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Old 03-08-2009, 09:33 PM   #261
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Originally Posted by ERD50 View Post
I understand your point, and I'm struggling with it too. It would appear that the ins cos are just an added layer, sucking up costs. The only reason to consider them is if the competition helps control costs over and above their profits.
There is one other minor point in addition to the good ones you raise: I think most people would agree that the insurance companies will have lower costs to administer these programs than the government will pay (though I'm sure some will argue the other way). What seems to irk people the most is the profit that insurance companies make over-and-above these costs. Now, I think it is highly likely that private companies, in competition, can administer this care at lower cost (even including profit) than the government can. Moreover, if the company is a public one, we all have the opportunity to buy stock in it and benefit from those profits. On the other hand, I cannot buy stock in the US government, and they don't pay a dividend. There's no "refund" to the public by way of dividends, as publicly-traded companies provide.

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Sorry, maybe I'm the one misunderstanding here, but I think samclam just threw the special groups out there as examples of the problem. I think he is saying he would not support picking out one group over another for favored rates, as that throws a wrench into the whole system.
Yep, that's right.

I had to go to w*rk today, and when I got back I found scores of new posts on this thread and also that I'd apparently sidetracked a discussion. My apologies!
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Old 03-08-2009, 09:57 PM   #262
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But isn't that problem fixed if everyone is required to have insurance, and ins cos have to take all who apply (as in samclem's outline)?

It would also seem to promote more preventive healthcare approaches, since all the companies would be "stuck" with any/all applicants for as long as the applicant wanted to stay with that company. It might take something to help keep the ins cos focused on long term results though. If they are looking to make this Quarter's numbers look good, preventive techniques are going to get the short end. But again, the govt might specify the minimum preventive techniques that must be covered.

-ERD50
I think the solution to healthcare is the same as the economy or any other problem we are currently facing in generally not more govt. If the govt must get involved, (and I think that happens way too often) then whatever system they set up allows people more opportunities through their own efforts to make improvements in their lives. That is why I am for things like 401k's, flexible medical spending accounts, etc.

These things are not mandatory, and people do not have to participate, and if that non-participation leads to their own financial or medical ruin, well the olive branch was extended if not taken. Now I think by now I understand the oposing point of view, which is basically most folks are not bright enough to do so.... so must be coercively forced to do it by the govt... "for their own good". Basically the idea behind mandatory heathcare coverage. That is a bit too totalitarian for my liking.

We need to have systems here in the US... where it is actually advantageous to be intelligent, and detrimental to be foolish.
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Old 03-08-2009, 09:59 PM   #263
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We need to have systems here in the US... where it is actually advantageous to be intelligent, and detrimental to be foolish.
Unfortunately, news of the last several months has pretty much confirmed the contrary.
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Old 03-08-2009, 10:35 PM   #264
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We need to have systems here in the US... where it is actually advantageous to be intelligent, and detrimental to be foolish.
I am a hard-core small government fan. But, the world I would like to see does not match the world we live in. I've observed these facts about the real world that enter into this discussion:
- People become ill and disabled in catastrophic/expensive ways that they cannot prevent. In addition, in many cases it was not even possible for them to have provided medical insurance for themselves. Careful here-I'm NOT saying it is necessarily the government's (i.e. every other citizen's) responsibility to pick up the tab for these expenses, I'm only making this observation to point out that the normal action/consequence feedback process that is so essential to successful individual action in almost every other area of our lives are not be at work in all cases here.

- Moral/ethical/purely theoretical arguments aside, our society has demonstrated that we will not allow poor people/incompetent people/irresponsible people/unlucky people to bear the costs of their medical treatments by themselves. It is possible to argue that things should be different, but in the US, this is the actual situation. So, it is logical to look at ways we can make the best of this situation--reducing costs as possible to everyone, since we are paying the costs anyway.

- There's no doubt that we spend a tremendous amount, in the aggregate, on medical care in the US. By many accounts, we spend enough to provide high quality medical care for many/all citizens within the current medical-cost budget. So, there's at least the chance that an effective system can be found that more efficiently provides better care to more people without paying more money. We just need to find the system.

