Anger Can Set Off a Heart Attack
By NICHOLAS BAKALAR
Angry enough to have a heart attack? It might actually happen.
A new analysis has found that outbursts of anger can significantly increase the risk for irregular heart rhythms, angina, strokes and heart attacks.
Researchers combined data from nine studies of anger outbursts among patients who had had heart attacks, strokes and related problems. Most of the studies used a widely accepted anger assessment scale; one depended on a questionnaire administered to patients.
They found that in the two hours after an outburst of anger, the relative risk of angina and heart attack increased by nearly five times, while the risk of ischemic stroke and cardiac arrhythmia increased by more than three times. The findings appeared in The European Heart Journal.
The researchers stressed that the actual likelihood of having an anger-induced heart attack remains small. Still, for people with other risks for heart disease, any increase in risk is potentially dangerous.
The senior author, Dr. Murray A. Mittleman, an associate professor of medicine at Harvard, said that little is known about ways to prevent anger from causing heart problems. “Are there specific behavioral interventions that would be effective? Medicines?” he asked.
“There have been proposals for both,” he added, “but we need more and better research.”
I wonder whether any studies have been done on the risk of heart attacks and strokes induced by slow, burning anger of the type created by an inability to find work, by working two or three jobs and still not being able to support a family while watching CEOs and bankers walk away with millions of dollars in salary and bonuses and benefitting from tax-payer subsidized government payouts?
- SPC
Why Black Women Die of Cancer
By HAROLD P. FREEMAN
SINCE the early 1970s, studies have shown that black Americans have a higher death rate from cancer than any other racial or ethnic group. This is especially true when it comes to breast cancer. A study published last week in the journal Cancer Epidemiology found that, in a survey of 41 of America’s largest cities, black women with breast cancer are on average 40 percent more likely to die than their white counterparts.
The principal reason for this disparity is the disconnect between the nation’s discovery and delivery enterprises — between what we know and what we do about sick Americans.
In 1967, I started working in Harlem as a cancer surgeon. At that time, and through the 1980s, Harlem was a community of poor black people, and the death rate from cancer there was among the highest in the country. At Harlem Hospital, the five-year survival rate for breast cancer was a dismal 39 percent, compared with roughly 75 percent for Americans over all.
I imagined that I could “cut cancer out of Harlem.” But I soon learned that the disease would not yield to a surgeon’s knife. Why? Because the patients were coming in too late. I examined many black women who were visiting the clinic for the first time and who already had incurable breast cancer, sometimes with ulcerated and bleeding breast masses.
I began to see that cancer’s invasiveness was deeply rooted in human conditions, and began asking questions such as: What does it mean to be black in America? What does it mean to be poor? And what does it mean to be black and poor and at the same time to have cancer? Saving lives under these conditions has dominated my career ever since.
The reasons for black and white differences in breast cancer outcomes are complex. Although the incidence of the disease is higher among white women, black women are more likely to die from it. Young black women tend to develop a particularly aggressive form, which no doubt contributes to the disparity. But for many years, the dominant cause of higher mortality has been late-stage disease at the time of initial treatment, in part as a result of black women being less likely to undergo mammography.
Nudity, humor used to get youth sign up for health care in Maine
With those 18-to-34 making up just 19% of the state’s sign-ups so far, ad appeals get ‘hip’ as the March 31 deadline nears.
Advertising executives didn’t need a scientific study to surmise what would draw young adults to ads that encourage people to buy health insurance through the Affordable Care Act.
They went with skin – lots of it.
“He may not be naked. He could be wearing a Speedo,” Wendy Wolf said with a laugh, referring to an ad showing a young man who is otherwise unclothed but covered by a strategically placed laptop computer.
“Dude, it’s time to get covered,” proclaims the ad for www.enroll207.com that ran this week in the Portland Phoenix alternative newspaper.
Wolf, executive director of the Maine Health Access Foundation, and others are making the final push to enroll Mainers age 18 to 34 before the ACA’s March 31 deadline. Experts say the enrollments will hold down insurance costs while benefiting those younger Mainers.
Statistics released this week by the U.S. Department of Health and Human Services show that 19 percent of the 25,412 Mainers who had signed up on the federal health insurance marketplace through Feb. 28 are in that 18-to-34 age bracket.
That’s below the national average of 25 percent, and partly reflects the challenge posed by Maine’s population, the oldest in the nation.
