Medicare’s real beneficiaries: Last week, a tribal discussion broke out, along predictably narrow lines.
Had Obama achieved 7 million insurance enrollments? Or was it really much less?
One tribal group kept saying, “Much less.” Within the other tribal group, a multimillionaire and his trusted companions signed up for the role of the clowns:
MATTHEWS (4/3/14): For months, conservative critics have predicted the total failure of the president’s health care law. So when the president announced this week the law had enrolled over seven million people into the health care exchanges, did they react with some humility or at least some acceptance? Not quite.“Truthers?” In fact, we don’t know what the actual number is at this time, or how many of such people will be newly insured.
VAN SUSTEREN: You have said “cooking the books,” the administration. Do you stand by that?
BARRASSO: I do. We still don’t know how many people who have gone to the Web site to sign up actually paid.
JINDAL: We don’t even know what those numbers mean. We don’t know how many of those folks actually paid the premiums.
CRUZ: Well, look, the numbers are a bit of funny math, because they’re giving you numbers of who signed up. Those numbers don’t reflect, number one, who actually bought insurance and paid their first month’s premium.
MATTHEWS: What can you say about these guys, besides they are health care enrollment truthers right now?
Joan Walsh is editor at large at Salon and an MSNBC political analyst, and Michelle Bernard is the president of the Bernard Center for Women.
Nor does it gigantically matter in the longer run. But fish gotta swim and birds gotta fly—and tribal acolytes are going to argue the narrowest current point.
A larger point about our health care “system” was on the front page of yesterday’s New York Times. Abelson and Cohen reported some sobering Medicare facts.
Hard-copy headlines included:
ABELSON AND COHEN (4/9/14): Medicare Opens Its Books On Doctors and PaymentsHere’s how this fits into the larger discussion which never occurs within our clown-run press corps:
One Physician Got $21 Million in 20012—Dozens More Were Paid Millions
A tiny fraction of the 880,000 doctors and other health care providers who take Medicare accounted for nearly a quarter of the roughly $77 billion paid out to them under the federal program, receiving millions of dollars each in some cases in a single year, according to the most detailed data ever released in Medicare’s nearly 50-year history.
In 2012, 100 doctors received a total of $610 million, ranging from a Florida ophthalmologist who was paid $21 million by Medicare to dozens of doctors, eye and cancer specialists chief among them, who received more than $4 million each that year. While more money by far is spent for routine office visits than any other single expenditure, one of the most heavily reimbursed procedures—costing a total of $1 billion for 143,000 patients—is for a single treatment for an eye disorder common in the elderly.
Last week, Barasso, Jindal and Cruz were saying that the number will be smaller than 7 million. Chris, Joan and Michelle knew how to reply:
Barrasso, Jindal and Cruz are racists, these tribal clowns pleasingly said.
Handed this simple-minded fare, we liberals grow slow and clueless. With that in mind, let’s discuss what we liberals often say about “single payer” or “Medicare for all.”
Routinely, we suggest that single-payer would be the answer to the inordinate costs involved in our American health care. As yesterday’s front-page report suggests, it tain’t necessarily so.
You could create a single-payer system which was absurdly costly. Our country may already have such a system—Medicare itself!
Question: Have you ever seen statistics which show how much we spend per person on health care, as compared to other countries, for people over 65?
We’ve never seen those statistics, although they may well exist. Let’s just say you won’t likely see them watching the jugglers and the clowns on The One True Liberal Channel.
We’ll take a guess—those statistics would show that we spend much more per person, in that age group, than other developed nations. Yesterday’s front-page report did little to make us think otherwise.
Watching Matthews throw R-bombs about will do little to make liberals smarter. (On the bright side, it helps him het richer.) It won’t teach us how our society actually works—and it won’t teach us how to reach out to the wider population to address the obvious looting which drives these gruesome statistics:
Health care spending, per person, 2011:Compared to France, $4400 per person was disappearing into the maws of our health care “system.” That’s $4400 per person!
United States: $8508
United Kingdom: $3405
That’s money that disappears from wages. For a family of four, multiply by something resembling 4.
(Liberals and conservatives alike are getting looted this way.)
You’ll never hear this from Matthews and Walsh. Matthews and Walsh are looting you too.
Matthews and Walsh are playing a game. The name of their game is “Don’t Care.”