I want to retain individual freedom and an emphasis on individual responsibility. But, given the real world (see above) and the way things are headed, I think arguing for a theoretically pure market-oriented approach is a waste of time. It's now time to roll up our sleeves and see if the principles we know can work (competition, individuals making choices based on their own interests and situation, individuals sharing to the maximum extent possible in the risk/rewards of their decisions) can be applied to the actual medical/cultural/economic/political environment in which we live.
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Old 03-08-2009, 10:44 PM   #265
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These things are not mandatory, and people do not have to participate, and if that non-participation leads to their own financial or medical ruin, well the olive branch was extended if not taken. Now I think by now I understand the oposing point of view, which is basically most folks are not bright enough to do so.... so must be coercively forced to do it by the govt... "for their own good". Basically the idea behind mandatory heathcare coverage. That is a bit too totalitarian for my liking.
armor99, while I generally agree with you, I think healthcare is different for a number of reasons.

#1 - the "money" reason: For the ins cos to be in a position to offer reasonably priced coverage for average citizens, we really need to have everybody covered. With out that, many people will try to go without... until they get sick. Those people are going to be expensive to cover, and yet, they didn't pay in for all that time. The only recourse ins cos have is to try to exclude "pre-existing conditions", and that is a real can of worms - fraught with error, fraud, expense. Mandatory coverage solves that.


#2 - the "have-a-heart" reason: Consider the middle class (just to keep class out of the equation for now). Regardless how much an individual may work towards maintaining a healthy lifestyle, stuff happens. And that stuff can wipe out an honest, hard-working family. It can wipe out the family who spent lavishly and had little savings, and it can wipe out the LBYM family with a good nest egg. I'd hate to see that happen, and I'm willing to have some of my tax money go towards supporting that family. Now maybe this isn't about having a heart, maybe it's about realizing that family might be mine. It's about risk sharing, something we do in society.

#3 - pragmatism and the poor - back to hard cold numbers. We will end up paying for the poor anyway. I'd rather see that done in a more regimented way than waiting until they show up in the ER. A good preventative program might just save us all money, and improve the lives of the poor.

I feel strongly enough about all those to turn away from my normal Libertarian views. I really do think this is different. Take my money for this, but I do want to see it used reasonably effectively, and it's fine if I don't get back all I put into it. That's almost always the desired outcome when you buy insurance.

-ERD50

PS - ummm, what samclem said!
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Old 03-08-2009, 11:37 PM   #266
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Well thank you for taking the time ERD50. I thank those that agree with me, and thank people even more when they disagree. It provokes me to think further. Might even change my mind at times...

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armor99, while I generally agree with you, I think healthcare is different for a number of reasons.

#1 - the "money" reason: For the ins cos to be in a position to offer reasonably priced coverage for average citizens, we really need to have everybody covered. With out that, many people will try to go without... until they get sick. Those people are going to be expensive to cover, and yet, they didn't pay in for all that time. The only recourse ins cos have is to try to exclude "pre-existing conditions", and that is a real can of worms - fraught with error, fraud, expense. Mandatory coverage solves that.
When the outcome does not seem to make sense any more, check your premises, and you might discover one of them is wrong. In my opinion, the premise that "reasonably" priced coverage MUST be provided for everyone, is incorrect. I still believe there are market based solutions to this problem such as starting a health insurance policy for your child when they are born. People do it for a college funds. Maybe the govt allows another type of 401k like fund to be used only for health related problems. Maybe insurance companies start offering plans for newborns that if used until the child gets to 21 are not dropped for X number of years. Not ideal... not perfect.... but neither is the world we live in.

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#2 - the "have-a-heart" reason: Consider the middle class (just to keep class out of the equation for now). Regardless how much an individual may work towards maintaining a healthy lifestyle, stuff happens. And that stuff can wipe out an honest, hard-working family. It can wipe out the family who spent lavishly and had little savings, and it can wipe out the LBYM family with a good nest egg. I'd hate to see that happen, and I'm willing to have some of my tax money go towards supporting that family. Now maybe this isn't about having a heart, maybe it's about realizing that family might be mine. It's about risk sharing, something we do in society.
Feel free to do what you wish with your money. I applaud your ideals! I might even choose to do the same thing! I think charity is great, but forced charity is also known as extortion. And extortion even for the most noble of causes (as this certainly is) does not justify the means to me.

