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October 28, 2005

Always Bad Incentives. Always.

Nathan Newman's penned a post criticizing me for giving Wal-Mart a pass on their efforts to cherrypick employees so as to keep their health care costs down. He writes:

Employers shouldn't be excused for completely rotten, immoral activities just because a better policy would make compliance with the law easier. This is bleeding heart liberalism applied to the largest corporation on earth, as if Ezra is excusing some kid caught purse snatching with the excuse that society had failed to provide better economic alternatives to a life of crime, so it's really society's fault that the victims lost their property.

But Nathan's got the situation wrong. Wal-Mart is very much abiding by the law. And as they voluntarily expand their health coverage far beyond anything required by statute, legality is even less in question. There's no question that Wal-Mart is fulfilling their legal obligations, what Nathan wants them to do is move towards altruism in employee benefits, exactly what they've spent the last few decades proving totally outside of their corporate character. Nathan continues:

Bashing the government for Wal-Mart's actions is just bad politics. Talking about the incompetence of government in designing our health care system as an argument for entrusting government with MORE responsibility for managing that system is probably the most self-defeating approach possible. But the more large corporations like Wal-Mart are attacked by the public for their health care policies, the more those companies will have an incentive to push for national health care to relieve the pressure on them.

You know who fucked up our health care system? Not just the government -- the unions. Particularly the trade unions led by Samuel Gompers and George Meany. When our health care system was still soft and malleable, they ignored opportunities to expand it across the board and instead focused solely on their workers. Medicare was part of that, it helped in collective bargaining by calming fears about insurance for retirees. It wasn't until Walter Reuther in the late 60's that the union movement began looking seriously at nationalized health care, but it was his UAW going it alone. The AFL-CIO rejected Ted Kennedy's compromise plan, one of the great mistakes in their history. And they similarly used anger at NAFTA as a reason to sit out the 1994 health care battle, helping to doom Bill Clinton's effort. So tell me again how unions are crucial to nationalized health care in this country, as I've just not seen the evidence. Maybe they've now learned their lesson and wouldn't make the same mistake twice (indeed, I think Andy Stern is actually quite savvy about using industries he's organized to win mutually beneficial political concessions), but maybe not.

Nathan well knows that I'm an ally of the Labor movement. But just because you believe in a cause, doesn't mean you should lie about context. Wal-Mart, as a profit-hungry, gleefully self-interested corporation has no interest in transcending statutory obligations to give workers a great deal in benefits. And they never will. Nor do I see any evidence that the union movement is soon to take over their stores, so crafting my posts so as to advance the anti-Wal-Mart case (something I do fairly frequently anyway) seems a bit silly. The point of my article thus stands: in the health system we have -- one largely created by union decisions, government tax quirks, and corporations -- there exists a spectrum of incentives for insurance providing employers to discriminate against ill or old applicants. Wal-Mart is acting exactly as we'd expect, exactly as countless others act. You want that to change? Then change the situation. For once, this isn't about Wal-Mart.

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» Letting Wal-Mart Off the Hook from Labor Blog
Responding to the nasty Wal-Mart memo, where the company laid down a strategy of discriminating against the unhealthy and disabled to keep down health care costs, both Kevin Drum and Ezra Klein in a sense defended Wal-Mart, since the irrationality of e... [Read More]

Tracked on Oct 28, 2005 1:25:51 PM

Comments

I do a fair bit of interviewing and hiring. My understanding is that one cannot make a policy stating that "unhealthy" people won't be hired. I'm assuming that they mean health problems besides the sniffles or a cold. If they have a visible disability, then it is illegal to deny them the job on that basis, even if it is a "physical" job. Part of the ADA is that reasonable accomadations must be made.

Furthermore, if the applicant has something like cancer, there is no way to tell - necessarily - without asking questions in the interview, also illegal. I guess it hinges upon whether this memo is just some guy talking about how it would be great if they could only hire really healthy people who work well, are smart and loyal and honest and satisfied with $10/hr. Something tells me that there is more to the memo, and that managers are going to ask completelly inappropriate questions in interviews because they know that few people really know what is ok and what is not. The problem is proving that this is what they're doing, although the memo stating their intentions might make it easier.

