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3/10/2013 5:59:00 AM
Husband and wife doctor team wary of Obamacare
The doctors are in: Sen. Kelli Ward (private practice) and husband Mike Ward (Kingman Regional Medical Center emergency room) discuss the state of health care and how it could be impacted by the Affordable Care Act.SUZANNE ADAMS/Miner
The doctors are in: Sen. Kelli Ward (private practice) and husband Mike Ward (Kingman Regional Medical Center emergency room) discuss the state of health care and how it could be impacted by the Affordable Care Act.

Suzanne Adams-Ockrassa
Miner Staff Reporter

INGMAN - State Sen. Kelli Ward and her husband Mike are both physicians. She has a private practice in Lake Havasu City, he works in the Kingman Regional Medical Center emergency room. They sat down with Reporter Suzanne Adams, News Editor Alan Choate and Editor Rich Thurlow on Feb. 22 for a lengthy interview.

Part 1, published in the March 3 Miner, was focused on health care delivery from the perspective of a state senator who is also a physician, with Kelli Ward offering most of the input. This segment deals with health care in the age of the Affordable Care Act - Obamacare.

Miner: Can you give us an overview on the changes in medical care due to the Affordable Care Act?

Mike Ward: I think its important to emphasize that Kelli is very well aware that she ran on an anti-Obamacare message and was elected with over 71 percent of the district. She's sensitive to that. We are, both. We don't believe in it. Philosophically we don't believe in it.

Kelli Ward: I believe in the free market. I think we are going far, far afield of the free market. There really is a great state of Maricopa. So much revolves around that area, which you know, the mega population is right there. But a lot of things they want to do there are not what would work for the whole rest of the state.

But I've had people from the Phoenix area, not legislators but other people, say, "Well, you need to tell your constituents what is good for them and what they want." I think that's one of the things wrong with government, is that people are patting their constituents on the head and saying, "Oh, honey, don't worry. I know best and I'll do what's best for you." I'm really striving to keep in touch with constituents and let them know what's happening and get their input.

I like the lobbyists. I think that they're great. I think they have great information. I equate them to drug reps. In my practice, I always had pharmaceutical reps come in. They have great information, cutting-edge technology and all these things. But I also have to remember the same with drug reps as with lobbyists - take everything with a grain of salt, because they have a product and that's what they're paid to sell you.

Mike: It's knowing your market, too. I think there are some constituencies that would be probably more accepting of, "Oh, well, I trust you to get this done." That's not what's here.

Kelli: Yes. That is not what is here. They want to know what I'm doing and they want to be sure I'm doing what they want. That's what I'm trying to do. I can tell you I get emails from other parts of the state that are not always complimentary. Mostly they're about guns. I've said, "I live in Mohave County. Don't try to tell me from Tucson to bring gun control, because we don't want gun control where I live. We want to enlighten you about the freedom and the rights of law-abiding citizens. We shouldn't be treated like criminals."

It's interesting to see the emails from other places. Our guys really are awesome. Our guys and ladies that send me emails are just amazing. Not one person from our district has sent me a mean or attacking email. Somebody from, I don't know if he's from Needles or Fort Mohave. He's a KTOX guy. He sent me an email to tell me I'm not smart. He asked some of his people to demand that I appear on their station at a time. "We demand that you call in tomorrow at 7:15 a.m." I had a meeting that day at 7 o'clock.

So it's interesting. That's been the only bad guy, hundreds of nice people.

Miner: Can you give us an overview of where we go from here with medical care?

Mike: I think we have a lot of challenges. We know that there are financial challenges in our marketplace in our rural part of Arizona. Kingman Regional is very different from other hospitals in the county, being a not-for-profit entity, being responsive to the community, not to shareholders. It's truly run by a community board by some pretty talented local business people.

The challenges we see are paying for services. Clearly the hospital is doing well right now. I don't know if it's because the volume was up really high through the winter. Really, after Christmas, when flu season hit, we were staggering in volumes. It was crazy what we were doing in the emergency department. There were a couple days we had over 180 patients a day check into that ER. Which is far, far above our average.

Miner: What's average?

Mike: When I started working here in 2004, 80 patients, 90 patients a day was a real difficult day to get through. Certainly the volume has grown, but I think the volume's grown in ways that reflect what's going on out in the community.