Here come the 2011 Health Care per person spending chart again.ReplyDelete
Once again we ask what fact has Bob diappeared since he started using that chart?
We'll give you a hint. It has nothing to do with race.
Another hint. It has nothing to do with the missing "s" in comes or disappeared.Delete
Yes, Finland seems to have disappeared. And Bob made a very big deal about how little per capita Finland was spending on health care when he first introduced this chart.Delete
Bingo, We have a winner. The first time it disppeared I wondered if it was just an error. Now that it has disappeared twice, we see a pattern.Delete
Is this just an error he made once that is now repeating itself due to copying and pasting. Or is Bob, like Maddow in referring to Page "17" instead of Page "117," possible trying to deceive us? We don't know.
We can't possibly know since blog commenters form the key constituent group in "We the People Are Dumb" so Bob won't answser us. Unless we comment on Drum's blog.
Somebody refresh my memory, but when Bob was talking about Finland (and Poland), re: public education and test scores, wasn't one of his points that you couldn't really compare a homogenous society like Finland with a diverse society like the U.S.?Delete
Comparing education and comparing health are surely different.Delete
Never said they weren't.Delete
Just interesting that Somerby looks deep for nuance and further explanation when it comes to such things as Finnish tests scores and female wages.
So, what's your point?Delete
My point is this: Somerby looks deep for nuance and further explanation when it comes to such things as Finnish test scores and female wages.Delete
But per capita health care costs? Just throw out the numbers. There is only one explanation -- looting.
Test scores are not dollar amounts. I do think businesses are looting when it comes to paying women less than they are worth, so I am with you on that one. "Looting" refers to the costs being higher than what they should be because someone is benefitting financially from our system. This is not the first time he has posted on this subject and some of his attitude has been explained at greater length before.Delete
Somerby does not explain who is manipulating our news services, who is paying Maddow and Matthews to disinform us. He doesn't talk about the plutocrats who benefit from the income inequalities in our society, who is benefitting from the neglect of the interests of our underclass. He is consistent in that.
No one is preventing you from offering your opinions about who these unnamed looters might be, why it is happening, how it might be stopped. If you think there is no looting going on (a naive view), you are welcome to explain why costs are high and to defend those costs. No one is stopping you from any of that.
For some reason, you'd rather just carp at Somerby. Wonder why that is.
I am not saying there is no looting going on. I am taking issue with Somerby lazily placing the sole blame for the high cost of health care in the U.S. on "looting" which is a very serious charge.Delete
We have an extremely inefficient health care delivery system in the U.S. And a lot of that is profit-driven. Do we really need all the urban hospital beds, when rural areas are under-served?
Does every hospital need every multi-million piece of equipment?
Does the fact that there are so many uninsured have anything to do with driving up health care costs? Would we lower costs with better preventative care, rather than treating those without insurance in emergency rooms -- the Dubya universal health care plan?
Does our culture factor in? How many gunshot wounds does the typical hospital in Finland treat in a given year?
How about our lifestyle? You ever talk to a visitor from another country? They are astounded that we have fast food everywhere, and that Americans seem to be eating 24/7.
Not to mention our consumption of high calorie soft drinks. And beer.
So yeah, I can think of lots of reasons our health care costs might be higher, IN ADDITION TO deliberate fraud and looting.
But of course, you'd rather defend Somerby no matter how disengenous he gets. Wonder why that is.
It's not a blog about healthcare. It's not a blog about education, per se. It's a blog about media coverage of these issues, among other things. The issue here is that the Finnish test scores get covered ad nauseam while healthcare spending per person is rarely mentioned.Delete
Health care costs per person is rarely mentioned?Delete
Oh good grief! It will take you five seconds to google all kinds of stories about this issue from multiple sources.
Dear boy, just because Somerby says it's so, doesn't make it so. Don't be such a rube. Do some checking -- and some thinking -- for yourself before you take anything he says at face value.
The fact is a comment a few posts back looked up the source of the chart, found it was from OCED, the folks who brought us the PISA test the Finns do well on and Bob loves to deplore. And the chart itself was from an article about Finland. The commenter found that ironic. Bob just disappeared the Finns thereafter. But Bob does not read his comments, right?Delete
I looked at the OECD chart for 2011 and there is no reason to include or exclude Finland. It is little different than the many adjacent countries in the chart, all spending considerably less than the US. He may have included Finland in the past for some specific reason related to his series of education or using Finland as a comparison nation, but omitting it from the list has no implication for the picture conveyed by the numbers.Delete
Trying to gin this up into some sort of complaint about Somerby, some mystery over why it is gone, is just another specious troll complaint aimed at disparaging Somerby.