Posted by: Stephen | Oct 28, 2005 11:30:54 AM

I think you and Newman are somewhat talking past each other here. You're both right. Specifically, you're right about Wal-Mart being rational here. If I were Wal-Mart's CEO, I'd be doing the same thing (one more reason not to take the job). But Newman is right about the politics of the situation. He writes that "Bashing the government for Wal-Mart's actions is just bad politics"--and he makes a convincing case. The nut graf is this:

"Bashing the government for Wal-Mart's actions is just bad politics. Talking about the incompetence of government in designing our health care system as an argument for entrusting government with MORE responsibility for managing that system is probably the most self-defeating approach possible. But the more large corporations like Wal-Mart are attacked by the public for their health care policies, the more those companies will have an incentive to push for national health care to relieve the pressure on them. But bash government, and those companies are happy to see attention diverted from them."

To me, the real thrust of his argument is that your post was detrimental to the goal you both share--ensuring universal health care. There's no call for this sort of internecine strife

Posted by: Dan Miller | Oct 28, 2005 1:12:37 PM

Ezra-- First, I recognize you are an ally and corrected some folks at TPMCafe who misinterpreted what I was saying; this is about the rhetoric used and responsibility assigned. This is not an attack on your integrtity and or intentions, but on your rhetorical strategy. So treat this as a friendly debate :)

The crime by Wal-Mart is not that they provided health care. It's that, having been pressured to provide health care, they can't try to cut their costs by ILLEGALLY discriminating in hiring practices.

Yes, Wal-Mart had the perfect legal right to provide no health care. But once they agreed to provide the care, they come under the coverage of a range of laws, from discrimination laws to ERISA. And that memo showed clear evidence of illegal intent.

And Ezra, you've got the union history DEAD WRONG. The unions in the immediate postWWII period were fighting hard for universal health care, Harry Truman -- supported by the union movement -- fought for a national health care bill that was defeated in 1949. This was part of the full-onslaught against unions, including Taft-Hartley. But the commitment to national health care was there from early on, and they pushed through what they could -- Medicaid and Medicare -- over the potential opposition filibusters in the 1960s. And you better believe that without the unions, those parts of our national health care wouldn't be in place without hard union lobbying and mobilization. So you are blaming unions for not being powerful enough to pass the whole national health care law at various points.

Part of my point about targetting Wal-Mart is that the only way to get national health care is to put so much pressure on the corporations that they join the effort for passage, rather than being on the opposite side.

As for the Clinton plan, the unions had their doubts about various proposals in that legislative mess, but blaming the unions for that fiasco is wrong when they had serious doubts about whether some plans would make life worse for their members. I was in California in 1994 when the nice liberals supporting single payer health care decided to sign onto a provision excluding all undocumented immigrants from government health care. SEIU pulled away from support of that initiative because it would have put into law a system that would have ripped away health care from tens of thousands of unionized immigrant workers then receiving health care.

This whole fight is complicated since so many people have a lot to lose from changes to the status quo.

But blaming unions and "government" in the abstract are attacking the wrong enemies. The enemies are precisely the Wal-Marts of the world that fight any effort by their own workers to demand health care and politically fight any serious effort to create a national health care system.

Your instinct to immediately attack allies of health care like unions, while saying we shouldn't get mad at Wal-Mart, is EXACTLY the stance of too many liberals for too many years that has frustrated me to no end.

I'll go off on the relative failures of union strategy in many situations but who do you think is funding most of the grassroots efforts RIGHT NOW to defend Medicaid from GOP budget cuts?

But why do so many people run away from bashing the corporations that should be providing health care? At some level, the costs of health care should be part of the costs of a car or Wal-Marts prices. Keeping the workers healthy is as much a cost for producing those goods as the shipping costs to the customer. Many governments around the world, including Germany and much of Europe, provide national health care through putting the costs largely on employers. Single payer health care is a reasonable alternative, but strengthening the employer-provided system of health care, while expanding Medicaid to cover anyone who is unemployed is also a reasonable approach as well, and similar systems work throughout Europe.

Posted by: Nathan Newman | Oct 28, 2005 1:16:14 PM

Part of my point about targetting Wal-Mart is that the only way to get national health care is to put so much pressure on the corporations that they join the effort for passage, rather than being on the opposite side.

