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Ruddcare

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An Australian Newspaper
Prime Minister to unveil sweeping $16bn health reform

STEVE LEWIS, MARK KENNY, CANBERRA

July 26, 2009 09:40pm

PRIME Minister Kevin Rudd is to unveil a sweeping $16 billion public health reform blueprint today.

Under the reform, four out of five Australians will be tied to a single doctor and all patients guaranteed a GP appointment within two days.

And a subsidised dental care scheme would be introduced as part of the biggest shake-up to health in decades. The Government also is being urged to build stand-alone elective surgery hospitals in an ambitious push to cut hospital waiting lists.

Your say: Does Dr Rudd have the right prescription for our health care woes? Leave a comment below

In a controversial move, the blueprint recommends considering accommodation bonds as part of a move to allow aged care providers to raise extra revenue.

This has again raised the spectre of elderly people having to sell their family home in order to gain access to a high-care aged facility.

The 300-page report from the Health and Hospitals Reform Commission obtained by The Advertiser says Australia has an "overloaded sickness system and offers scant resources for illness prevention and early intervention".

In a major attack on obesity, every primary school would have access to an on-site nurse to encourage children to exercise and stop eating fast foods.

The report, containing 123 recommendations, is expected to form the basis of the Government's second-term agenda.

The report warns that governments will not be able to afford our current health system within 25 years – unless radical change is introduced.

With millions of Australians suffering chronic or sustained diseases and illnesses such as diabetes and obesity, the report says these people – together with young families and indigenous people – should be encouraged to enrol with a single doctor who will co-ordinate all their healthcare needs.

Dr Christine Bennett, who was hand-picked by the Prime Minister Kevin Rudd to conduct a 16-month inquiry, has bluntly warned there is a "pressing need for action" to tackle the fragmented health system.

In its 300-page report, the panel outlines a massive shift in the treatment of mental health patients. In the wake of high-profile suicides from cyber bullying it has called for early intervention by trained nurses in mental health cases.

New 24-hour "rapid response outreach" teams would also be rolled out to respond to attempted suicides and other mental health emergencies.

The report outlines a $500 million plan to address glaring disadvantages faced by rural communities.

This includes $143 million in top-up payments for GPs and other medical practitioners.

Sick people living in the bush would also receive $250 million a year in travel and accommodation subsidies as part of efforts to ensure they receive equal health access to city people.

The Commission has backed off recommending an immediate Commonwealth takeover of state public hospitals but it does suggest Canberra may eventually need to fully fund public health services.

On Sunday, Mr Rudd said he could still seek a mandate through a referendum at the next election.

The report calls for an urgent injection of funding, of up to $5.7 billion a year. The costs of the new Denticare scheme is estimated at more than $3 billion – although this could be offset by a hike of 0.75 per cent in the Medicare levy.

With increasing levels of obesity and diabetes, the Government has been told to establish a new national preventive health agency.

The Government has also been told to introduce a national system of electronic patient records by 2012 – giving individuals the power to keep personalised health records.

Every Australian should be able to have a personal electronic health record that will at all times be owned and controlled by that person, the report says.

And it sets out 12 national health targets which include a call for every Australian to be able to get an appointment within two days, an ambulance within 15 minutes and elective surgery within three months.

Rising healthcare costs means that governments won't be able to meet future funding needs without significant reform, the report says.

The 100 recommendations will "transform the Australian health system", Dr Bennett argued.

Mr Rudd has backed away from a pledge to take over public hospitals but the report calls on him to take over 100 per cent funding of public hospitals in the long term.