Unless you can explain why it matters that Finland is no longer on the list, stop bothering people with this silliness.
Bob may have very good reasons for once citing Finland then disappearing said nation without a trace from his chart. We don't know. He doesn't tell us.Delete
But he not only once included Finland, he made a very big deal about the low health care costs in Finland. Then when it came to test scores, he told us how unfair it was to compare Finland with the United States.
After that, Finland is wiped off the face of the health care cost charts.
Again, not being able to read Somerby's mind, we don't know why Finland vanished without a word of explanation.
But it is curious. After all, Finland not being at the bottom of the chart, was not easily and mistakenly lopped off. But then again, this all could be a legitimate health care cost study, done in good faith, though somewhat botched.
Health care costs in Finland are considerably lower than in the US, as are many other nations. There is no reason to include Finland in preference to any of the adjacent names in the chart. It is near the middle in costs. You implied that Somerby did something wrong by leaving it out. What was your point? Why does this matter?Delete
You don't seem to have any reason for pointing this out, other than to say something negative about Somerby. That pretty much defines you as a troll.
@ anon 12:20Delete
I have no doubt that the information on per capita health care costs is available--but that's not the issue, is it. The observation is that Finnish test scores qualify as a MSM meme and health care costs do not. That seems like an accurate observation, although it's certainly empirically falsifiable.
I find myself wondering whether the increased health care spending is specific to health or whether it occurs in all areas of American life. Could you compare food costs this way across countries? There is the Big Mac Index that compares the cost of a hamburger around the world, as an indicator of travel expenses. Some countries (such as Mexico) subsidize basic foods so poor people can eat. We subsidize milk. You could compare costs for education and suggest that our university system is looting because we do not subsidize higher education but do subsidize K-12 (some other countries are the reverse, making parents pay for K-12 but providing free college).ReplyDelete
My sense is that economists study this kind of thing. Assuming that there is looting when costs are higher here, without also taking into account a bunch of other factors, is probably not a fair comparison. What would be a fair comparison? I don't know but I bet there is something in the literature about it.
Paperback books cost twice as much in Great Britain. They are looting recreational readers. But that's OK because people there will save on their health care.
I wonder if it ever occurred to Somerby, when he aks you multiplyReplyDelete
the per person expenditure by four, that he may be as guilty of demagoguery here as is he claims Democrats might be on the gender
wage gap. The forces driving the cost of health care in this country are not coming from family units that are that average size.
You could create a single-payer system which was absurdly costly. Our country may already have such a system—Medicare itself!ReplyDelete
Question: Have you ever seen statistics which show how much we spend per person on health care, as compared to other countries, for people over 65?
Bob, I could kiss you! This is a point I've been making for years. For years, there's been a push for some version of government health care, but the arguments in favor of it were always phony. Yes, the US spends a lot more on health care, but we can't fix that problem if we don't know the real cause. From what I know, here are some of the key reasons why health care costs are so much higher than in other countries:
-- Our health care providers get paid better
-- We pay more for prescription drugs
-- Our unique tort liability system not only makes liability insurance cost around 10 times as much as in other countries, but it forces doctors to practice "defensive medicine' - that is provide more tests and more treatment than medically needed in order of avoid being sued later.
-- We do a great deal for premature infants and for dying elderly patients.
Obamacare does little to attack these areas, which is why is isn't a good approach to reducing the cost of health care in America. Sadly, we're stuck with it.
David in Cal, we are glad you wish to kiss BOB instead our royal personage.Delete
We thought about titling this comment:
Your Zarkon Gets Results
We have no objection whatsoever to having this expert once again reproduce his famous chart and repeat one of many questions we first asked over a month ago.
"We don't spend that much per person. It is how much we spend on average per capita. How much of it is spent in the last year off a dying person's life? How does our average per capita spending on health care rank when only spending on those 65 years of age and older is calculated? Are we being looted? Or are we on a spending spree managed (or mismanaged) by our government on unnecessary and/or overpriced efforts to prolong, often in misery, the last year of a person's stay on the planet? We have yet to see BOB do the kind of analysis when he presents this statistic that he demands when someone (read Rachel Maddow) presents something like the wage gap.
