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Healthcare Success: Failure and Federalism

Unlocking the key to success in the healthcare debate means understanding failure much more than it entails understanding healthcare. NCLBWhatever our Congress conjures up is NOT going to be the healthcare panacea they want us to believe it will be. Citizens and legislators must understand this. Ponder their undertaking: do you really think that our federal legislators can create a one size fits all, national healthcare plan that is fully successful on the first attempt? As you mull that around for a moment, allow me to refer you to…. (Drum roll please) ….No Child Left Behind. NCLB could be defined as a very successful FIRST START. Unfortunately, President Bush, in his last State of the Union Address, asked us to believe the program wildly successful as it stands. (Even Laura doesn’t believe that.) However, if President Bush had asked us to consider that NCLB represents a success because we have learned a lot from it, then that would be an entirely different matter. At the very least, the program has developed excellent metrics, and it has demonstrated initiatives that DIDN’T work and so should not be replicated. There is much in the failures of NCLB on which President Obama can build. arraFrustration comes from unmet expectations. The American Recovery and Reinvestment Act is a good example. The Administration and Congress are already considering a second stimulus. Does our predisposition towards instant gratification know no bounds? Huge portions of the first stimulus remain unspent, yet we appear ready to conclude that a) the stimulus was ineffective; and b) that even though it was ineffective we should do it AGAIN. Notwithstanding the premature conclusion on the efficacy of the first stimulus, if I grant the premise I’m more inclined to conclude that the initial plan as flawed conceptually and definitely should not be repeated. If Congress asks the public to believe that the healthcare plan they eventually hoist upon us is the final solution, two expectations are set: first, there will be the expectation by Congress that they must continually tell us how fantastic the new healthcare system is, at the expense of making required changes. Congress will be constantly “selling” their plan to Americans rather than evaluating it for ways to make improvements. Second, Americans will be frustrated because we will see the inefficiencies and problems and will be left with little optimism that tweaks and modifications are forthcoming, particularly in the face of a self-congratulatory Congress.
Congress must acknowledge that with the Bill’s passage comes the realization that healthcare reform will be a process rather than an event. Of course, saying that aloud would be self-defeating. Americans would know that tweaks are coming, creating barriers to investment in the new healthcare system limiting its effectiveness. This is, in part, why healthcare implementation should be left to the states. taxesCongress should play to its strengths: collecting money. Its strength does not rest in creating and managing national service programs. The states, however, are much better (though not outstanding) at understanding the needs of their residents. State implementation pushes the healthcare debate closer to the people and to governments more responsive to the people than a national system would. Additionally, it allows for the simultaneous implementation of 50 separate healthcare experiments. Best practices will be derived. Lessons will be learned. States can make subsequent modifications to their own plans based on the success (or failure) of other states’ plans. Fifty smaller programs will be easier to initiate, more nimble to manage, and quicker to change. Making implementation the responsibility of the States also serves to isolate Congress from accountability and it leaves open the opportunity to create a subsequent National Healthcare System should a States emphasis be a resounding failure. But, if it comes to that, the National System will benefit from the results of 50 prior experiments and the Congress will be able to say that their first instinct was NOT socialist, but federalist in nature.
 
The Democrats seem determined to push legislation through despite the objections of blue dog Democrats and many Republicans. Any plan that is not bipartisan in nature means that the Democrats will have no one with whom to share the blame when version 1.0 flops. Their plan should not only co opt Republicans but co opt the States and Americans at large, in order to share responsibility and accountability.
 
Congress’s role should be two-fold: develop a national means to collect funds that will be extended to the States in order to fund their programs (perhaps a national sales tax); and develop a set of guidelines that each state program must include. Those guidelines ought to provide coverage for all uninsured children; protection against financial ruin due to a major illness or accident; the ability to obtain coverage regardless of a preexisting condition; coverage that continues even when people are laid off, change jobs, move to another state or start their own business; premiums, deductibles and out-of-pocket expenses that are affordable relative to family income; and the ability to keep current health coverage if desired.
 