"The Commonwealth would have close to total responsibility for government funding of all public health care services across the care continuum – both inside and outside hospitals,' it says.
My thoughts:

- It's about time we had decent dental care covered under the public system.
- I'm not sure how much having nurses in primary schools will discourage obesity, but I guess it's better than trusting parents to do it.
- People whinge about old people having to sell their family homes to get into a nursing home, but to be honest, if they already live alone, they're not going to be using their home once they get in the nursing home. I guess that if they still have a partner who doesn't need to go into the nursing home it would be a problem, but for the price of an average house in my city you could rent an average house for 18 years, so I don't quite see why rental isn't an option for reasons that aren't related to the home ownership culture we have here.
- The biggest issue is how it tackles the issue of the aging population
- It's probably good for my state, since SA has an older population than any state apart from Tasmania, IIRC, and having more Commonwealth Funding is a good thing.
- As for the tax increase, I don't mind so much, as long as we're getting more out of it.
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Re: Ruddcare

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I'm a bit puzzled by the nurses to combat obesity thing. Both primary schools I went to didn't have canteens and we played plenty of sport. On top of that I'm fairly certain studies have shown that it's dietary habits at home that have the biggest role in childhood obesity.
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Re: Ruddcare

Post by Lusankya »

I think the nurses to combat obesity thing is there to make it look like they're doing something about it, although really when it comes to things like obesity it's really the fault of crappy parenting and lazy kids.
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Re: Ruddcare

Post by thejester »

Yeah, chalk it up with the internet filter and the new anti-terror laws as yet more of Rudd's 'we need to look like we're doing something' attitude to areas where simple legislative fixes don't actually work.
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Re: Ruddcare

Post by Stark »

Oh man we need more hysteria over the filter boondoggle. :) AS BAD AS CHINA! Turns out the govt will waste money on shit if it makes them look good to bogans?
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Re: Ruddcare

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My thoughts
This has again raised the spectre of elderly people having to sell their family home in order to gain access to a high-care aged facility
They already do, and frankly you don't need your own home if you go to a nursing home / hostel (if you live by yourself). Or we could have something which allows them to rent it out and help pay the bills.

Public dental health would help. Hopefully it will be cheaper to go to a dentist. I have a feeling dentists who make big bucks doing less hours than doctors, which arguable see sicker people won't be happy about that. Oh well, can't please everyone.

Unfortunately until I see these 123 recommendations, its hard to comment on them.
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Re: Ruddcare

Post by Lusankya »

Well, if you want to see the recommendations, you can find them here in a bunch of small PDFs (or one enormous one if you prefer). I can't really comment on them much, because at least 50% of them seem to be a bunch of fluff to me.
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Re: Ruddcare

Post by mr friendly guy »

Here are the first 10 recommendations. Don't have time to go into it at the moment, but it smells like fluff. Maybe the good stuff is later on in the report.


Building good health and wellbeing into our communities
and our lives

1. We affirm the value of universal entitlement to medical, pharmaceutical and public hospital services under Medicare which, together with choice and access through private health insurance, provides a robust framework for the Australian health care system. To promote greater equity, universal entitlement needs to be overlaid with targeting of health services to ensure that disadvantaged groups have the best opportunity for improved health outcomes.

2. Australian governments and the Australian community should acknowledge that the scope of the universal entitlement and service obligation funded by public monies will need to be debated over time to ensure that it is realistic, affordable, fair, and will deliver the best health outcomes, while reflecting the values and priorities of the community. Mechanisms for effectively conducting this dialogue should be developed and should include expert clinical, economic and
consumer perspectives.

3. Listening to the views of all Australians about our health system and health reform is essential to the ongoing sustainability and responsiveness of our health system. Accordingly, we recommend regular monitoring and public reporting of community confidence in the health system and the satisfaction of our health workforce.

4. We recommend that public reporting on health status, health service use, and health outcomes by governments, private health insurers and individual health service providers identifies the impact on population groups who are likely to be disadvantaged in our communities.

5. We recommend the preparation of a regular report that tracks our progress as a nation in tackling health inequity.

6. We recommend the development of accessible information on the health of local communities. This information should take a broad view of the factors contributing to healthy communities, including the ‘wellness footprint’ of communities and issues such as urban planning, public transport, community connectedness, and a sustainable environment.