Maine CDC officials confirm document destruction order in public testimony
The Government Oversight is taking testimony from five Center for Disease Control officials Friday.
AUGUSTA — Two officials in the Maine Center for Disease Control confirmed Friday that the agency’s deputy director asked an employee to destroy public documents related to the awarding of $4.7 million in public health grants.
Debra A. Wigand, the CDC’s director of public health, and Andrew Finch, senior program manager for Healthy Maine Partnerships, testified that Christine Zukas, deputy CDC director, had asked Finch to destroy the documents
The testimony was delivered in a public session after the Maine Legislature’s investigative panel voted against going into a private session to hear the testimony of five CDC officials. The agency is being investigated for the management of the $4.7 million in grants and for destroying public documents related to the grant awards.
Members of the Government Oversight Committee voted 7-3 Friday morning against a private hearing requested by the attorney for the agency. It was the first time the committee had ever been asked to hold a private session, something allowed under a law that covers legislative investigations.
The five CDC officials testifying today are Sheila Pinette, director of the CDC, Wigand, Finch, Zukas, and Lisa Sockabasin, director of the Office of Health Equity.
All of them were initially invited to testify voluntarily, but all declined.
Mysterious phone poll on MaineCare adds twist to fierce debate
Were the calls to hundreds of Mainers asking negative questions on expansion an attempt to influence opinions? And who paid a consultant to do the survey?
AUGUSTA — Hours after a hotly debated Senate vote Wednesday on Medicaid expansion, hundreds of Mainers received automated telephone calls that could intensify the debate over expanding the public health insurance program to more than 60,000 uninsured residents.
In the computerized poll conducted Wednesday evening, participants were asked whether they would support expansion of Medicaid if they knew that nearly one in three people eligible for coverage are former prison inmates.
That and other negative assertions regarding Medicaid expansion raised questions about whether the survey was a push poll, designed to change public opinion rather than gauge it, and subject to the same campaign disclosure laws as political advertisements.
The calls also raised questions about who commissioned the poll, why, and whether its claim about prison inmates is accurate.
Wednesday’s vote in the Senate was a blow to backers of Medicaid expansion. The bill passed 22-13, leaving supporters two “yes” votes short of the two-thirds majority needed to override an expected veto by Gov. Paul LePage. The House could vote next week.
The poll was paid for by Action Point Campaigns, a consulting firm in Florida that has the same address as Strategic Advocacy, a political consulting firm that has operated in multiple Maine campaigns and is active in Florida.
Strategic Advocacy is run by Roy Lenardson, a 20-year veteran of Maine politics and an adjunct fellow for the Maine Heritage Policy Center, a conservative advocacy group that opposes the expansion of Medicaid. The firm has locations in Augusta and Ave Maria, Fla., a planned college community that is led by Tom Monaghan, a Roman Catholic philanthropist who founded Domino’s Pizza.
Strategic Advocacy is also affiliated with the Foundation of Government Accountability, a conservative advocacy group led by Tarren Bragdon, a former head of the Maine Heritage Policy Center. Both groups have vigorously opposed expansion of Medicaid in Maine and Florida.
Bragdon, who lives in Ave Maria and whom Lenardson describes as a close friend, was at the State House during the buildup to Wednesday’s Senate vote. His organization deployed a social media campaign last week opposing Medicaid expansion.
Bill Nemitz: CDC officials' request for secrecy mocks good government
The “CDC” acronym can stay, but the name needs to change: Henceforth, the Maine Center for Disease Control and Prevention should be rechristened the “Maine Center for Damage Control.”
The new moniker would better reflect the agency’s real focus as its months-old document-shredding scandal winds its way from a pending lawsuit in federal court to a hearing before the Legislature’s Government Oversight Committee.
To wit: In the wake of a report by the Office of Program Evaluation and Government Accountability detailing serious (if not criminal) skulduggery by top CDC officials in doling out $4.7 million in Healthy Maine Partnerships grants in 2012, the bipartisan committee hopes to have a chat Friday morning with CDC Director Sheila Pinette and four of her underlings.
The “CDC Five” all were subpoenaed to appear before lawmakers after refusing (on advice of their attorneys) to do so voluntarily. Three of them also are named as defendants in a whistleblower lawsuit against the Maine Department of Health and Human Services by former CDC program director Sharon Leahy-Lind and office manager Katie Woodbury.