They talk about some of the Medicaid and AHCCCS stuff when up to 100 percent of the federal poverty level childless adults started dropping off.

One of the things we heard in one of Kelli's town halls was someone said, "Well, they were kicked off."

Well, no, they weren't kicked off. Had they been responsible and kept their paperwork up and filled out the forms when they were supposed, they would have stayed on. And that's why there are still about 70,000 people, childless adults, throughout the state that are still on. Because they made sure they did the things they needed to do to not fall off, where they have to recertify every so often.

We've seen a change in our payer mix and that's challenging because our volume's gone up. Our average per patient pay has gone down. So we've had to increase staff when our reimbursement is going down.

Kelli: So you do more work for less.

Mike: Our current numbers are changing. Our self-pay rate from July on is up to about 15 percent. In emergency medicine, as an emergency physician group, we collect typically about 6 percent of those dollars and it varies, but our collection rate goes down. Our Medicaid has dropped as a percentage but it was up high. Two years ago, it was 40 percent of patient volumes.

Now it's down to about 30 percent. So about a 10 percent drop.

The problem with Medicaid for me as a business person is that if you come to the emergency department, which is the highest cost care, to seek care for a non-emergency, and because we bill that at a lower level because it's not urgent, sometimes it's not even acute, the reimbursement that we get versus the cost of malpractice, the cost of billing for those services and the cost for paying the provider, whether it's a physician assistant or a PA, we may lose anywhere from $9 to $40 to see that patient.

Kelli: That's what I say to people whenever they ask me about Medicaid expansion. It's basically a slowly failing business model. If you're going to increase the population of people that you lose between $9 and $40 dollars on for every visit, eventually that's going to stop working for you. The people who are able to make up that shortfall are going to be decreased. How will you stay open?

Businesses don't just stay open for the goodness of their heart. They stay open to be able to make a living and to make money. If it's suddenly all negative, how many people will stay in and continue to do it? What will happen to the model that we function under for medical care?

Mike: The other argument is you have lots of people that are self-pay. So you're losing even more money on those so you'll lose less.

Kelli: Except for what I told you before, you're more likely to seek care.

Mike: The problem is they're also not talking about ... if you raise the eligibility percent to 133 or 138 percent, numbers that are being tossed around, there are people who are currently privately insured through their employer or through a family health plan who are trying to make ends meet by keeping their own health insurance who will now qualify.

So those private insurances are what keep us afloat. Commercial insurance may only make up 25 or 28 percent of our payer mix, but it equals more than 50 percent of our reimbursement.

If those people fall out of commercial payers, that's what's going to harm the hospitals. That's what's going to harm groups like me. This isn't a charity organization.

I have people who work for my company who expect to get paid an hourly rate and they, like everyone else in the country, want to get raises. So they pressure you for raises at a time when your reimbursement really is going down, although they're working harder for it. So it's a struggle.

I worry about Obamacare. I think in general there are so many moving pieces. I know (KRMC CEO) Brian Turney talked a lot about the rules and regulations that affect the hospital. It's not that it's so hard to comply with acceptable standards in health care. It's having to hire the people to then create the documentation to prove that you are. That's the other side of the piece. It's not that people in health care don't want to do the things you want to do. It's that you have turn around and prove it.

Kelli: And I think that's in every industry.

Mike: It is. The regulatory burdens as a whole. I always thought that if Arizona positions itself as the place of freedom and opportunity and not of handouts, then we would attract businesses that want an employee base that wants to work. I think the more we give away, the less incentive there is to work.

I don't mind giving my money to whoever needs it. I just don't like giving my money to people that just want it.

There's no accountability in that system. There's no accountability for how our tax money is being spent in the Medicaid system because the federal government says we can't hold them accountable. We can't ask them to pay a co-pay if they go to the emergency department. We can't expect behaviors from them that are healthy, whether it's not using drugs or not smoking or whatever it is. You can't have any expectations.

Even the cigarette tax and fines in Obamacare which go into effect in 2015, which could affect a normal, working, regularly insured person up to $4,000 a year in additional costs.

It's not going to affect those people who are of lower income who will be on the Medicaid system. That accountability isn't there. They're going to be allowed to continue to smoke and to do those other things that the government is trying to modify our behaviors by fining us.