If such analysis revealed the biggest problem with American health care costs is the outrageous costs of treating terminally ill elderly, what then? Do liberals really want to revisit the issue of pulling the plug on grandma?
Just a thought.
TDH February 26, 2014
BOB has had six weeks to do a little research since he cares so much. Sad to see he hasn't. But there was that jam on that very major bridge and all those misimpressions to castigate if not correct as a result.
It isn't clear what you mean by "little" but Obamacare does address several of these areas. For example, it does permit group/organizational negotiation of drug prices to reduce prescription costs, it tries to standardize standard of care to minimize disparities across states, some physician payment limits are imposed. Addressing the difference between the US and other countries with respect to preventative medicine should bring down costs in the longer run.Delete
You need to be aware that demographically the average age in the US is much lower than in comparable countries in Europe, so they may have greater pressures to reduce costs than we do because elderly are a larger percentage of those served by their health care providers.
KZ, next time, post your comment in either Drum's or Dowd's comment threads. Bob might notice it there.Delete
But yes, interesting how Bob says you can't just take raw numbers and throw them out there without further explanation when Maddow does it.
Bob apparently doesn't realize that physicians and others in the health-care system have leverage because Medicare is only part of the market - if their demands are not met, they can pull out. Of course Obamacare does not change this greatly. We know that single-payer can work, because it does so in other countries. No other advanced country has our "free-market" system and nobody else has costs remotely as high. Our system doesn't work, the others do - pretty simple.ReplyDelete
Our system doesn't work at providing care at a reasonable cost. It does work reasonably well at providing care. Our health outcomes aren't as good as those of several other countries, but part of that may be because of social problems not found in more homogeneous nations (less diversity, less poverty, less tolerance of personal freedom resulting in greater compliance with treatment).Delete
"It does work reasonably well at providing care."Delete
For whom? (Cui bono?) That is the question.
Btw, the American myth that we are some crazily heterogenous country and the rest of the world is full of homogenous populations: b.s. Finland, maybe that's accurate. Germany? France? Great Britain? Peru? Chile? China? India? Well, I'll stop thinking of the countries whose current populations show that our pride in heterogeneity is misplaced.
For what it's worth, Bob is the last place I'd come to learn about the problems with "healthcare delivery"(in the wretched parlance of our day) in the US. Or for media coverage of it. (I really shouldn't say "media coverage": bob only even tries to cover a narrow range of outlets, mostly a few people on MSNBC and the NYT.) mch
The younger average age of the US compared to countries in Europe is a verifiable fact, not an opinion.Delete
"Last week, Barasso, Jindal and Cruz were saying that the number will be smaller than 7 million. Chris, Joan and Michelle knew how to reply: Barrasso, Jindal and Cruz are racists, these tribal clowns pleasingly said."ReplyDelete
Ummm, no Bob. Matthews called them "truthers". Truthers are the people who think 9/11 was a U.S. government conspiracy -- that the feds did it, and are still covering up the "truth."
You are perhaps conflating "truther" with "birther". Those are the people who forced the first black president to produce his birth certificate -- both short and long form -- to prove his citizenship. And they still won't shut up.
The racism is about the constant attacks on Obama over matters that would not be an issue for someone else -- that is being considered racist. Somerby didn't misspeak.Delete
"Barrasso, Jindal and Cruz are racists, these tribal clowns pleasingly said."Delete
No he didn't misspeak. He lied.
No, he didn't lie -- because certain liberals have been accusing conservatives like Barrasso, Jindal and Cruz of being racist because of their complaints about Obama's so-called lying. Anyone with two eyes knows the left has been lodging accusations of racism against critics of Obama on the basis that Obama has been criticized more than past presidents because he is African American. Whether that is true is debatable. The fact that such complaints have been made is not in dispute. It is part of the left's rhetoric.Delete
So, I think you are the person lying here.
Anon @ 12:17 AM we would stop a bit short of saying BOBarino lied on this one since Bernard injected a generic element of race into being the source of a broad range of criticism of Obama. and Matthews agreed with her. BOB covered that previously, but not here.Delete
Looking at his specific statement BOB quotes from Matthews here which relates to the three Senators and their comments on ACA enrollment, it is hard to get "racist" from "truthers." And it is unfair to put Walsh in the mix here at all.