That sounds quite right to me. As they say, there is more than 1 way to skin a cat. In this case, we might want to use all methods. Not just pressuring our elected officials to make the case for national health, but convincing the corporations to see the light as well. We've already made the case that the auto industry should be pushing our side, what makes Walmart so different? The fact that they don't currently have healthcare? Thats bogus.

The question, I think, would be the point of contention, which is to say is there anything intellectually dishonest with criticizing Walmart for their pro-business practices. Well, from a liberal's point of view, is there? Afterall, we're always lauding companies that are pro employee (e.g. Ben and Jerry's.)

Posted by: Adrock | Oct 28, 2005 1:50:54 PM


You could always use the democratic process to pass legislation requiring businesses to provide healthcare. That *IS* the goal, isn't it?

It seems liberals are holding these businesses to a standard that you are unwilling to put into law.

Posted by: Fred Jones | Oct 28, 2005 3:41:31 PM

It seems liberals are holding these businesses to a standard that you are unwilling to put into law.

Which would be easy to do, given that we controll the Executive Branch and both houses of Congress.

Posted by: Tom Hilton | Oct 28, 2005 3:47:17 PM

Hey Nathan. And of course this is all friendly -- I've been too big a fan of yours for too long to have it be any other way. Nevertheless, you're still wrong ;)

Let's start with the union stuff, as this is probably the only time I'm ever going to argue with you on labor history. The AFL-CIO supported Truman's plan, but they didn't put resources behind it and it was always a lost cause -- anyone looking at Congress knew that. Lewis, of the Mineworkers, originally promised support but withdrew his backing when his members won health insurance. The UAW was lukewarm, particularly after they won health insurance themselves. The CIO, in 1946, decided to stop working on legislative solutions and passed a resolution for "security through bargaining." In other words, their support was perfunctory, in-name-only stuff -- they didn't fight for it, and in some cases they nearly opposed. Beth Stevens, who studies this, argued, "the political pressure exerted by the American labor movement was...a demand for a private alternative to state-run welfare programs." George Meany summed it up when he said "we certainly don't look to the political structure for our wages and working connditions, we get them our way."

The simple truth is that the unions never did much for national health care -- there's basically no debate I know of on this point. The reasons, through history, were many: sometimes myopia, sometimes racism, sometimes a focus on skilled workers -- but there simply was no labor movement for nationalized health care. It just never happened. And their role in 1994 was spiteful, they sat it out, sometimes for good reasons, but generally not. SEIU may have had noble reasons, the AFL-CIO did not. And without them, what chance had ClintonCare?

Look: I love unions. Labor and health care are my two key issues. But the've not gone together well historically. It's simply the case that a major reason for our current system was union myopia through the decades. They did not fight for Truman, they rejected Kennedy's compromise, they sat out Clinton's efforts, etc. They got what they needed for their members and left others to flounder, Meany being a particularly bad offender and Reuther being an exception to the rule. The unions may believe differently on this now, but that's been their history. Indeed, there are a fair number of political scientists who solely blame America's labor movement for our lack of nationalized health care. I don't agree with them, but it's a viable stance.

As for the rest of it, I never understand this concept that business will one day wake up and realize we need good universal health care. Even GM hasn't bought into that. They just want the responsibility off of their shoulders. That means an ever-more individualized system, as national health care means serious tax increases, while certain conservative/hsa proposals don't. The Wal-Mart memo was very clear on this political strategy.

And in the end, no one's running away from bashing corporations. I spend a fair percentage of my day blasting Wal-Mart. But they're not going to start providing good health care no matter what I say. So let's put the blame where it lies -- not on employers, who have all the wrong incentives to provide health care, but on the government. What we want isn't a better plan from Wal-Mart, but a better plan nationally, and the way to get that, I think, is convincing the country that their employers are trying to take their coverage away. That, in fact, is true. And the way to drive it home isn't to lambast Wal-Mart for their singular badness, but to explain how Wal-mart is typical, is the same as every other employer in this respect. Americans need to know their employers won't protect them, and beyond that, they need to know why. Saying it's just a single big, bad corporation is a mistake. Saying it's endemic to the system is true.

Posted by: Ezra | Oct 28, 2005 3:53:48 PM

Our overall national health care situation won't get better by trying to impose broader and better employer-provided health insurance - employers don't want this burden, and they have some good arguments related to global competitiveness on their side. And, transferability of coverage would still be a problem and work against a more portable work force.