7. We support the delivery of wellness and health promotion programs by employers and privatehealth insurers. Any existing regulatory barriers to increasing the uptake of such programs should be reviewed.

8. We recommend that governments commit to establishing a rolling series of ten-year goals for health promotion and prevention, to be known as Healthy Australia Goals, commencing with Healthy Australia 2020 Goals. The goals should be developed to ensure broad community ownership and commitment, with regular reporting by the National Health Promotion and Prevention Agency on progress towards achieving better health outcomes under the ten-year goals.


9. We recommend the establishment of an independent National Health Promotion and Prevention Agency. This agency would be responsible for national leadership on the Healthy Australia 2020 goals, as well as building the evidence base, capacity and infrastructure that is required so that prevention becomes the platform of healthy communities and is integrated into all aspects of our health care system. We recommend that the National Health Promotion and Prevention Agency (NHP&PA) would also collate and disseminate information about the efficacy and cost effectiveness of health promotion including primary, secondary and tertiary prevention interventions and relevant population and public health activities.

10. We support strategies that help people take greater personal responsibility for improving their health through policies that ‘make healthy choices easy choices’. This includes individual and collective action to improve health by people, families, communities, health professionals, health insurers, employers and governments. Further investigation and development of such strategies should form part of NHP&PA work on the Healthy Australia 2020 Goals, targeting cross portfolio and cross industry action.
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Re: Ruddcare

Post by weemadando »

OK, playing "Centrelink guy" to start with:
Of course people should have to fucking sell homes or find a way to monetise them to offset the cost of aged care. Right now there are so many loopholes and exemptions that they can effectively become a rent-free property for any relative who wants to move in - and not count towards the assessment of fees. People should ALWAYS try to find a way to support themselves before turning to the gov't for a handout. And even if they were just to have to ensure that "market rent" (as defined by the AVO) was charged on the property and the profits of this went towards their fees, then that would be a huge offset already.

From a personal PoV:
Public dental care without a decade long waiting list will be great. My question: will it be enough to make me give up on paying for that portion of my private health cover? Or will it just increase the cost of my private health cover AND increase my taxes. After all - a 1000 a year tax hike is 2% of my income and for that much I'd really want to see real improvements. Sure this is selfish, but the fact is that I already pay a massive amount to NOT be a drain on the public system, in addition to paying a massive amount to the public system in the form of tax.

They are going to have to take a huge axe to their spending to do this. Or they could have - you know, not blown hundreds of fucking billions on bullshit stimulus packages. I don't think I'm surprising anyone when I say I'm not exactly fond of the idea of voting Labor at the next election. The Rural Reforms are interesting, but it's the same song that every gov't has sung for decades. And they'll still fail to find staff to man those hospitals and clinics and surgeries and programs.

The most interesting part for me is how they say: "In 25 years we can't afford this." Just like the fucking pension system. The problem is that there is a massive voter bloc who don't give a fuck because in 25 years they'll be dead and damned if they want anything changed now that will disadvantage them in their twilight years.
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Re: Ruddcare

Post by mr friendly guy »

I have a few generic suggestions, when I have time ie after I sat my second exam I can go into more specific things. But right now, how about

1. TAX JUNK FOOD.

Yes I eat junk food occasionally, but so what? With the GFC, the only eateries that seem to thrive is junk food ones. Taxing them will reduce the consumption like with taxing cigarettes did to smoking and gives us more revenue. More revenue to spend on health.

I can even let Mcca's and KFC advertise to kids as long as we tax them. And McDonalds was my favourite food growing up as a kid, and I loved their advertising. But I never became a junk food junkie. I guess thats what responsible parenting is.

2. Increase taxes on cigarettes.

Oh wait, Turnbull is whining about how its a tax grab and not a health measure. Why can't it be both? Turnbull has been such a disappointment.