Congress in general and the Democrats specifically, are so busy trying to demonstrate their genius that they will miss the opportunity to truly impress us—with their humility. George Patten said, “Never tell people how to do things; tell them what to do and they will surprise you with their ingenuity.” President Truman similarly noted that “It is amazing what you can accomplish if you do not care who gets the credit.” Our Congress ought to heed these two philosophies and empower and entrust the people and the states to do for themselves. federalist_papersIt’s true that failure is not an option: it’s an inevitability. A federalist approach, vis-à-vis the socialist boondoggle on the table, creates 50 opportunities for success, and more importantly 50 opportunities to learn from our inevitable missteps. The success of healthcare reform rests not in what Congress produces in the coming months, but rather how well Congress incorporates mechanisms to respond to the shortcomings of their foresight.
 
Failure, rather than being avoided, should be embraced.
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Healthcare: The Fairest System is the Most Unequal

Those in favor of systemic healthcare reforms will tell you that our current healthcare system is unfair. A June 6, 2009, NY Times editorial noted, “to abandon the goal of universal coverage…. would be unfair to the 46 million uninsured Americans….” It’s time to pause and define our terms as we consider what kind of national healthcare system we want in this country, and the forthcoming August Congressional recess gives Congress and Americans alike that very opportunity. life libertyAt issue is the difference between EQUALITY and FAIRNESS. Our common American interest in equality stems from one of the best known phrases in our founding documents: “We hold these truths to be self-evident, that all men are created equal….” Equality, as noted here, does not guarantee equality of experience, but rather equality of opportunity. All men are CREATED equal, the preamble to the Declaration of Independence says. This is a declaration concerning the immutable value of every human citizen and a promise of opportunity unconstrained by prejudice, not a promise concerning quality of life. The attendant rights associated with this valuation of human life are that all men “are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness” (not prosperity, housing and healthcare). Our unalienable rights deal with the process of the American experience. There is no promise of success or guarantee of reward. What we are granted, as Americans, is EQUALITY OF OPPORTUNITY, not equality of experience. Governments established on the precepts of equality of experience are defined as communist—the sharing of collective resources for the utilization of the group. Is equality of experience what we want in America? Is it UNfair that some Americans have health insurance and some do not? It is UNFORTUNATE, but it is not UNFAIR. What’s UNFAIR is the current financing mechanisms under consideration in Congress for healthcare. robin_hood_classicIs it fair that someone would study hard and get good grades in high school so that he can go to college, where he studies hard and gets good grades so that he can get a good job with health benefits, and then to have his salary taxed so that those who have squandered those same opportunities might have EQUAL benefits? These Robin Hood economics are fundamentally UNFAIR. Fairness would ensure equal reward for equal investment. What Congress is considering is equal reward for disparate investment. The United States has many problems and is not without its faults. Yet many, many citizens find ways to take advantage of the opportunities they are afforded. A free, appropriate public education is afforded to all American children. school busThousands of youths every year, in the very worst public schools, are able to work hard and use the education they are provided to get into college where new opportunities await. Meanwhile, many of their peers choose to be victims, forfeiting the opportunities they have because they perceive their opportunities aren’t equal to opportunities afforded to other segments of American society. Notwithstanding the veracity of the latter, the real shame is that they cannot see what they’re forfeiting. Yet, as adults, these same individuals cry out because they do not have benefits that others have. They do not have those benefits because they have not earned those benefits. No one wants life to be fair; they want it to be unfair in their favor. Any future healthcare system should perpetuate the historical American understanding of EQUALITY and FAIRNESS—what is FAIR is that all Americans have equal opportunity. Ensuring equal access to a system that provides incentives for hard work and disincentives for sloth is in keeping with American values. There should be varying degrees of healthcare coverage to reflect the vary degrees of investment individuals make in obtaining those benefits. There should be extra reward for extra work. As it turns out, the fairest system is also the least equal. I’m comfortable with that.
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It's the Constitution, Stupid

There are little nuisances in life; and there are BIG nuisances. The bigger nuisances usually make my heart flutter and my stomach churn: I can’t get my mind off of them and I am constantly angling in my head for ways to avoid them.

sotomayerThere was much about the recent nomination hearings for Supreme Court nominee Sonia Sotomayor that left me feeling uneasy. (The Senate Judiciary Committee has scheduled a vote for Tuesday and her confirmation is all but assured.) In hindsight, most of that unease is reactionary and emotional.