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#3 - pragmatism and the poor - back to hard cold numbers. We will end up paying for the poor anyway. I'd rather see that done in a more regimented way than waiting until they show up in the ER. A good preventative program might just save us all money, and improve the lives of the poor.
With respect to you... I have never bought this sort of arguement. I lived in NYC and heard people say things like.... "Well it is your fault that your bike got stolen, YOU did not have a strong enough lock on it!" As though it was considered prevalent to the point of normalcy, that people SHOULD steal your stuff if not secured properly. I supppose I am seen as cold and heartless... and I will have to accept that. But another persons need does not lay a legitimate claim on what I personally own. No matter how great that need is, or how much I might personally have. Bill gates does not owe any homeless man $1, just because he is the richest man on earth, and they are the poorest. I signed no "social contract" with anyone. For those that I love... that I care about.... those that I CHOOSE to help... I will. I believe this is consistant for food, clothing, shelter, and healthcare. And lack of any of those things will make you just as dead. I do not see why healthcare gets some special status that food, clothing, and shelter do not.

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I feel strongly enough about all those to turn away from my normal Libertarian views. I really do think this is different. Take my money for this, but I do want to see it used reasonably effectively, and it's fine if I don't get back all I put into it. That's almost always the desired outcome when you buy insurance.
I agree with you here... I too want my tax money to be used in a reasonable way. I truly believe that if all of the social programs, and welfare, and free medical treatments went away, people would not wonder about aimlessly and die on the street. I sincerely believe they would find ways, and the market would adapt itself to find more ways of treating people. But if this is never tried... it will always be the way it is right now. I once worked in a factory that was ~70% line workers. Low payed workers of questionable legal status, doing assembly work. Yet I saw almost all of them had a cell phone on them. I though it was interesting that a cell phone was considered such a high priority item. I got by for years without one, and could again if I needed to. I would think $30 or so a month could be used on other more important things. Give people more important things to worry about, and maybe they can come up with their own solutions. I do not think people will become more responsible for themselves until a point is reached in which they HAVE to.

Always with respect... thanks...
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Old 03-09-2009, 03:39 AM   #267
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Haha! I think what you said is true,armor99. We need free medical treatments. Need government provide a good policy.
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Old 03-09-2009, 05:42 AM   #268
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The only thing I can say about insurance for those over 65 is stay away from HMO's.

Take the medicare with a good medgap policy.

If you get really ill, the HMO will write you off and try to shuffle you out of hospital ASAP, to them it's better that you choke. I've had this experience with my mom, and my FIL, both sick, both couldn't walk.

Mom had medicare, they took their time treating her. FIL has Humana HMO, they shuffled him out of hospital, to rehap ASAP, then shuffled him to nursing facility where we paid.

The funny thing is that FIL was in more serious condition than mom, but she got more intensive quality care, better rehab, better outcome. HMO"s for elderly are death traps. These situations took place simultaneously, and it took me a while to figure out what the deal was, when there is financial incentive, your life means nothing.

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Old 03-09-2009, 08:02 AM   #269
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When the outcome does not seem to make sense any more, check your premises, and you might discover one of them is wrong. In my opinion, the premise that "reasonably" priced coverage MUST be provided for everyone, is incorrect. .
I appreciate the challenges armor99, like I said earlier, this is really helping me to clarify in my own mind where I stand on the issue. It's complex, so debate like this is helpful.

Reading through your response, I get the sense you are diverting my comments down a different path than what I intended. So let me clarify - first, I'm not saying that we MUST provide reasonably priced care for everyone, what I am saying is conditions have led me to believe that it is BEST for the vast majority if we do so.


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Feel free to do what you wish with your money. .... I think charity is great, but forced charity is also known as extortion.
This is different from charity, or from me saying "if you think taxes should be higher, go ahead and contribute". I think you are forgetting the comments that some of us have made about how the whole insurance plan works more effectively, and cheaper when everyone is in it. It eliminates self-selection. There is a huge advantage to the majority for that.