3. Increase taxes on alcoholic beverages.

Won't be popular, but maybe we can target specific ones like alco pops to minimise the political fall out. Oh wait, Turnbull objected again. Along with Family First senator Steve Fielding. Maybe they think getting booze is every families right, and thats putting families first. Except if you are gay, then your family doesn't count.

I will be able to talk about more specific things, as pertaining to the running of hospitals etc when I have more time. These are just generic suggestions which aren't difficult to implement, but just need the political will. Which we aren't going to get from the Liberals.
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Re: Ruddcare

Post by weemadando »

Taxes on cigarettes = YES. Money + immediate and future health benefits.

Tax on Alcohol = YES. Money + immediate and future health and public/road safety benefits. Can we even make it a flat "alcohol tax" where the tax is %age alcohol by volume x volume (in L) = tax in cents per purchase? I dunno about that, but I think that it should be transparent and actually rate the amount of alcohol in the container purchased, not just single out one type?

Tax on junkfood = YES. I'm a fatty and I fucking endorse this. Though maybe we should look at a tax being levelled on fat/sugar content not just junkfood.

Increase petrol tariffs and shove ALL that money back into public transport and the development of city planning in Australia which isn't motor vehicle reliant. The only reason I drive to work is because it costs only marginally (and I mean MARGINALLY) more to own and operate my car per year than it would to buy the tickets to commute to work (not to mention I use the car for shopping etc). And because Connex and the Victorian Gov't hate public transport not only does the cost work out about the same, it takes about half the time using my car than it does taking public transport. HALF. And this is driving through serious congestion.

You want to go a long way towards fixing obesity and strike a blow against respiratory disease and the road toll (and cost of the MAIB) in the bargain? INVEST IN MAKING CITIES IN AUSTRALIA PEDESTRIAN FRIENDLY. AND BIKE FRIENDLY. And have good public transport that people WANT to use, because it's easier than driving and you'll actually have people doing SOME exercise each day. Anyhow - that's a slightly off-topic rant.
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Re: Ruddcare

Post by JointStrikeFighter »

Tax on alcopops = increased hard spirit sales.
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Re: Ruddcare

Post by loomer »

Are increased liquor sales really a problem, though? I'd rather know a man who developed a taste for proper, gin martinis growing up than one who thinks the epitome of drinking is some pre-mixed bullshit.
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Re: Ruddcare

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JointStrikeFighter wrote:Tax on alcopops = increased hard spirit sales.
Try goon. The quickest and cheapest way for teenagers to get pissed remains goon + fruit juice. It's cheaper and more potent than alcopops.
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Re: Ruddcare

Post by mr friendly guy »

Gleaned a few more details from the West Australian so I can give a few more thoughts.

1. E - health system

Sounds like a good idea. You don't know how irritating it is when you ask people their past medical history and their reply is, can't you get it from the notes (when the notes haven't arrived yet). It becomes more problematic if they have been interstate. The only other difficulty (besides implementation of course) that I can see, is how this new program works. WA hospitals are in the process of introducing / have introduced the standardised discharge summary writing programme. While it has some neat features, ie can be emailed directly to GPs, remembers patients list of medications (so you don't need to cut and paste from previous summaries) I find it "unwieldy" in terms of writing a summary as it demands virtually dot points and no prose. Its a minor nitpick and its hard for me to describe it unless you try typing in it. Generally if they can iron out these bugs it would be great.

2. Bonus scheme to hospitals for reducing waiting times in emergency departments and reducing waiting times for elective surgery.

This sounds like a bad idea on the surface. Ok, maybe if you were a free market lover you might think this is awesome. However some UK colleagues have reported the NHS doing this, and basically it ends up punishing the hospitals who actually need more help and MORE funding. Frankly I have misgivings about this, but I am willing to let the government wow me.

As for reducing wait times via bonuses... Ok, rant on.