I think in general we're holding up. We're looking forward to the other hospital opening as a free standing ER, which we hope will happen this fall. We need the space, more than anything. We're pretty landlocked. Most emergency departments look at patients per bed per year and we're at the maximum of most reasonably run institutions. Certainly not by design. I think that before Hualapai was going to open, we were looking at plans for not only ER expansion at KRMC but building an entire new wing on the hospital which would have included a brand-new ER that was of the size that would meet the community's needs.

So we're going to have to divide our staff to take care of the same number of patients, which are going to increase because of Obamacare. I think that we're out of space. Flu season is tapering down. We're seeing less and less flu.

Kelli: Spring breakitis.

Mike: We don't see a lot of that here. But what summertime does bring us is increased travelers and a lot more vehicle crashes and that kind of travel.

Miner: As physicians, what's the best thing about the Affordable Care Act?

Kelli: Silence.

Mike: I know you asked Brian (Turney) this question. I think that as physicians, certainly we want people to have access to affordable, high quality health care, which shouldn't include an emergency department visit for other than emergencies.

But we're not going to get that. It's a great thing to talk about and yes, its great that your kids can stay on your insurance until you're 26. I think that helps a lot of people out.

Kelli: But the unintended consequence of that is a lot of childbearing goes on between 18 and 26. So, the parents are covered on their parents' insurance but the grandkids aren't. And in Arizona, there is no product that you can buy. Basically, they expect them to be uncovered or on Medicaid in that population. That was not intended, I don't think.

Now, we're seeing the 26-year-olds, some of them have benefited from it, so now they're starting to go off. And they're like "Oh, what do we do? We don't know what to do. I can't [get] insurance. I can't do this. I can't do that."

Are we just going to say, well, you need to stay on your parents' forever? What happens to the next generation? There is no parents' insurance.

I get frustrated because there are public service announcements and things that are paid for with my money to tell me what I like about Obamacare, even though I don't. They're basically doing a propaganda campaign to convince people that they really do like something that all of the polling shows people don't like. They're trying to change public opinion through propaganda, I feel.

Miner: The president says that it's documented that people are saving money, but I haven't witnessed that personally.

Kelli: I haven't had one person tell me that.

Mike: We know that health care costs are rising, health insurance is rising and so to say that the ACA will bring ... it's really a misnomer.

Kelli: It's the UACA, unaffordable care act.

Mike: Because it's really not affordable care. The problem with health care, there's two problems that we agree on.

One, if someone else is paying for your health insurance, you are not a health care consumer. You are a health insurance consumer if you are actually buying it. But in most cases, it's an employer or the government buying it for you, because there's no consumerism, as a general rule. In health care, it doesn't experience the same market forces that other free markets do because there's no responsibility.

If I go to the grocery story and I only have $100 to spend on groceries, I'm not going to spend $200. One, the store won't let me, they'll arrest me. I can't do it.

But in health care, no one knows how much the bread costs. It's not like we're hiding it. Half the time, I don't know what the bread costs. I know what I charge but everyone pays a different rate.

That's one of the major problems with the cost of health care. People are not consumers.

Private health insurance is going up. It's not going down.

Kelli: I can't quote the study, but by 2016 the average cost for a family of four will be $20,000 for their health care.

Mike: It's an IRS study.

Kelli: Yeah, I think it is. Right now people aren't spending $20,000 for a family of four. For me, and maybe I'm just cynical, but I think this is basically set up to put us on a path to single payer health care, which I consider socialized medicine.

As a doctor, would that be easier? Of course it would be easier to have just one person, one rate, but you also lose all of the entrepreneurial ability. The best doesn't rise to the top because everyone gets the same thing. I don't think people will say, "Oh, here's the bar. How can I go over it?" They'll say, "Where's the bar and how can I barely meet it?"

So I think that the quality of care will go down. The amount of care, the services that are offered will definitely go down. But everyone will have a little bit of something.

I don't think that's the best way. I think the best way is to purchase or negotiate for the services you want. Not say, "Well, we need to spread it all out."

I'm not a redistributor. I think you should keep what you earn and help those who can't help themselves. I heard that all the time through the campaign and now in office, that people in our district are very charitable, but they want accountability for people who they perceive, whether it is real or not, are taking from people who work and choosing not to work because it's easier for them.

