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big pharma. How else to realize the libertarian dream of hell for poor people and deals for the rich with no middle class with any power. If only the planet was a game of golf where the closer you are to your goal of being 1% the easier everything gets. But if you are born poor you get nothing. Less than nothing. If you scramble your way to the lower middle class all you can afford is a skinny healthcare plan that doesn't help you if someone in your family gets really, really sick and only the rich can afford diabetes medication. What a wonderful world to build. 
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