welfare.
While it looks as if Obama is screwing the pooch thus far, I give him more intellectual credit than that. He's not nearly stupid enough to misread the intentions and desires of those who busted their tails to put him in office. No one could be that obtuse.
However, what that makes him then is little more than Bill Clinton: Republican-Lite.
"Can someone give 1 example of a liberal reform defeated by liberals for not being liberal enough, that was later re-introduced, from scratch, and resulted in a better outcome for liberals? Because I can't."
Well, Kent, you haven't quite convinced me. But you, Sir, are a Formidable Opponent!
Thanks for the kind words about the debating, by the way. I hadn't really thought you an “opponent.” I'm just thinking aloud as I hope you are, and I assume we all kind of want the general good. I'm not motivated by agenda, just by the details as they are unfolding and by what seems right and just. I'll take any solution from any camp that seems like it works and if you could convince me of what you're saying, I'd go with that. It just doesn't ring true thus far that giving in on this will somehow lead to good.
A different take I have on this, is what the democratic public is willing to accept. I thought Thoth captured it nicely recently in his "Right Wing Jesus" post, how the right and it's supporters march in lockstep and the left are too busy bickering with each other to remember to come up with a common strategy. No where is that more apparent than now. What I found disturbing is the small amount of protesters outside of the white house for Lieberman's visit and the large amount there to support Baucus' rally. Tea party? Now?
Where has muscle of the left's citizenry gone? Why are we not protesting? How can one city and its greed hungry maggots rule the masses against their will? Especially when it is the will of the people who put them there? Now, who exactly is letting this happen? WE ARE. Our hands are not tied. If letter writing and the like is failing, then you take the next step. You would do that in any other situation, why not this one? I truly am at a loss as to how we all just sit and watch it all happen and act as if we have no power. I don't mean that as a criticism, more as a "why"?
I sit in the same boat as Trig and Soap Box Amy. I do not not know how much insight Nowonk actually has to participating in our healtcare system, while I think he is mad smart about politics. The healthcare industry are crooks - they have put my family on the verge of bankruptcy. And, we had money. Serious money. All gone. A big downward spiral which started with one of the corporate games they played which put us 34K in debt with private insurance, from there, it was like a slow, downward spiral as debts mounted and the cash started leaking out. Then any small life setback, never mind the big ones, just added to the problem exponentially. And still, we are dealing with the medical fallout of the original health care issue and about to lose our insurance at the end of this month which has been basically useless (paying $900/mo) except for the nearly bi-weekly ER visits. Welcome to America's healthcare system.
Who killed real reform? Why can't we have it? Everyone says it's not possible and give a whole potpourri of reasons. If this is a "foundation" or a "beginning" then that infers the reasons we can't have true reform today will somehow magically go away.
The illusion of reform is worse than no reform at all. We need to be working on solving the roadblocks to reform instead of wagging the dog by the tail by trying to co-opt corrupt politicians. Obviously, putting the Dems in power means nothing but putting a friendly mask on the rip-off.
As long as we continue to sanction greed in this country, we're only going to get more of the same: greedy leaders for a greedy populace.
Rated.
Yeah, let's talk about the "charge people more" part. I currently have health insurance through a program sponsored by the state and administered by Blue Cross. It's a kind of "last chance" program for people whose COBRA is exhausted, or for people who have preexisting conditions and can't get insurance elsewhere.
My monthly premium is $742. There is an annual $500 deductible, and after that a $1000 maximum out of pocket. So that comes to $10,400 per year -- for one person. The cost of prescription drugs is excluded from that. Drugs are $5 per month for generic, and $70 for name brand. So someone taking a couple of drugs for which there is no generic could end up paying a total of around $12,000 per year, all things considered.
My guess is that this cost would be typical.
Nick, I'll address the filibuster in an upcoming post. I hear your frustration, though.
Roger, I think you're right. A Dean/Gore ticket would seem nice to me... I'd expect a Romney/Huckabee and a Lieberman/Palin ticket up against it. I wonder if this gets worse whether Biden will go rogue as Bush did against Reagan, not that I think he'd make a credible candidate.
It seems to me that we shouldn't have started this administration with health care, but with congressional reform - the whole thing seems to be crumbling due to thinking of every corporation and every legacy but that of the American people.