I'm not a believer in from each of his abilities to those according to their needs, because eventually it works out that nobody is working. Because why would you work really hard to give all of your earnings to someone who's needy and choosing not to work?

The developmental disability community is just so amazing. I wish more people would model after that. They're trying to get more money in the budget. That's one of the people that are lobbying us. And they've been cut and cut and cut.

But the people who live there, we did a legislative forum there, they want to work at New Horizons. They're just crying out, "We want to work more." There are places where they're able to go and able to work.

I was talking to somebody, one of the lobbyists that came in, and they were talking about they were doing some apprenticeships with that community, especially people who have autism. They were having them shadow plumbers. They said if they need something done the same way every single time, this is the guy. They come to work on time. They come to work happy and they come to work ready to do whatever you ask them to do.

That's so rare in the normal population. You want to say, "Hey, let's find some appropriations for this community that wants to help themselves." They need help. You can tell they need help, but they want to be a part of that helping process. I think that's what most people want to do to help people who are in need is have that accountability piece, and that's missing.

Mike: Disclaimer. We have health insurance. We're covered under Tri-Care. I'm still in the National Guard. I'm still active. I'm an active participant in the Guard. So Kelli's not taking the state health insurance.

Kelli: But I know I'm on government insurance through Tri-Care. But we never use our insurance.

Mike: We want it to be there, if we need it. But we're not frequent utilizers of health care.

I guess that's the other dichotomy, and Kelli talks a lot about this as well. When you go out and buy life insurance and homeowners insurance and automobile insurance, it's insurance.

Kelli: Something you buy and hope never to use.

Mike: That's right. When people buy health insurance, they fully intend to use it.

Kelli: A lot, some of them.

Coming Monday: The final questions and answers.

ICT - Dr. Mohtaseb

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Reader Comments

Posted: Friday, March 15, 2013
Article comment by: From the Lips of ...

Love Anson's Nephew's translations. Ya made only one small error,

“I like the lobbyists. I think that they're great.”

Translation – After I get done with this hokey State Rep job, I'll get a job that really pays - Yes, I'll love that lobbyist thing.

Posted: Wednesday, March 13, 2013
Article comment by: Real Doubtful

Mike Ward....We didn't elect you. Why are you even there? I thought Sen. Ward was a doctor as well and therefore versed in the topic without your imput.
Concerned about what my tax payer dollars are providing, expecially when it is a two for one deal.

Posted: Monday, March 11, 2013
Article comment by: Carol Reddin

Thank you for this well-written and informative article. My husband and I are new to Mohave County and we've been treated at KRMC and by several medical professionals. We've been treated in a very courteous and professional manner and are thankful for this! Keep up the good work!

Posted: Monday, March 11, 2013
Article comment by: Anson's Nephew

Well as the original "bad guy" who disagreed with Ms Ward it would appear as if there are quite a few "bad guys" in the County. Get the picture, Kelli.

Posted: Monday, March 11, 2013
Article comment by: Disenchanted Patient

I guess my best "take-away" from this article is Francis Perkins' post. Her comments brought to mind one of my biggest complaints about the healthcare system, which is that I can rarely get a detailed price list for my medical treatment plan ... if I can even get a written treatment plan that is in layman's language as well as in the medical code language that I have to use in knowledgably discussing my treatment/potential bill with my insurance company. When we go to a restaurant, we get a menu that lists each food item and it's cost. At medical facilities, we are expected to sign an open contract with no actual knowlege of the details and itemized costs. I have specifically asked for more information and have been refused, or in other cases, been given insufficient or misleading information. I deeply resent this and believe it is criminal. Also, I don't trust most surveys because they seem to guide me into answering in a particular way that doesn't reflect the true direction of my opinion. The Affordable Health Care Act is my greater hope right now, with it's continued tweaking as needed, because the health system we have been saddled with over the past decade plus is so out-of-control. Additionally, the pharmaceutical industry with all it's media advertising seems to be trying to turn us all into junkies of some kind of pill or another. Take THIS comment, Kelli, and run with it!

Posted: Monday, March 11, 2013
Article comment by: The Fox Hound

Thank you to all the Kingman daily Miner reporters who did such a great job of interviewing Mike and Kelli that all 20 reader comments thought she was full of Bull. Your doing your job for the miner to bad you couldn't work for us once in a while.