I, like most people I’m sure, understand the importance of the Supreme Court Justices. With their lifetime appointments, they have the ability to greatly affect America’s strength and longevity. I am in no way surprised by President Obama’s nomination. For better or for worse, Sotomayor’s confirmation will have little anticipated effect on the Court’s operation and leanings. She is expected to take the ideological place of the same judge whose position on the court she is assuming—David Souter. Souter, though nominated by George H.W. Bush and assumed to be a conservative at the time, was a part of the Court’s left-leaning axis, along with Justices Stevens, Ginsburg and Breyer.

tequilaJustice Souter’s departure left me pondering whimsically what could have been if only a different president was making the nomination. Evaluating Sotomayor against the hypothetical is what made my stomach feel as if I’d had ten tequila shots last night. But watching the hearings left me with no such nausea: in fact, just the opposite. Because she delivered much of what I expected, I had little frustration, and I was free to evaluate the proceedings on a different level.

What struck me most, and left me feeling both confident and nauseous about the state of the Republic, was the emphasis on our Constitution. This should be no surprise—this is, in fact, the job of a Supreme Court justice.

Many inquisitors cloaked their partisan questions in a Constitutional light; that they felt compelled to do so reinforces the importance of the Constitution in the conduct of our government. No matter what the intent of the question, or the politics of its asker, the very fact that Republicans and Democrats alike paid homage to our Constitution in this manner is evidence of the shared values of Americans from both parties. It reminds me that our shared love for this document and belief in its perpetuation and application serve to unite us as Americans more than divide us as partisans.

AP GOP Minorities DebateBut unease churned my stomach when I noted how infrequently Constitutional dialogue is included when other legislation is created. Congressman Ron Paul (R-TX) brought a Constitutional emphasis to last year’s Presidential election but his message was lost amidst his screeching, nearly hysterical delivery. Heaven forbid Congressman Paul is ever in charge of anything, but I wish he had a place on the President’s team. Maybe he could hold an honorary position in the President’s entourage. He could just sit quietly in the back of the room until his strident adherence to the Constitution was needed. Whether it should be heeded or not would remain the providence of key decision makers, but it would be nice to know that the Constitution itself was explicitly afforded a hearing in the policy making process.

npr2The daily news, with its Red State/Blue State graphics, and the juxtapositions of FoxNews and MSNBC or NPR and the EIB Network can leave one with the impression that this country is one poorly timed shooting away from another civil war. But the confirmation hearings brought out the very best of the American political system—differing viewpoints on how to achieve a common objective: support and defend the Constitution of the United States.

constitutionThe Sotomayor hearings showed me once again that the American Gospel is that those whom the Constitution serves value it above all else. Too many Sotomayor-like nominees will make me wretch, indeed. But the Court remains in balance for a variety of reasons and I can’t help but think that its current teeter is in keeping with American opinion. So, for today, I am not concerned about Justice Sotomayor. Neither am I thrilled. But, and this is more important, I am optimistic about the American form of government and its viability for the 21st century because its real strength lies in those it serves. Now it’s our job to demand that Congress heed the Constitution as much during the health care debate as they did during the Sotomayor hearings.

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Is Sarah Palin the Republican Greg Brady

Time will tell how smart Sarah Palin is. Her position on the Republican ticket last fall was very polarizing. Core Republicans were apologists for her credentials and style, arguing that she was an experienced leader ready for the national stage. Others saw her as an inexperienced, unpolished, unprepared governor of a small state ready to be a national stooge. 

I like what her selection said about the GOP—that it was willing to take a risk and look to an up and coming generation for new leadership.  Many others within the GOP felt the same way. She was fresh and exciting. Her arrival was the best possible outcome for a blind date set up by a friend with historically bad taste. She was witty, attractive and engaging. But is she marriage material? 

For those who were and might still be enamored with Ms. Palin, it’s time to study this objectively. There’s no need to defend the indefensible just to prove that you were right last fall. The election is over; it’s time to reflect on Sarah Palin thoughtfully and honestly as you look to the future. 

breadinthosethreads500Unless Ms. Palin fades quietly into the background (not likely), she has two choices: she can pursue the presidency or she can capitalize on her political celebrity.  If she chooses the former, I’m afraid she’s going to discover that she is the Republican equivalent of Greg Brady’s “Johnny Bravo.” 