I'll return to my 30 person bus-trip-lunch story. Let's say the lunch stop offers lunches for $15 each. But they offer a discount $10 lunch to groups of 30 or more, and throw in dessert. Maybe you are one of 5 that would prefer to brown bag it. You will "cost" the group $125. It is in the best interest of the group to all have lunch. And it doesn't really make sense for the brown-baggers to say, we'll just chip in the $125 to protect our right to brown-bag it. No one is really served by that.

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I do not see why healthcare gets some special status that food, clothing, and shelter do not.
This is the argument I expected from you, because it's the same one I struggle with! Yes, where does it end? Well, I think samclem talked to this more than I did, but basically, health problems are further from that cause/effect/responsibility connection than those other things. That is why I think it is different.

And as I said earlier, I think we could *all* benefit from this, if administered reasonably well.


-ERD50
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Old 03-09-2009, 08:08 AM   #270
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When the outcome does not seem to make sense any more, check your premises, and you might discover one of them is wrong. In my opinion, the premise that "reasonably" priced coverage MUST be provided for everyone, is incorrect. I still believe there are market based solutions to this problem such as starting a health insurance policy for your child when they are born. People do it for a college funds.
There are a number of problems with this. I'll give one big example. Insurance companies come and go and policies come and go. Each time you want or need something new, underwriting is required. How many policies are around that were around when you were a child? How do we deal with the present situation where almost no one is carrying a policy from childhood. The problem simply is that the market only want healthy people and the market will figure out a way to get it.

Homeowners insurance doesn't cover the fact that your house was poorly built. The insurance company will cut you off if you have too many claims. We can live with that because there are other options. Rent. Buy a better house. The same model just doesn't make sense for health care.
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Old 03-09-2009, 10:05 AM   #271
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Homeowners insurance doesn't cover the fact that your house was poorly built. The insurance company will cut you off if you have too many claims. We can live with that because there are other options. Rent. Buy a better house. The same model just doesn't make sense for health care.
Actually I think this analogy is interesting. A major catastrophic health issue can be related to a major catastrophic hurricane while the typical illnesses one gets can be equated to the minor home owner insurance claims. Using this point of view an easy correlation can be drawn from public health insurance and wind pool insurance. People claim that the wind pool only takes the high risk customers, but in reality it does not. The major damage from a hurricane is from the storm surge not wind damage. Many insurance companies in coastal areas won't insure against wind, but it is a minor outlay for a hurricane.

I had heard rumblings of a bill requiring an insurance company to provide homeowners insurance in MS if they offer it in other states and want to do business for other forms of insurance in the state. Basically if the company provides auto insurance in MS and homeowners insurance in another state they must also provide homeowners insurance in MS if they wish to continue issuing their auto policies. The goal of the law was to prevent the companies from issuing gravy auto policies and abandoning the homeowners. I never was able to read the details or find out what happened to the law, but it sounded interesting.

My point is there are more creative ways of providing health insurance than for the government to stifle the free market, which they seem bent on doing.
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Old 03-09-2009, 10:57 AM   #272
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Would you please comment on how Canada handles health care for non-citizens? Tourists?
And then there's baby tourism:

CTV.ca | Quebec doctors report rise in baby tourism

I'm not sure why it's particularly an issue in Quebec.
Ireland had this same problem until they passed a law that stopped babies acquiring citizenship just because of place of birth.
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Old 03-09-2009, 10:58 AM   #273
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I am a hard-core small government fan. But, the world I would like to see does not match the world we live in. I've observed these facts about the real world that enter into this discussion:
- People become ill and disabled in catastrophic/expensive ways that they cannot prevent. In addition, in many cases it was not even possible for them to have provided medical insurance for themselves. Careful here-I'm NOT saying it is necessarily the government's (i.e. every other citizen's) responsibility to pick up the tab for these expenses, I'm only making this observation to point out that the normal action/consequence feedback process that is so essential to successful individual action in almost every other area of our lives are not be at work in all cases here.

- Moral/ethical/purely theoretical arguments aside, our society has demonstrated that we will not allow poor people/incompetent people/irresponsible people/unlucky people to bear the costs of their medical treatments by themselves. It is possible to argue that things should be different, but in the US, this is the actual situation. So, it is logical to look at ways we can make the best of this situation--reducing costs as possible to everyone, since we are paying the costs anyway.