Posted: Monday, March 11, 2013
Article comment by: Dave hayes

Looks to me like Mrs. Ward has more than "one" person who feels she isnt doing a good job. But she seems to live in a fantasy world of her own.

Posted: Sunday, March 10, 2013
Article comment by: Does my insurance cover verbal diarrhea?

Wow. Thank you to the Miner for printing that unfiltered transcript. After reading it several times, my current impression is that neither subject has any clue what the Affordable Care Act will bring. My further impression is that they are hiding their ignorance behind indulgent anti-Obama-care sentiment. Too bad. I don't know what Obama-care will bring either. I was hoping for leadership and insight. Looking forward to the next installment. Maybe I will find "final answers" there.

Posted: Sunday, March 10, 2013
Article comment by: David Rogers

ACA is here to stay. You will need to adjust or find a new occupation.

Posted: Sunday, March 10, 2013
Article comment by: Dave hayes

I don't appreciate Mrs. Wards comments, I have NEVER sent her an email. Whoever she is referring to is NOT me. I have reported on her attacking her contituents who disagree with her by posting thier comments on one of her many facebook pages and then proceeding to cheer on her supporters to attack the dissenter. Mob mentality. Kelli better get her facts straight before she shoots off her mouth, When I do send her an email, she'll have no doubt it's from me. She just alerted my lying politician radar.

Posted: Sunday, March 10, 2013
Article comment by: Marla Kiriakidis

I note that Dr. Kellie's first thought is for the free market, not the welfare of the people. No one, NO ONE, should be making a profit from peoples health. I can't trust any doctor that's first worry is about money, not patients.

Posted: Sunday, March 10, 2013
Article comment by: Frances Perkins

The Ward's analysis is flawed and full of the GOP talking points on the Health Reform law. Its scary that this is part of the decision making process in Phoenix. There is no such thing as a "free market" in health care. A free market assumes that all parties have equal access to actual pricing and outcome information, and can make a reasonable selection for service. You cannot find the actual price for service or product in health care,MIT all depends on who is paying and what insurance you have and who is giving hidden discounts. In fact all hospital and drug prices seem to be mythology. Plus much of health care selection is irrational. When someone goes to an ER and they are bleeding or have a heart attack, they are not asking the price of bandages or heart medicine.

Drug companies and medical products companies don't want you to know what they cost because of hidden discounting, in fact many contracts have clause requiring their cost to be undisclosed. And they sure dont want you know what the for profit hospitals (Havasu Regional) executives are being paid. Please read Time magazine March 4 edition on health care costs and billing. It will scare you to death. The Health care bill is trying to bring logic into the system, and disclosure, and disclosure or rejection of kickbacks doctors get for prescribing a certain drug or product. Our office got a canoe for writing so many prescriptions from our drug rep. As a constituent I resent the implication people get sick just to use the system. No one gets sick on purpose, no one chooses to get cancer. The premise of the health care law is a REPUBLICAN idea, get more people paying into the system, and per unit coasts go down. Get some facts right, Mr. And Mrs. Ward.

Posted: Sunday, March 10, 2013
Article comment by: Dean Edwardsen

If they are worried about money they bill it should mean the that Obama Care benefits the patient rather than the doctor.

Posted: Sunday, March 10, 2013
Article comment by: juan gonzales

you said ( If I go to the grocery story and I only have $100 to spend on groceries, I'm not going to spend $200. One, the store won't let me, they'll arrest me. ) So your saying if some has a heart attack and has no insurance the doctors say sorry, but here a Aspirin. Now get out of here !!! WOW Mike

Posted: Sunday, March 10, 2013
Article comment by: Say What?

Some of what you're saying... maybe nearly a third ... I'm not comprehending. Please rephrase it.

Posted: Sunday, March 10, 2013
Article comment by: Republicans - Always Push for More Paperwork for Little People

"...kept their paperwork up and filled out the forms when they were supposed,..." I'm sure the Ward duo have a different story when they are asked to fill out a form to be reimbursed for medical treatment from Medicare folks. Those darn Republicans push for bigger government, more paperwork - gee.

Posted: Sunday, March 10, 2013
Article comment by: Anson's Nephew

“Kelli Ward: I believe in the free market.”