In WA we plan to introduce a 4 hour rule where the hospitals will somehow figure out how to get people out of ED within 4 hours. Usually that will involve them being seen by the relevant surgical / medical / psychiatric specialty team members before that. Now we are only in the gathering phase, but some people have tried to enforce this. Problem is, sometimes it gets busy and with not enough doctors on the admitting team, its not possible, so ED admits them under the team to save time and get their numbers looking good. If you can't see why this is bad, lets put it this way. If you were the doctor in charge, and a patient was admitted under your care which either a) you didn't know about b) you know, but you haven't assessed and they had an adverse outcome, eg they died, would you be happy to face the claims of negligence?

Lawyer : its under your name, patient died its your fault
Doctor : but I never even saw the patient.

BTW, that was the subject of an episode of MDA, medical drama on ABC starring Kerry Armstrong and Jason Donovan.

So far it hasn't happen to me. The worse I had was patients who I thought didn't need to be admitted (they were most probably not THAT bad, and could be managed at home with the proviso they come back to ED if their condition deteriorates unexpectantly).

You heard it here first. If bonuses to reduce ED wait times gets introduced, there will be pressure for the ED doctors to do this, and admit them under a specialty without the team's registrar seeing them AND THEY WILL DO IT.

What they need to do is roster a 2nd registrar for busy specialties, with duties to handle ward calls and to help out the admitting registrar if the shit hits the fan. Like they do in Adelaide, apparently.

3. Overhaul medicare to allow private health care companies to administer some medicare functions?

Such as? Private health already competes with public hospitals (which isn't a bad thing from my POV as it takes some of the load off public, except when a politician keen to show he is in touch with the average guy goes to a public hospital instead of a private one - Mark Latham I am looking at you). Since public hospitals to my knowledge aren't funded by medicare, they are funded by the states, which most probably gets some help from the Feds in the form of GST revenue, I am curious as to what they will compete in. Paying GP fees?

4. Greater spending on disease prevention.

Need more details, but since we are talking prevention, advertise the ACAT (Aged Care Assessment Team) service for the community more. Also advise relatives on guardianship issues. What we wish to avoid is patients who are dementing, or just generally getting on a bit and not able to take care of themselves to finally present to the hospital with either exacerbation of an existing medical condition secondary to poor self care (eg not taking meds) or with just not coping at home, where we then start the ACAT process. If we can already get the ACAT assessment done in the community we can start the ball rolling into getting them placed into a hostel / nursing home depending on what type of facility they require and WHEN (thats the clincher) their condition deteriorates to the stage when they can't cope at home. Thus they may go straight to the aged care facility without needing to come to hospital first.

Oh and tax junk food, increase taxes on cigarettes and alcohol like I said, if you are interested in prevention.

On another note, Rudd is visiting 3 WA hospitals. I have a feeling besides he will visit one rural and maybe 2 metropolitan, although one of them would most probably be a peripheral hospital (to maximise his exposure to different types). I am optimistic he will visit Fremantle, then I can tell him what I think. But I will first congratulate him for getting rid of the wanker Howard. :mrgreen: This will naturally be followed by rants suggestions on how to improve things.
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Re: Ruddcare

Post by weemadando »

The "performance incentive" stuff also has one unchangeable and irreplaceable companion:

FUCKING LIES.

After the hospitals fail to actually fix a problem and realise that they aren't going to get the extra funding, then they'll find ways to do it. Whether this is just cooking the books or actually endangering people by fucking about with practices who knows - but this is what happens every fucking time you try something like this.
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Re: Ruddcare

Post by Ford Prefect »

loomer wrote:Are increased liquor sales really a problem, though? I'd rather know a man who developed a taste for proper, gin martinis growing up than one who thinks the epitome of drinking is some pre-mixed bullshit.
Man, most kids around my age with bottles of spirits just dump some amount into a glass with some fruit juice. Most kids my age just want to get drunk; they want something that goes down easy and in huge quantities. This is the part of the popularity of goon; you could tax that, but it'd have to be by something like 4000% before it stops being dirt cheap.
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Re: Ruddcare

Post by bobnik »

Ah, goon. I've been trying to repress those memories, and it wasn't even me drinking it. :?