Greg and his five siblings were auditioning for a talent show. As good as the ensemble was (gag me), talent agent Tami Rogers spotted Greg and singled him out for a promising solo career as Johnny Bravo, complete with a groovy, bullfighter/disco chic uniform.  Greg decided to postpone college and leave his family behind only to discover that the record label was “sweetening” his songs and that, ultimately, he had been chosen because he fit the suit. Greg’s vanity and self-importance allowed him to believe he was more than he really was. 

Sarah Palin had one shining moment--her VP acceptance speech (any doubts that the speech was “sweetened” by a team of Republican linguists and word smiths?). Otherwise, I think it’s accurate to say that Senator McCain selected her because she “fit the suit.”  She was a woman to run against Obama’s blackness; she was outdoorsy, Christian, and neo-conservative.  On a ticket quickly losing relevance, she was the perfect choice—the right woman at the right time. 

805676cSince that speech, Ms. Palin has had multiple opportunities to get smart on the issues and to develop strong positions on how government can help America move forward. Yet time after time she disappoints.  We heard during the campaign that she often wasn’t well educated on the issues, choosing, rather, to wing-it.  

Honestly, I could live with that, IF (and it’s a big IF) she explicitly stated that her approach to leadership is to rely on strong core convictions and values that provide a specific vision for America and that she surrounds herself with experts who provide her a broad range of non-partisan advice from which she chooses solutions, programs, and initiatives which support her convictions and values.  She might well say something like, “As Governor of Alaska it hasn’t been my job to deal with and understand foreign policy in the Middle East; but let me tell you about the things I believe in that will guide my administration's actions in that region. I believe in American exceptionalism. I believe that people worldwide have a God given right to certain liberties. It is not important that other governments pursue and apply democracy the same way we do in America. What is important is that individuals are able to determine their nation’s form of government for themselves and to have certain human rights afforded to them. America’s role is facilitating the promulgation of liberty and self-determination.” 

In this case she is saying 1) I don’t know; 2) It’s ok that I don’t know—it’s not my job to know; but 3) if given a chance here’s what I believe. It’s not just an answer it’s an entirely new leadership style. It’s not important that she HAS the solution or that she can create one in isolation. What is important is that when given options she is WILLING and ABLE to make hard decisions that are consistent with core principles. This could have been her way-ahead—play to her strengths.  

Instead, she has bumbled and fumbled her way through virtually every personal appearance since Minneapolis.  She hasn’t expressed well-defined core principles. She hasn’t been honest about her approach to governance and she hasn’t gotten smart on the issues. 

clinton dolemondale2_t600We need to also face the facts about her situation—as a losing vice-presidential candidate the odds are against her. In recent memory, only Bob Dole and Walter Mondale have gone on win their party’s next nomination and they were both running against strong incumbent President’s (Clinton and Reagan, respectively).
 

If Sarah Palin were to win the GOP nomination in 2012 that would tell me something entirely different about the GOP and not at all flattering. Her nomination would be the last chapter of the book on modern republicanism that began with Reagan’s 1964 speech supporting Barry Goldwater. It would be a tombstone for the GOP as we know it; an epitaph. While I believe those things are necessary, I don’t think Republicans need to wait eight years to reinvent themselves. Let the loss in 2008 be the end and Sarah Palin’s nomination was just the last gasp effort for survival; a fitting climax to the end of an era. 

Ms. Palin’s other option, as laid out by daughter Bristol Palin’s former fiancé, is to make money. At this, I think Ms. Palin could be wildly successful. She could become a professional fundraiser, speaker, talk radio host or Fox News talking head. The support she already has likely would afford her access and sway in a variety of fields for which she’d be well compensated. It would be both humble (quietly acknowledging her inability to become president) and self-serving. 

potterI have no problem with people benefiting from their experiences. Turning one opportunity into a fortune is the American way.  I don’t begrudge Daniel Radcliff his multi-millions just because he looked like Harry Potter and happened to be 11 years old at the right time in pop-culture history. 