But for a national health insurance system to get off the ground (whether government-single payer, or joint employer-employee-government funded) business must join in the clamor for this solution.

Beating corporations over the head about their bad objectives or poor coverage tendencies won't get them aboard the national health insurance train nearly as well as saying that health insurance shouldn't be an employment-related matter - but a necessary and needed national risk pool to which all citizens can join in (once again, setting aside the payment formula).

Progressives (and labor untions) shouldn't have to negoatiate with each employers periodically about health care when national legislation can be enacted (and tuned) with the support of all those concerned about the solution.

I agree with Ezra to the extent above. I probably would not use Walmart in any example at all however - unless I was trying to show the cynicism with which corporations fiddle with health care to keep costs down yet hide under the fig leaf of providing some kind of health coverage.

Employer-provided health care (any plan controlled by the corporation's officers) is, and should be, a dead or dieing species. A national health plan, however funded, is clearly a better solution for all - employers, unions, unrepresented workers, and the unemployed/disabled.

Posted by: JimPortandOR | Oct 28, 2005 4:50:47 PM

Ezra-- Let's start with the key issue-- talking about "government" as an particular actor is a rhetorical florish, favored by rightwingers but just odd in a democracy where government actions are the end-product of a bunch of political decisions of non-government actors. So the people you blame are those refusing to provide what is demanded.

Where unions have control of the workplace, they work to provide health care. Where they control the political situation, they expand health care coverage.

Where business has unrestrained control of the workplace, as with Wal-Mart, they restrict health care coverage. And where business controls politics, they fight against health care laws.

So who should you be attacking? "government" or the businesses that fight against health care in their own workplaces and on Capitol Hill?

Bashing unions for their choices of where to devote their political resources at least makes sense sociologically, but is still misplaced. If a serious comprehensive health plan that improved all workers lives was ever up for a vote, unions would support it. They supported universal pensions with social security and were the lobbying muscle behind both Medicaid and Medicare. And continue to support expanding health care coverage through CHiPs and every other legislative health care success that has happened.

The health care debacle is owned by a lot of folks, but making the unions the fall-guy is ridiculous. It starts with Ira Magaziner and Hillary Clinton's commission developing a plan without including COngressional participation or a lot of different folks involvement. By refusing to build consensus among progressive forces, the Clintons left space open for the GOP to dig in and just say no. Remember it was Bill Kristol whose memo summarized the GOP goals-- block ANYTHING and everything.

And talking about labor history in the 1945-1950 period in any kind of singular way is just ridiculous. You had so many different political positions among various unions, some Communist-led unions pushing for policies far more radical than Truman's. And 1946 saw a massive corporate counterattack and partial defeat of for unions in major strike wave, followed with the GOP takeover of Congress that fall.

So if unions were evaluating what their clout was to pass broader legislation, you are blaming them for realism in not expecting the state to help them-- they'd have to fight for it themselves. Which is what happened in most of Europe over the years as well-- the difference was that the health programs for unemployed and poor folks ended up more generous in Germany and other states were an employer-based model came to dominate.

And you keep jumping over the fact that when political opportunity opened, labor unions were the key political actors in helping push through Medicaid and Medicare. Yes, the UAW was often the leader in the 1960s, but they were backed by a range of other unions who, first, helped elect the politicians who voted for those laws but also participated in the lobbying that made them successful. As Taylor Dark, to cite another historian of political work by unions argued, LBJ never could have passed his Great Society programs without the help of Reuther and, yes, George Meany. In fact, the labor reporter of the NY TIMES accused the unions of being too cooperative with the White House, saying labor had "become a White House political appendage, rather than a vigorous initiator of independent policy."(p 56 in THE UNIONS AND THE DEMOCRATS) But other observers saw all this social legislation as following labor's long-time goals, suppressed during the years of McCarthyism and Eisenhower. As the Congressional Quarterly said in 1965: "The lawmakers' action in the fields of civil rights, anti-poverty, education and other social welfare areas under Mr. Johnson's energetic and experienced leadership generally followed the unions' longstanding stance on social legislation."

As Dark also writes: "The Social Security Department of the AFL-CIO, under the direction of Nelson Cruikshank, ahd worked assiduously during the 1950s and early 1960s to promote the idea of national health insurance for the aged. The AFL-CIO also funded and staffed a separate organization, the National Council of Senior Citizens (NCSC), which became one of the most prominent of the organizations building support for the organization."