HR 676 is about the people. I'll never understand cratering something healthy just to have your own way ... it's like smashing someone else's sand castle. The petulance of the Republicans seems to be catching.
bluf, indeed, I could hardly believe that so much hay (or was it “hey”?) was made over that really inconsequential remark. It was like some weird episode of Monty Python.
a.k.a., happy to be of help. I lost a fair bit of sleep last night doing this one, but I was glad for a good response.
froggy, some good points there about the need for non-commercial basic services.
al, post after post, you complain bitterly that the author is not making the point they should, that the author isn't being the right kind of involved citizen, that the author is a sheep preparing himself to be eaten by one of many wolves, etc. Yet you never really say what you would do. You're a ready source of criticism, but I'd love to see you go a step further and make some affirmative suggestions about how you'd construct the Utopia you seem to think we're all overlooking.
My sense is that it's been so compromised that like you Kent, I'm not sure it is better than the mess that exists now.
I don't know why the Dems so fear the filibuster. Wouldn't it be a political winner if they stuck to their guns and kept something pretty close to Obama's original proposal and then just dared the Repuplicans and Lieberman to filibuster all they liked? Then let's see who the public backs - the principled option or the obstructionist brayers.
Kudos for another thoughtful post.
Travellini, yep, I think HR 676 is worth spending more time on.
Steve, what would cause you to vote for something you didn't like?
Mishima, some useful numbers. Thanks for sharing them. :)
Bart, some good points about the messages sent. Thanks for adding that texture.
Harry, I so wish there was more transparency. Weren't we promised that when Obama took office?
Traveller, I think originally Dean stayed out to retain his objectivity. He was impressively neutral as DNC chair. It is sad that once Obama was in office he didn't turn to Dean as an obviously useful resource to help administer things. Then again, there may have been some issue of pride and wanting to push his own plan. Who knows? I expected Obama to put Gore in on Climate, too, and he hasn't done that either. Sad. In both cases (Dean and Gore), too, I'm convinced that if these guys had just stepped forward and requested more of the stage, they'd have been given more visibility. I think both kind of waited to be sought out.
I'm not trying to say something more "stupid" than normal. I just am. Certain topics baffle ...
For the Life of me ... huh?
Some topics have to be left to others. Wise. My logical faculty functions like a withered mummy. It's a Pitdown hoax? It's a pharmacy gimmick, and/or a AMA Insurance QUACK! FRAUD!
It's just gibber and I confess - That I fail to comprehend. It reminds me of a 'new-fang' snake-oil, and greed-hustler latest sham. IMO.
It's sorta like a (for want of a choice of better words that really AIMS) -
Spring Pokeweed brews.
Communicate HEALTH -
It's POKEWEED Rx # -
same-same profiteering.
Physicians heal for free?
That's thought for later?
Greed's Not to be trusted.
This summer I hung out in DC when we (my son took my farm job) did three farmer markets. One Market was on K -Street where the lobby gang wine and dine. Oy, and sip $200.00 bottles of rot-brew. One Farm Market was by the White House. I love to wander around the plush eateries and meet people who tell their personal stories.
Learn from peeps, ducks, and People. Sushi? hush. okay. It's so difficult to figure out these Vested Interest? Huckster? Bad case of politico's Gingivitas?
WHATeVER? So- Thanks. We all need to share? Various mental Gift/Insights are necessary.
on and on.
There is no healthy organized institutional Plan? It's like there is NO healthy creed.
Dogma, gangs,
cult religions,
a Ugh frantic,
a Oy, revival!
tent hoopla!
a ill fanatics!
extravagant!
fake zealots!
excitements!
quack quack!
ill ministers!
I am just thinking dangerously aloud and ask people like You etc., to keep dissecting.
It's a sad corps.
a army of greed.
corruption. sigh.
corpus- ill nation.
apology- shush up!
I mean- I'll listen.
thanks- hospitality!
Your hearts are in the right place for wanting more...but you are kidding yourselves.
Defeating it an expecting something better to come along is like something Lewis Carroll would dream up...and he'd have the Red Queen advocating it.
Hold your c0llective noses if you have to...but give it your support.
Or at least, that is my opinion. I may be wrong. I did think the Beetles would never make it big!
'vers libre'
But, your clear.
I talk too kooky.
You speak French.
That's more lucid.
Politico is a loony!
I just pop-off ` Oy!
THIS BILL NEEDS TO DIE. EVERYONE WHO STALLED A WORTHWHILE BILL, AND EVERYONE WHO WAS SUPPORTED BY INSURANCE MONEY NEEDS TO BE REMOVED FROM OFFICE.
What has happened in Congress, as exposed by this bill would make Benito Mussolini a happy, happy man. Fascism indeed.
(Sorry for the caps in the rant. I am really angry, and am as red in the face as Bernie Sanders last night on the Senate floor withdrawing his single payor amendment.)