The problem is, the five officials (again, those lawyers) now want their testimony to remain secret. No pesky reporters, no prying TV cameras, no public involvement whatsoever.
Can we say “unprecedented?” Yes, we can – never before has the oversight committee granted such a request.
How about “not in the public interest?” That too – anything the witnesses tell the lawmakers would, by law, have to be kept secret.
So why do it? Good question.
“I can understand why the lawyers don’t want it in public. If I were representing one of these people, I would feel exactly the same way – and for legitimate reasons,” said Sen. Roger Katz of Augusta, himself an attorney and one of six Republicans on the 12-member oversight committee.
That said, Katz added, “there’s a real public policy interest in making sure that the public’s business is done in a transparent way and is done in the light of day.”
Amen to that, senator. If ever there was a story that needs to see the light of day from start to finish, it’s this one.
The independent report by the Office of Program Evaluation and Government Accountability, delivered to the Government Oversight Committee in December, doesn’t name names. Still, its findings reveal a clearly flawed grant-award procedure in which fairness went right out the window and a critical document – a scoring sheet before it underwent a few “final adjustments” – mysteriously went missing.
Maine CDC officials say they were told to destroy documents
By Lindsay Tice, Sun Journal
Posted March 14, 2014, at 11:22 a.m.
AUGUSTA, Maine — Maine Center for Disease Control officials at the heart of a document-shredding probe told lawmakers Friday morning that they were ordered to destroy documents as a method of “version control.”
CDC Division Director Deborah Wigand told members of the Legislature’s Government Oversight Committee that CDC workers were asked to destroy documents.
In response to questions from committee members, she said that senior program manager Andrew Finch told her that he was asked to destroy documents and was uncomfortable with that.
She said she told Finch to do what he was comfortable doing.
Wigand repeatedly denied remembering that she was asked to destroy documents. She also denied asking anyone to destroy documents.
Wigand also said she didn’t think destroying the documents was an attempt at concealment but “version control.”
Wigand testified that Deputy Director Christine Zukas gave the order to destroy documents.
Finch testified that Zukas asked him to “purge my files for all the working documents.”
CDC staff were answering questions in open session after the Government Oversight Committee voted 7-3 Friday to keep the questioning in open session.
The committee subpoenaed Zukas, Wigand, Finch, CDC Director Sheila Pinette and Office of Minority Health and Health Equity Director Lisa Sockabasin to appear before it and answer questions under oath after the five officials declined an earlier invitation.
The oversight committee is the only legislative committee that can subpoena witnesses. If CDC officials had refused to appear, the committee could have gone to Superior Court to compel them to obey.
Sharon Leahy-Lind, the former CDC division director whose document-shredding allegations led to the investigation, also was subpoenaed to appear Friday. She was the only one who did not ask to testify behind closed doors.
The allegations of document destruction came to light last spring when Leahy-Lind, then-director for the CDC’s Division of Local Public Health, filed a complaint of harassment with the Maine Human Rights Commission. She since has filed a federal whistle-blower lawsuit.
She has said her bosses at the CDC told her to shred public documents related to grant funding for the state’s Healthy Maine Partnerships program. When she refused, she said, she faced harassment and retaliation. She since has left her job at the CDC.
A CDC office manager has echoed Leahy-Lind’s allegations and is seeking to be added as a plaintiff to her suit.
Posted March 13, 2014, at 3:25 p.m.
On Wednesday, Maine lawmakers once again declared their positions on Medicaid expansion from the floor of the Senate. What was remarkable was that, despite the fact that the bill to expand Medicaid to 70,000 low-income residents is significantly different from last year, the arguments against it didn’t really change. In fact, instead of the compromise bill drawing more support, it drew less.
Last year, 23 senators approved related legislation, while 12 opposed it. This time, the vote was 22-13. Moderate Republican Pat Flood of Winthrop switched his vote.
The state needs just two more GOP senators to stand up to an eventual and certain veto from Gov. Paul LePage, to reach the necessary two-thirds threshold in that chamber.
Is the art of compromise dead?
Don’t let anyone tell you differently: The bill these senators voted on Wednesday addressed all the real complaints of Republicans. Sponsored by Sen. Roger Katz, R-Augusta, it would have implemented a managed care system, to have outside entities handle the state’s Medicaid program, with built-in cost savings.