Seriously though, I support the idea of taxes on alcohol, cigarettes and junkfood. That last one is problematic though - how do you define it? You can't just say, for example, "anything sold by McDonalds" - they would argue, and perhaps rightly, that you can walk in and get a salad and a bottle of water. Perhaps a standard could be agreed on involving a kilojoules by serving and/or weight ratio?
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Re: Ruddcare

Post by Serafina »

Actually, Germany did increase the tax on alcopops - and consumption of those have dropped dramatically.
Thats no surprise, BUT - the amount of alcohol poisoning (of people below 25) also dropped by a huge margin since this tax has been introduced. And it was increasing before the tax was introduced.
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Re: Ruddcare

Post by Lusankya »

The thing about alcopops, if I recall correctly, is that you often can't taste the alcohol in them, so it makes it difficult to judge how drunk you're getting from them. If the lack of ability to judge was what was causing the alcohol poisoning, then that would make sense.
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Re: Ruddcare

Post by Serafina »

We are talking about alkohol poisoning - of course there is a lack of judgement.

People will get drunk willingly - but i doubt they want to poison themself. So, alkohol poinsoning only happens if you drink more/heavier than you intended.
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JointStrikeFighter
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Re: Ruddcare

Post by JointStrikeFighter »

Lusankya wrote:The thing about alcopops, if I recall correctly, is that you often can't taste the alcohol in them, so it makes it difficult to judge how drunk you're getting from them. If the lack of ability to judge was what was causing the alcohol poisoning, then that would make sense.
Which always seemed like bullshit too me; I have never measured my level of inebriation by "ZOMFG TASTED THIS MUCH ALCOHOL" For me it's always been a mix of "yeah i know ive had xyz number of drinks" and "yeah i feel pretty drunk"

The real "issue" with alcopops is you can drink them fast.
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Lusankya
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Re: Ruddcare

Post by Lusankya »

JointStrikeFighter wrote:
Lusankya wrote:The thing about alcopops, if I recall correctly, is that you often can't taste the alcohol in them, so it makes it difficult to judge how drunk you're getting from them. If the lack of ability to judge was what was causing the alcohol poisoning, then that would make sense.
Which always seemed like bullshit too me; I have never measured my level of inebriation by "ZOMFG TASTED THIS MUCH ALCOHOL" For me it's always been a mix of "yeah i know ive had xyz number of drinks" and "yeah i feel pretty drunk"
Newsflash: people are morons.
The real "issue" with alcopops is you can drink them fast.
And that is because you can't taste the alcohol.
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JointStrikeFighter
Worthless Trolling Palm-Fucker
Posts: 1979
Joined: 2004-06-12 03:09am
Location: Brisbane, Australia

Re: Ruddcare

Post by JointStrikeFighter »

Lusankya wrote:
JointStrikeFighter wrote:
Lusankya wrote:The thing about alcopops, if I recall correctly, is that you often can't taste the alcohol in them, so it makes it difficult to judge how drunk you're getting from them. If the lack of ability to judge was what was causing the alcohol poisoning, then that would make sense.
Which always seemed like bullshit too me; I have never measured my level of inebriation by "ZOMFG TASTED THIS MUCH ALCOHOL" For me it's always been a mix of "yeah i know ive had xyz number of drinks" and "yeah i feel pretty drunk"
Newsflash: people are morons.

Touche
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TithonusSyndrome
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Re: Ruddcare

Post by TithonusSyndrome »

JointStrikeFighter wrote:The real "issue" with alcopops is you can drink them fast.
I don't know what kind of alcopops you have down there, but I seriously can't even stomach one. No hyperbole. They're too goddamn sweet, and with the alcohol and putrid artificial flavoring it makes me nauseous.
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