- There's no doubt that we spend a tremendous amount, in the aggregate, on medical care in the US. By many accounts, we spend enough to provide high quality medical care for many/all citizens within the current medical-cost budget. So, there's at least the chance that an effective system can be found that more efficiently provides better care to more people without paying more money. We just need to find the system.

I want to retain individual freedom and an emphasis on individual responsibility. But, given the real world (see above) and the way things are headed, I think arguing for a theoretically pure market-oriented approach is a waste of time. It's now time to roll up our sleeves and see if the principles we know can work (competition, individuals making choices based on their own interests and situation, individuals sharing to the maximum extent possible in the risk/rewards of their decisions) can be applied to the actual medical/cultural/economic/political environment in which we live.
Great post, samclem! You should be on the healthcare reform task force.
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Old 03-09-2009, 01:46 PM   #274
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Virginia Postrel: Cancer and our health care conundrum | News for Dallas, Texas | Dallas Morning News | Opinion: Viewpoints

This appeared in the Dallas Morning News a couple of days ago. I goes to the heart of what concerns me.
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Old 03-09-2009, 02:17 PM   #275
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Virginia Postrel: Cancer and our health care conundrum | News for Dallas, Texas | Dallas Morning News | Opinion: Viewpoints

This appeared in the Dallas Morning News a couple of days ago. I goes to the heart of what concerns me.
Very interesting article. But there is something that I'm not getting. OK, I understand that govt policies could be restricting the use of expensive new treatments in order to keep costs down (while they fritter it away on wheelchair rentals ). But in this story, why is the insurance company, a for-profit organization, any more motivated to spend the $60,000?

The little bit of med insurance that I shopped for, my main concerns were just the basics: cost of course, understanding what was and was not covered, deductibles, co-pays, caps, renewal options, choices in doctors and hospitals, etc. But I never really thought too much about, and would not know how to go about determining the cos willingness to pursue expensive treatments. So it hardly seems like a tool to attract business.

Or, do they figure this treatment may well become cost effective in the future, so start now to help evaluate it?

-ERD50
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Old 03-09-2009, 02:45 PM   #276
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Haha! I think what you said is true,armor99. We need free medical treatments. Need government provide a good policy.
I guarantee you we will never have "free" medical treatments. Someone will always be paying for any medical treatment any of us receives.
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Old 03-09-2009, 02:57 PM   #277
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And then there's baby tourism:

CTV.ca | Quebec doctors report rise in baby tourism

I'm not sure why it's particularly an issue in Quebec.
Ireland had this same problem until they passed a law that stopped babies acquiring citizenship just because of place of birth.

Interesting. I've heard we have that issue here too.

A friend of ours recently married an Australian and moved there. She had a medical condition as a child and, before she could qualify for Australian universal coverage, had to submit extensive medical evidence that the condition was no longer a factor in her life. She says she really received extensive scrutiny.

I doubt we'd do that here in the States. I suspect it will be more of a "if you can get across the river or crawl up on the beach, you're fully covered the same as a long term citizen" philosophy. But who knows....

If we can ever get past the issues of what govt health insurance should look like and who will pay for it, these issues regarding who and what will be covered will come to the front. Those will be exciting debates! With private insurance, you pick the level of coverage you want. With govt insurance, it's likely that the coverage you have will be dictated by govt written rules and regs. That seems to be working OK in Canada. But as you said, Americans are an independent minded bunch and it won't sit well with some.

Oh yeah..... I agree with Ireland's action to remove the provision that if you're born in Ireland you're automatically a citizen regardless of your parents' citizenship. It makes sense.
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Old 03-09-2009, 09:15 PM   #278
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I guarantee you we will never have "free" medical treatments. Someone will always be paying for any medical treatment any of us receives.

Sadly.... I believe that "FREE" is the most expensive word I have ever heard.... Nothing is for free! Someone always has to pay. If you can see who is paying for it, be wary. If you cannot see who is paying for it, be terrified.... because the one paying is probably you....
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Old 03-09-2009, 09:29 PM   #279
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You guys keep talking about the fact that we will never have free treatment. We all know that.
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Old 03-09-2009, 09:57 PM   #280
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You guys keep talking about the fact that we will never have free treatment. We all know that.
Depends what you mean by "all." I was responding to another poster who was calling for "free" medical treatments. But I think we know that you know......
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