This is the Madonna School of Marketing: be outrageous and be visible. It’s a well-worn path and it plays to her strengths. But it would require accurate self-assessment even to her discredit.  

Ms. Palin's my age. With any luck at all she spent her afternoons as a child plopped in front of the TV taking in the folksy lessons of The Brady Bunch, now prepared to make a better decision than Greg.

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Conservatives for Waxman Markey

Particularly since gas prices hovered near $4.00 per gallon last summer it has been true that ENERGY ISSUES have been making for strange bedfellows. Traditionally the purview of the left, in the last few years there has been a greater outcry within the Defense community about the deleterious effects of America’s dependence on foreign oil.

Fuel convoys are the leading target of IEDs and snipers. Half of US deaths have occurred protecting convoys.
Fuel convoys are the leading target of IEDs and snipers. Half of US deaths have occurred protecting convoys.

Reflecting the military’s understanding of the national security implications, in the last few years we’ve seen theDefense Science Board Task Force Report on DOD Energy Strategy, two Center for Naval Analysis reports—National Security and Threat of Climate Change  and Powering America’s Defense: Energy and the Risks to National Security -- and the 2008 Joint Operating Environment Challenges and Implications for the Future Joint Force.

These documents make the case in no uncertain terms that the use of fossil fuels (particularly oil from antagonistic foreign states) and our national electrical infrastructure are issue of critical national security. From the latter CNA report:

• US dependence on oil weakens international leverage, undermines foreign policy objectives, and entangles America with unstable or hostile regimes.
• Inefficient use and overreliance on oil burdens the military, undermines combat effectiveness, and exacts a huge price tag—in dollars and lives.
• US dependence on fossil fuels undermines economic stability, which is critical to national security.
• A fragile domestic electricity grid makes our domestic military installations, and their critical infrastructure, unnecessarily vulnerable to incident, whether deliberate or accidental.

Yesterday the US House of Representatives passed the Waxman-Markey Climate Change legislation. There is much wringing of hands and gnashing of teeth over this development. The debate is not indicative of bad science. The debate is indicative of bad politics.

RushTopI haven’t got the first clue whether or not increasing global temperatures are caused by human activity. Global temperatures are getting warmer. There’s little debate on that. Rather, the debate centers on the cause and even within the scientific community there seems to be significant variance in opinion on this matter. There are many people with lots of letters after their names that can’t come to any consensus. For me to weigh in on the science of the issue would be preposterous in the extreme (I might as well start telling you that child-birth is painless because it didn’t hurt ME). NPRYet, Americans around the country are doing just that—flaunting their ignorance by parroting only the scientists they choose to believe without any real understanding of the science. Their opinions have more to do with the radio station they listen to and less to do with an understanding of the issues.

Those very same dynamics are at work in our Congress. Georgia Republican Paul Broun said that climate change is nothing but a “hoax” that has been “perpetrated out of the scientific community.” The debate on this legislation has become a referendum on the science of climate change and not about the broader issue of changing America’s energy paradigm. Our problems with electricity and fuel can be discussed in terms of terrorism, homeland security, the economy, jobs, national defense, foreign policy, American exceptionalism, innovation, family values, immigration, and national security. These are all bedrocks of the Republican platform. And I never mentioned the weather.

The debate on the science behind Waxman-Markey dumbs down any discussion on America’s future. Because America’s security and economic future is dependent on the changes we make to our understanding and use of electricity and fuel.

Republicans have long been seen as the Party of the US military yet Republican politicians still eschew the ideological consensus that is forming within the Pentagon—that change (nay, progress) must come in America’s energy appetite.

big boy pantiesIf the Republicans would put on their “big-boy panties” for a minute the buffoonery on the House floor might have been replaced with a vibrant, educated, paradigm-shifting discussion on why every American citizen needs to bear some of the burden in changing the way we power our lives. Democrats could have talked about the weather.support our troopsRepublicans could have talked about our sons and daughters dying on the fields of battle to ensure the supply of fuel for America’s SUVs with the yellow “Support Our Troops” ribbon on the rear window.

moses_parting_the_red_seaThere are some who don’t believe Waxman-Markey goes far enough. No one believes the bill is perfect; it’s not even close. If anyone unhappy with the bill is waiting for something perfect, forget it. For the Congress to create, in its first attempt, a bill that was effective and without fault would take a miracle of biblical proportions. This will simply be step one. Lessons will be learned and future amendments and legislation will address Waxman-Markey’s shortcomings. Progress will be incremental. But it does represent progress in changing the way Americans view fuel and electricity.