In all due respect, I think it should be the other way around. Kent and many people here have shown why this is an absolute betrayal of the American people, the political system as it was "supposedly" designed (completely backfiring or being used manipulatively to get exactly what "they" want), and an open hand to a corrupt corporate insurance lobby who owes their loyalty legally to their shareholders, not the people they serve (Obama said as much in his address).
So, pardon me if I don't want to be lectured. It isn't about snubbing anyone, it isn't about personal politics (I voted for Obama), it is about truly believing our political system has gone off the rails and the next step is to introduce reform to congress from a grassroots effort before any other legislation is introduced. It is absolutely the only way the American people will ever be represented again.
If you doubt me, listen to Tim. He has worked with the insurance industry for years - he knows what he is talking about.
...politics (particularly liberal/progressive politics) is mostly about getting as much as possible done considering the environment in which you are working.
With all respect...you, Kent, and all the rest are trying to Alice in Wonderland this world.
Look at the political landscape of the United States right now...and try to see what can and cannot be accomplished at this moment in time.
If you come up with much more than what is being obtained here...re-think the issue, because you came up with the wrong answer.
Moreover, someone likened it recently to Lucy (in Peanuts comics) and the football, always setting it up and then pulling it just as it's about time to get kicked. You're making the claim that this is incremental progress, but the paradigm is not that. It's that there will never be progress but this. It's an illusion of a step forward. Indeed, some people would be legitimately helped but in so doing many would be sold out completely. We need to all move ahead.
And you may say this is cheap for me to say, but I quite assure you that I feel at much at risk of this as anyone. I have health insurance now but like others who feel complacent, it could go away at any moment with a shift in the economy and I could find myself with the same evaporating care others have. What I want is not guaranteed infinite health care but fair health care. I promise you I am in no dream world on the point of what this will achieve. As it happens, I think just the symmetric thing about you, that you're the one seeing an overly rosy view. But I'm not making that the basis of my argument and I raise it only to say that such subjective characterizations are not good ways to manage the argument. Stay clear of ad hominem approaches, please.
Keep agitating in the direction you are...and we end up with nothing. Perhaps that "nothing" will lead to a better something...but I suspect you are pipe-dreaming.
But we both gotta do what we gotta do.
I'm holding up my end.
I think that if we pass this, there is ample fuel for the Republicans to say “look what they gave you and how terrible it is” and then to say “You don't want more of that do you?” I think if it passes there is wiggle room for insurance companies to up prices and no recourse for people to get out of paying and the ultimate indignity is that they can say “You asked for this.” I think we have so many things we must do in the world that if this passes, it will be the last we hear of it for a while. We have to solve jobs and Climate Change and ... it will be a long time before we get back to this. If it fails, it may get picked right back up or it may be a couple years, but it will be obvious to all concerned that something needs to be done. It could be that if we push for it to pass and yet it fails, the Republicans can spin it as “The American people saw through the need and said ‘no way.’ ” By being pro-active and voluntarily withdrawing it, they can't say that. And, in fact, they can say “The reason you don't have health care is the Republicans poisoned it,” which is in fact the truth.
All in all, I judge those reasons dominate. I don't mind you saying your reasons, and then we can just agree to disagree. But please don't put down my reasons without pointing to some structural reason why they are flawed.
Frankly, I think your position is going to win...just as I think the anti-Obama rhetoric among liberals and progressives is going to win.
Apparently we will not have meaningful health care legislation of any form...defective or perfect…at this time.
My guess is that Obama will be a one term president...succeeded in office not by a more liberal, progressive, or middle-of-the-road stick-to-his/her-guns Democrat…but by a rabid, dogmatic conservative who will head an administration that will make the Bush/Cheney thing seem relatively benign. I think our country and the world will continue, on an accelerated pace, the downward spiral started probably by Ronald Reagan, but more immediately by Bush/Cheney.
And I think we will go decades more before getting anything nearly as good as (admittedly) the shit currently being proposed…and then only because we will have sunk so low it will be catastrophic for us not to get something.
We’ll see.
We’ll both live our lives and see what happens, Kent. And I wish you nothing but the best in yours.
"But I'm not making that the basis of my argument and I raise it only to say that such subjective characterizations are not good ways to manage the argument. Stay clear of ad hominem approaches, please." - Kent
Wow - I will keep that line on my clipboard Kent. How many times I have longed for the words in many discussions to keep it on point rather than edging on personal attacks and/or emotional bating. Thank you for this.