Translation – price gouging by insurance companies, pharmaceutical companies and doctors is the way to go. More money for me.

“I like the lobbyists. I think that they're great.”

Translation – They give me money.

“Not one person from our district has sent me a mean or attacking email.”


“Somebody … He's a KTOX guy. He sent me an email to tell me I'm not smart. He asked some of his people to demand that I appear on their station at a time. ‘We demand that you call in tomorrow at 7:15 a.m.’ I had a meeting that day at 7 o'clock.”

Incorrect and made up. Dave Hayes has repeatedly asked Ms Ward, from the moment she announced she was running, to come on the air and be interviewed. He has never sent her an e-mail. Her reaction was to block his questions and comments from her Facebook page. Mr Hayes’ offer for Ms ward to come on the air remains a standing invitation with no “demand” – just “Come on down!” Why is she afraid to meet with someone – on the air – to answer some non-softball questions instead of using the KDM to attack a person who disagrees with her as a “bad guy?”

“So it's interesting. That's been the only bad guy, hundreds of nice people.”

I do not understand why Mr Hayes is being referred to as “bad guy” because he wants to interview Ms Ward on the air and ask her about her positions. I do know that I am also a “bad guy” because I sent her an e-mail that she immediately posted on her Facebook page where her “friends” attacked and told blatant lies about me.

Posted: Sunday, March 10, 2013
Article comment by: Kelli - Advocate of Socialized Medicine ?

"Kingman Regional is very different from other hospitals in the county, being a not-for-profit entity, being responsive to the community, not to shareholders. It's truly run by a community board by some pretty talented local business people."

Posted: Sunday, March 10, 2013
Article comment by: Who'd We Elect?

As I read the article I thought I was learning more of what Mike Ward thought than the views and positions of our newly-elected representative. Word count proves that to be the case

Mike Ward - 1676 words

Kelli Ward - 1381 words

Just think if Michelle spoke 18% more than Barack!

Posted: Sunday, March 10, 2013
Article comment by: Same Old Thing

Kelli Ward: I believe in the free market.

But healthcare is not a free market. It's a seller's market.

Her first statement is an untruth, so what can we believe about the rest of her babbling?

This much in print has to mean she's a Thurlow-favorite.

Posted: Sunday, March 10, 2013
Article comment by: Frank Harris

Yes, Keli, those opposed to your views are polite. But please don't misunderstand politeness for agreement.

Posted: Sunday, March 10, 2013
Article comment by: We Know What Her Next Job Will Be

Our state representative loves lobbyists and drug reps for their wonderful information. As one of her constituents I would like to see her calendar to determine how many hours she meets with health care lobbyists, drug reps. and those "selling things" compared to how many hours she, herself conducts independent research to obtain her own information. The insurance companies and pharmaceuticals love this woman, the informed constituent is very concerned about their voice being heard.

Posted: Sunday, March 10, 2013
Article comment by: Dutiful Republican

Sounds like a dutiful Republican woman. Who did we elect? the husband and wife team? This woman has been interviewed for multiple papers and each time her husband is also interviewed... Cut the cord or get out of office.

Posted: Sunday, March 10, 2013
Article comment by: The Fox Hound

I just loved the Mike and Kelli show. Two young libertarians living and loving in Kingman far away from the rest of the world. And Reality I might add. If you want to know whats wrong with heatlh care don't ask a doctor. Ask a real reporter or just go to utube and type in Steven Brill. He's a real reporter and he will tell you the truth. He recently did a great investagation on the health care industry and what they charge you for medical care. The cost of medical care is always going up because its based on what they feel they can charge rather than the real costs. The hospital will tell you that they have to charge like that because the real cost is hidden and they have to make up for it somehow. Yeah right so charging 1700 for a room and they charging a buck and a half for a tylenol is fair. Why didn't the Miner ask what Dr Kelli would have done about the problems that brought us to the aca. The biggest reason for going broke in America is medical debt for people who don't have insurance, and in some case for some who do have it. I didn't see anything about how to address our very real health care problem. But after all it is the Miner.

Posted: Sunday, March 10, 2013
Article comment by: john fenske

Complain, complain, complain. Lots of words but no action. It's my belief and hope that EVERYONE will get better healthcare as we work on OUR new healthcare system. Yes, it needs work so start living in the solution instead of the problem.

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