I support Waxman-Markey. Not because I believe in the human contribution to climate change, but because I believe that making adjustments to the way Americans view and use energy is the common thread in keeping America the greatest nation on earth for the next century.

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Steve McNair: America's Self-Indulgent Grief

I haven’t really looked this morning but I assume others are already saying what I’ve been ruminating since I heard about the Steve McNair shooting. So let me say it now—I don’t think this is going to end well for McNair’s reputation.


After the news broke yesterday, ESPN radio was filled with people commenting on what a great guy McNair was.  Steve’s brother, Fred, commented, “It's still kind of hard to believe. He was the greatest person in the world. He gave back to the community. He loved kids and he wanted to be a role model to kids.”


All of which may be true. But I’ve become so jaded and cynical on celebrity deaths there’s simply no way for me to look at the facts as they’ve been presented so far and not conclude McNair was having an affair with the 20 year old Sahel Kazemi.

 McNair Killed

Here’s what we’ve been told so far: McNair and Kazemi knew each other from a restaurant the quarterback and his family frequented.  There is a 2007 Cadillac Escalade registered to Kazemi AND McNair. Witnesses say McNair arrived at a condominium he owns between 1:30 and 2:00 am Saturday. They say Kazemi was already at the condo.


nm_couple_fighting_090216_mnThose facts alone would put most marriages in serious jeopardy.


Hey, maybe Steve and Shahel were planning the church bazaar. There are as many acceptable scenarios as there are illicit scenarios.


McNair, though, was discovered with multiple gunshot wounds, one to head. Kazemi had been shot once.


Multiple gunshot wounds sounds like a crime of passion to me. If you’re stealing a DVD player and the family penny jar, you don’t inflict multiple gunshot wounds—you fire once or twice and flee.


Eddie George, the former Tennessee Titans running back, played with McNair and spoke on ESPN radio yesterday.  He was filled with praise for McNair and the way he lived his life. I simply felt bad for Eddie. I wondered how he will feel if the foreshadowed circumstances come to fruition.


Am I bad person to think like this? In the middle of one family’s tragedy all I can do is imagine the consequences of purely hypothetical and tawdry events.


Adding to my self-loathing was my contempt for those who called, emailed and texted the ESPN radio host.  Fans poured out the grief: “We’ll never forget Steve.” “This is such a sad loss for America.”  “I’m devastated.”


Really? This is a guy who played football. If he hadn’t been a professional athlete we never would have heard of him. America’s fascination with playing the role of the drama queen is well documented. “How will we go on without Michael Jackson?” (Woe is me.)  You’ll buy someone else’s music.


ESPN’s radio host at least had the most relevant reason to grieve—a 36 old man was shot to death. That is too young to die. Indeed it is. But I’m sorry, 36 year old black men are shot in this country by the dozen and there’s little outrage. The feigned grief over McNair’s soon-to-come-to-light Shakespearean ending is hypocritical--unless you want to use him as a public face for a national tragedy.


McNair’s death IS sad. But it’s not EXTRA sad because he was famous. WE are EXTRA sad because we apparently place more value on the life of the famous Steve McNair than on Laquinn Tucker, a 37-year-old black man, who was shot several times and died June 5.; or Steve Moore, a 39-year-old black man who was stabbed in the chest and died June 2; or  Perry Wilson, a 36-year-old black man who was shot and died June 20.


The sad part is that, if my cynical, jaded prediction is correct, McNair’s actions will have brought about an extreme over-reaction from someone. He will have been in the wrong place at the wrong time with the wrong person. He will have fooled his family and friends. These are all very sad events.


I feel bad that I think like this, but honestly I don’t know how any relatively well-informed American could conclude otherwise, Truly, I hope I’m wrong. But aren’t we ALL sitting around today waiting for the other shoe to drop?


But let’s not make more of his death than it really is.  One man. One sad story. One death. Let’s hide our hypocrisy and keep our self-indulgent grief to ourselves.

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