Money saved from the changes would pay for the services needed by developmentally disabled Mainers on waitlists. The legislation would allow for the hiring of more fraud investigators and authorize a committee to study the roadblocks people face in getting off Medicaid.
After three years of the federal government paying 100 percent of the costs of newly eligible Medicaid recipients, the legislation would initiate a hard stop of the rollout unless the Legislature voted otherwise.
Not to mention it would give people health care who need it most.
Or that the Legislature’s nonpartisan budget office found it would cost only about $683,520 over three years.
Or that lawmakers in all other New England states have found a way to work together and move forward.
Or that the Affordable Care Act cut Medicare funding to health care providers, including hospitals, in anticipation they would get increased funding from Medicaid, meaning without expansion they’re facing big losses.
Or that, without expansion, the privately insured and providers will continue to pay the costs of treating the uninsured.
Or that the federal taxes imposed to pay for Medicaid expansion apply regardless of Maine’s expansion decision.
The path is clear, yet Republicans are so stuck in their own rhetoric and loathing of Obamacare that they can’t even recognize a compromise that answers their demands. Do they really think the status quo is better?
The most disappointing argument on Wednesday came from Sen. Brian Langley, R-Ellsworth, considered an important swing vote before he voted no.
Despite acknowledging the “great leadership” needed to enter into compromise, he ultimately relied on the same broken line of reasoning LePage also has used to argue in favor of denying benefits: that because he worked his way out of poverty, others can do the same, without governmental assistance.
Unfortunately, using personal experiences and anecdotes might be an effective way to get elected, but it makes for bad governing. Lawmakers need to rely on data and research to make the important decisions, not the history of one.
If having health insurance is truly a “disincentive to work,” as Langley said, then why does Norway have greater economic output per hour worked than the U.S., despite the fact all Norwegians have free health care?
Langley was referencing a Congressional Budget Office report from February that found the ACA will lead to a reduction in the labor supply. But the report also projected the ACA will boost demand for goods and services and, in turn, labor.
Eastern Maine Medical Center facing $7 million shortfall
By Jackie Farwell, BDN Staff
Posted March 13, 2014, at 4:25 p.m.
BANGOR, Maine — Eastern Maine Medical Center faces a $7 million shortfall from shrinking government reimbursements, fewer patients than expected, and a surge in unpaid care.
“We’re five months into our fiscal year, and we haven’t met our targets,” Deborah Carey Johnson, EMMC’s president and CEO, said in a notice on the hospital’s website. “As the only provider of many healthcare services for the northern two-thirds of the state, it’s important that we are able to quickly adapt to today’s rapidly-changing healthcare environment. The flexibility we show today will help ensure that we’re strong in the future.”
The $7 million operating loss stemmed from much lower revenues than anticipated in January and February, Johnson told the Bangor Daily News on Thursday. EMMC recently funded its reserves with millions of dollars funneled to the hospital as part of Gov. Paul LePage’s pledge to repay Maine’s hospitals nearly $500 million in Medicaid debt, but remains in the red on day-to-day operations, she said.
“Overall, EMMC is still extremely financially sound, as an organization,” Johnson said. “We’re sort of looking at this as a rough patch, if you will, that we need to take very seriously.”
Government payments to the hospital for treating Medicaid and Medicare patients are projected to fall by an estimated $10 million compared with last year, largely through cuts outlined under the Affordable Care Act. While those cuts were anticipated, higher revenues to offset the losses haven’t materialized, Johnson said.
“That’s a huge decrease in reimbursement,” said Dr. James Raczek, the hospital’s chief operating and medical officer. “You don’t hear about that, nobody’s talking about that with the Affordable Care Act. The political fight is over the insurance mandates and the Medicaid expansion.”
At the same time, charity care, provided for free to patients who can’t afford treatment, and bad debt, including unpaid medical bills, currently total $27 million over the last five months — an $8 million increase over the same time frame last year. Other hospitals are seeing similar jumps, Johnson said.
“That’s throughout the state, it’s not unique to us,” she said.
EMMC anticipated a drop in charity care and bad debt as a result of more Mainers gaining health insurance coverage under the federal health reform law, the notice states.