Any objective history of Medicare and Medicaid admits that labor was the KEY force fighting for passage. So calling labor's support for expanded health coverage "perfunctory" is just wrong historically.

Yes, labor has chosen not to waste its resources on politicians who didn't have the votes or the competence to pass legislation-- and Clinton in the end had neither -- but when the votes were there, labor has fought like hell for health care.

Given the idiocy of the Clintonites in pissing off labor AND Capitol Hill Democratic allies during the 1994 health care fight, it just pisses me off to see folks trying to fob off blame on the unions. Just highight the fact that the fight was in 1994, instead of 1993 when Clinton had more political capital. But no, Clinton decided to fuck over labor with NAFTA as his first priority in 1993 and only after he had done that did he go into an election year -- when it is always hard to pass major legislation -- and try to pass health care. Where health care could be filibustered like the rest of Clinton's 1994 legislative initiatives.

But let's return to the original issue. Why isn't it an employer's responsibility to provide health care? Why run away from assigning that responsibility? You can make arguments for relieving them of that responsibility through a government-run system, but I have no problem bashing Wal-Mart for taking people's labor one day, and then letting them die of leukemia the next because the company was too damn cheap to provide health care.

If you can bash unions for not doing enough politically, why can't you bash companies for not taking care of your employees.

Talking politics can't just be about incentives. Yeah, I can do law and economics with the best of them, but that's the language that loses elections. Once people decide that people deserve health care, then you can talk about the best incentives to achieve it, but if you can't convince them that Wal-Mart should be paying its own employees health care, why should they feel the taxpayers have an obligation to do so?

Posted by: Nathan Newman | Oct 28, 2005 4:56:43 PM

I think we're just going back and forth in quote wars now, so I'm just going to leave my other post to put in my position on unions. The point, however, is not that unions should be anyone's fall guy, but that health care isn't a union v. business issue. Or, insofar as it is, that's been the problem and we need more government involvement.

As for Medicare, labor did a helluva lot on that, partially because it gave them so much more bargaining power on private insurance as retirees were covered. I'm glad they went to bat, but it's a bit of a different issue. Further, I don't blame unions for 1994 -- it's multicausal -- but they didn't help, and it was just one more in a pattern of moments when they could've really fought for nationalized health care and instead whiffed on the opportunity. In every case, there were other things going on, other agents to blame, etc, but neither does Labor ever come out looking great. That's not to diminish all the phenomenally important, progressive things Labor has done, but we should be honest about the record.

As for the other issue, I actually do not believe companies should be responsible for covering their workers. I just don't. Insofar as we've got this insane employer insurance system, we should support attempts to force them to offer insurance, but it shouldn't be their role. The aim, I think, in this period of declining employer-based benefits, is to convince Americans that this is a stupid task to give to business, and it should be instead put on to government. And the significance of this memo isn't that it's another opportunity to attack Wal-Mart, but show that this is only interesting because we have a leaked document proving it.

You'll never get profit-driven entities to willingly provide good insurance -- they will always want to cut their costs, cut your coverage, and save some cash. And that's the point here. If we could convince Americans of that simple reality, we could create the necessary support for nationalized health care. But I don't think simply bashing Wal-mart is going to take us much further. In the memo, they say they need to take a mnuch larger role in the health care policy debate. That means more money towards HSA's, HRA's, and other cost-shifting devices, not national health care. But if voters really understood that what Wal-Mart's doing goes on all the time and can never, ever be stopped, I think you'd see a lot more support for change.

Anyway -- happy halloween! Off to find a wig...

Posted by: Ezra | Oct 28, 2005 5:21:18 PM

I think Dan is right that you guys are talking past eachother (with respect to the wal-mart debate, not so much on the union history digression).

You'll never get profit-driven entities to willingly provide good insurance -- they will always want to cut their costs, cut your coverage, and save some cash. And that's the point here. If we could convince Americans of that simple reality, we could create the necessary support for nationalized health care. But I don't think simply bashing Wal-mart is going to take us much further.