More than 25,000 Mainers have signed up for private health insurance under the Affordable Care Act, making the state a leader in enrolling residents through Healthcare.gov, according to new federal data released Tuesday. With those policies taking effect Jan. 1 — and some later given the troubled rollout of the website for the insurance marketplaces in Maine and 35 other states — hospitals haven’t yet seen a big drop in charity care, said Andrew Coburn, a rural health expert and chairman of the Master of Public Health program at the Muskie School of Public Service at the University of Southern Maine.
“That effect of greater access to health coverage won’t be felt until right around now,” he said.
The federal government has not yet released data on where individuals gaining health coverage under the Affordable Care Act live, so it remains unclear how many reside in EMMC’s service area.
“Some of the numbers in the state look good, but we’re not convinced that it’s actually decreased the true number of uninsured in the state, just by the fact of our amount of free care and bad debt we’re seeing,” Raczek said.
Senate hearing: Learning from other nations' health systems
Hearing convened by Sen. Bernie Sanders
On March 11, Sen. Bernie Sanders of Vermont chaired a Senate subcommittee hearing on what the health care system in the United States can learn from other countries, particularly Canada, Taiwan, Denmark and France. The following 6-minute video features the testimony of Dr. Danielle Martin, comparing the U.S. and Canadian systems while dispelling myths about health care in Canada.
For a detailed account of the proceedings, including direct links to the full video and to the individual, written statements presented there, see this Quote of the Day post by Dr. Don McCanne, PNHP's senior health policy fellow.
A four-minute highlight video of the hearing, including all of the panelists from this extraordinary (and to our knowledge, historically unprecedented) session, is availablehere.
For how the testimony of the Canadian physician, Dr. Danielle Martin, has been received in Canada, click here.
http://www.pnhp.org/print/news/2014/march/senate-hearing-learning-from-other-nations-health-systems
On March 11, Sen. Bernie Sanders of Vermont chaired a Senate subcommittee hearing on what the health care system in the United States can learn from other countries, particularly Canada, Taiwan, Denmark and France. The following 6-minute video features the testimony of Dr. Danielle Martin, comparing the U.S. and Canadian systems while dispelling myths about health care in Canada.
For a detailed account of the proceedings, including direct links to the full video and to the individual, written statements presented there, see this Quote of the Day post by Dr. Don McCanne, PNHP's senior health policy fellow.
A four-minute highlight video of the hearing, including all of the panelists from this extraordinary (and to our knowledge, historically unprecedented) session, is availablehere.
For how the testimony of the Canadian physician, Dr. Danielle Martin, has been received in Canada, click here.
http://www.pnhp.org/print/news/2014/march/senate-hearing-learning-from-other-nations-health-systems
Doctor who schooled U.S. senator ‘thrilled’ by Canadian support
By Carmen Chai
Global News (Canada), March 13, 2014
TORONTO – Dr. Danielle Martin knows Canadians are proud of the country’s universal health care. She is too.
At a U.S. Senate subcommittee earlier this week, the Toronto family doctor laid the smack down on American officials who alleged that doctors and patients were fleeing Canada for greener pastures in the U.S.
Martin knew she had to stand her ground. But she didn’t expect the overwhelming response from Canadians who are now applauding how she handled the heated exchange.
So far, she’s been hailed as a national hero for “schooling” the U.S. Senate.
“I think it taps into a really deep pride that Canadians have about single payer health care. I don’t think it’s about me. The basic value that Canadians hold that access to health care should be based on need and not ability to pay is very fundamental to how people view themselves as Canadians,” Martin told Global News on Thursday morning.
“We see our health care system get misrepresented and trashed in the American media as part of their debate quite a lot and that’s a source of real frustration for Canadians,” she said.
The Women’s College Hospital doctor was invited by senators to Washington for a panel on what the U.S. can learn from other countries that function on a single payer health care system. Martin joined a panel of international experts on single payer health care models – doctors from Denmark, France, and Taiwan also shed light on the system.
It was during the question-and-answer period when Martin and Republican Senator Richard Burr began their verbal sparring.
“On average, how many Canadian patients on a waiting list die each year? Do you know?” Burr asked.
“I don’t, sir, but I know that there are 45,000 in American who die waiting because they don’t have insurance at all,” she said.
“What do you say to an elected official who goes to Florida and not the Canadian system to have a heart valve replacement?” Burr asked. He was referring to Newfoundland Premier Danny Williams’ decision to head to Miami for heart surgery in 2010.
“It’s actually interesting because, in fact, the people who are the pioneers of that particular surgery…are in Toronto, at the Peter Munk Cardiac Centre, just down the street from where I work,” Martin quipped back.
Finally, when Burr asked why Canadian doctors are leaving the public system, Martin shot down his claim: “In fact, we see a net influx of physicians from the United States into the Canadian system over the last number of years,” she said.
Global News (Canada), March 13, 2014
TORONTO – Dr. Danielle Martin knows Canadians are proud of the country’s universal health care. She is too.
At a U.S. Senate subcommittee earlier this week, the Toronto family doctor laid the smack down on American officials who alleged that doctors and patients were fleeing Canada for greener pastures in the U.S.
Martin knew she had to stand her ground. But she didn’t expect the overwhelming response from Canadians who are now applauding how she handled the heated exchange.
So far, she’s been hailed as a national hero for “schooling” the U.S. Senate.
“I think it taps into a really deep pride that Canadians have about single payer health care. I don’t think it’s about me. The basic value that Canadians hold that access to health care should be based on need and not ability to pay is very fundamental to how people view themselves as Canadians,” Martin told Global News on Thursday morning.
“We see our health care system get misrepresented and trashed in the American media as part of their debate quite a lot and that’s a source of real frustration for Canadians,” she said.
The Women’s College Hospital doctor was invited by senators to Washington for a panel on what the U.S. can learn from other countries that function on a single payer health care system. Martin joined a panel of international experts on single payer health care models – doctors from Denmark, France, and Taiwan also shed light on the system.
It was during the question-and-answer period when Martin and Republican Senator Richard Burr began their verbal sparring.
“On average, how many Canadian patients on a waiting list die each year? Do you know?” Burr asked.
“I don’t, sir, but I know that there are 45,000 in American who die waiting because they don’t have insurance at all,” she said.
“What do you say to an elected official who goes to Florida and not the Canadian system to have a heart valve replacement?” Burr asked. He was referring to Newfoundland Premier Danny Williams’ decision to head to Miami for heart surgery in 2010.
“It’s actually interesting because, in fact, the people who are the pioneers of that particular surgery…are in Toronto, at the Peter Munk Cardiac Centre, just down the street from where I work,” Martin quipped back.
Finally, when Burr asked why Canadian doctors are leaving the public system, Martin shot down his claim: “In fact, we see a net influx of physicians from the United States into the Canadian system over the last number of years,” she said.
Dr. Danielle Martin gives Washington a lesson on Canadian health care
Toronto doctor touts benefits of Canada's system in Washington
By Meagan Fitzpatrick, CBC News Posted: Mar 13, 2014 12:45 PM ET Last Updated: Mar 13, 2014 4:38 PM ET
As the debate about Obamacare rages on in the United States, a Toronto doctor calmly defended her country’s health-care system before a partisan U.S. Senate committee in Washington this week and explained that the single-payer model is not to blame for wait times — and that Prime Minister Stephen Harper is not a socialist.
Dr. Danielle Martin, a family physician who is also vice-president of medical affairs and health system solutions at Women’s College Hospital, was the Canadian voice on an international panel at a committee studying what the U.S. can learn from other countries.
“I do not presume to claim today that the Canadian system is perfect or that we do not face significant challenges,” Martin told the committee on Tuesday. “The evidence is clear that those challenges do not stem from the single-payer nature of our system. Quite the contrary.”
Martin outlined the benefits of Canada’s health-care structure and contrasted it with the American one, while noting the strong public support in Canada for the idea that access to care shouldn’t depend on one's ability to pay.
“We do not have uninsured residents. We do not have different qualities of insurance depending on a person’s employment. We do not have an industry working to try to carve out different niches of the risk pool. This is a very important accomplishment and as we watch the debate unfold as to how to address the challenges you face, we are reminded daily of its significance,” said Martin.
Martin, who also holds a degree in public policy and is an assistant professor at the University of Toronto, said a lot of work is being done on reducing wait times in Canada. Moving away from a single-payer system and introducing more private health care is not a solution and would likely exacerbate wait times in the public system by drawing health-care resources away from it, she told the senators.
Conflicting views on Canada
Sitting next to Martin was another Canadian, Sally Pipes, who is now an American citizen and leads a think-tank in San Francisco that advocates for the free market. Pipes gave a decidedly different view of Canada’s health-care system.
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