What harm can it do? I don't see how "pressure Wal-mart" and "pressure the government" are mutually exclusive here. Ezra is right that you'll "never get profit-driven entities to willingly provide good insurance". All the more reason to fervently hold them accountable for it, since this is the task which the government is increasingly offloading to Wal-Marts of america.

The (evil) genius of the privatization strategy is that it allows the government to deny accountability in favor of the private sector, which in turn does .. nothing. This is why it behooves us to hold both of them equally accountable. A progressive strategy should be relatively agnostic as to where the healthcare comes from: You want Wal-Mart to do it? Fine. You want the government to do it? Fine. But shit or get off the pot already.

Posted by: Chris Wage | Oct 29, 2005 11:17:27 AM

But of course you can "get profit-driven entities to willingly provide good insurance". General Motors and other unionized companies have been doing so for decades, far better than the government ever has under Medicare and Medicaid.

Whether a single payer system would be better than a more universal employer-based system is a good argument, but we aren't anywhere near a single-payer system right now.

At the non-theoretical level, the debate is not between single payer health care and an employer-based system, but whether Wal-Mart employees get NOTHING or whether Wal-Mart will be pressured to provide health care.

And in the real world debate, saying people shouldn't be mad at Wal-Mart just isn't very helpful.

In theory, I'm far to Ezra's left since I think Wal-Mart itself should be run by the government or its employees, or some combination of the two. So I'm the last to defend private control of our health system.

But what I care about is how to move things towards those longer-term goals, and the first step is pressuring Wal-Mart to provide health care for their employees. Either that's the first step to expanding health care in other companies, or those companies will join a crusade for national health insurance to save themselves money.

If the latter, Ezra and I can be in full agreement then in supporting that bill. But at the moment, Ezra is living in 2020 and I'm fighting in 2005 for workers who need help -- and have some chance of getting it right now.

Posted by: Nathan Newman | Oct 29, 2005 11:36:51 AM

Everybody is missing a rather significant data point: Chief Execs have great health plans and they aren't necessarily the healthiest employees. Additionally, all that crap that they spout about "being competitive" and "protecting the shareholders" is ridiculous in light of what their compensations, particularly the deferred portion, cost shareholders a bundle in taxes and administration. Those on top of fringes like free merchandise, corporate planes, apartments, car service, health care plans, corporate boats etc. are what are really racking up the percentages of sales, not necessarily health care. Additionally, since Walmarts have their own pharmacies, they should be delighted to pay drug benefits and buy the goods wholesale.

I am sick to death of the greed. How many pied-a-terres, corporate apartments, additional houses do these clowns need? Why are shareholders putting up with it? If the workers made more money, shareholders would see higher profits, believe me. It's time for us as a country to do something about this, particularly moving defense industries back into line with real life. They are way too big a part of our economy and the Bush stock portfolio than is good for our economy.

Finally, when is somebody going to point out that "free trade" which is based upon the hypothesis of comparative advantage is a joke. Comparative advantage was the brain child of Ricardo, a 17th century Brazilian economist. Ricardo wrote his idea for an agrarian culture with very unmobile capital and relatively similar labor costs. In short, it is nothing like today's economy. It is about as applicable as a knight's armor is to self-protection today. Would a knight's armor stop a bullet? NO. Is it intended to be protective? Yes, but for a completely different generation of weapons and conflict. This is the same parallel as Ricardo's theory.

MK

Posted by: Madame Karnak | Oct 29, 2005 4:20:40 PM

I am a regular reader of liberal blogs and think that you guys have come across a brilliant strategy. "Pressure companies to provide healthcare, so that they end up passing the buck to the government to save their own bottom line." This is great in so many ways. It helps in the short run, provides the correct incentives for the long run and, my favorite, frustrates the right wing radical ideologues' vision of an ever more privatized Amarica. The strategy is proactive and requires the resources available to responsible, politically active citizens. Chutzpah and perseverence. Force Wal-Mart to side with us or become another GM. Either way, we win. This is the kind of anger, cleverness and determination the left wing desperately needs.

Posted by: Jughead | Nov 9, 2005 3:51:57 AM

It is unfortunate to hear so many lack health insurance. We really need to improve our health care system. Health insurance is a major aspect to many and we should help everyone get covered.

Posted by: California Health Insurance | Nov 10, 2005 6:16:44 PM

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Posted by: casimira | Oct 11, 2006 1:48:54 PM

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