We would normally give BOB three "Kesslers" for this one.
But BOB is tying something two of the three did discuss at some point to a specific set of statements which were not part of that discussion. They never used the word "racist"
but BOB did not put quotations marks around it.
We find this remarkably similar in style to a TV infotainer who once said a Police Chief in a tiny New Jersey town replied "essentially" to a suggestion from a cop on the businest bridge in the world that the cops suggestion for traffic diversion was "crazy."
BOB called that "insinuation." I believe he also used words
like "nasty," "slimy" and "pimping." (Check for yourself...2/22/14).
So instead of Three Kesslers, we will give BOB Nine Maddows. (He said three people called three Senators the R word.)
Anon @ 10:11 we are sorry we were typing away when your comment was posted. Let's check your reasoning skills.Delete
Generic "people" of a certain ideology have been accusing other people of a different ideology of being racist. So therefore, when BOB says three specific people said three other people are "racists," even though it is clear they did not do so, it is not a lie because unnamed people have called other unnamed people that name.
BOB has also called blog commenters "dumb." We have noted our agreement with BOB from time to time.
KZ, your concerns are noted.Delete
Perhaps I should have used one of BOBarino's many euphemisms for lying in which one can call a person a liar but then claim he didn't.
And perhaps I should have noted what a swell guy Somerby is in private before I asked how society could tolerate such a person.
It is the Bob Way! But it is also useless to ponder how much money Bob stuffs into his pants from writing this blog.
KZ, you are still confused about who said what. The three people named are conservatives. They are not the ones calling anybody racist. The people using the term racist are not named and are presumably not three in number. They are liberals and they are calling those three conservatives racist because they are critical of our African American president, more so than they would be of a president of a different ethnicity (hence the claim of racism). Bob is referring to those liberal accusations when he talks about the racism of the three conservatives. He manifestly does not consider them racist and he has not ever agreed with the wholesale labeling of conservatives as racists by liberals, on the basis of perceived slights to Obama (slights he usually points out have been endured by many other presidents).Delete
Bob is not lying. You are misunderstanding, misreading, his statement. I cannot know whether your mistake is deliberate or due to a genuine failure to understand, but your attributions are incorrect. I am done pointing this out to you. Nothing is going to make you stop attacking Somerby, so this is a huge waste of time.
People who read Somerby's blog tend to be those who share his value of accuracy in news reporting. That's why it hooks us in when trolls concoct these misinterpretations of Somerby's daily posts. It is hard to let this garbage stand, just as it is hard for Somerby to let the garbage of Maddow, Matthews, and others stand uncorrected.
KZ, please do us all a favor and get a real hobby.
I agree with this. Vermont first put in cost controls and then put in single payer.ReplyDelete
It's in the Vermont statute (and to be clear, I agree with it) and it was a condition of the state accepting single payer. Vermont also had a community health care center system in place and people use it. They're clinics. I've used a community health center (for a pregnancy) and I felt I got great, high quality care, but you have to be willing to use a clinic. I don't know that all Americans would do that. We're accustomed to a "private" physician.
No one mentions it.
"Our unique tort liability system not only makes liability insurance cost around 10 times as much as in other countries, but it forces doctors to practice "defensive medicine' - that is provide more tests and more treatment than medically needed in order of avoid being sued later."ReplyDelete
This is baloney. Thirty states have put in "tort reform". Texas is one of them. They have more state protections for providers than any other state.
They also have the single most inequitable health care system in the country, and the most expensive care.
Also, we don't have a "tort liability system". It's state law. It's different in each of the 50 states.
One would think all of the people who have been repeating this for 30 years would at the very least understand that, the difference between state and federal. There is no national tort "system". It's state law.
Anon -- I was involved in liability insurance internationally. Yes, our states vary, but overall the US tort liability system is much more expensive than other countries.Delete
David, no matter what the subject, you claim expertise. This is the logical fallacy known as "appeal to authority."Delete
But please share with us some of that claimed expertise.
How much did the "system" pay out in successful liability claims against medical malpractice? What percentage does that amount to against the total costs of health care in the U.S.
And what percentage of the claims were so unjustified that we need to restrict a victim's ability to sue for medical malpractice?
The amount paid out for medical malpractice is not a large share of total medical expense. OTOH I have seen studies claiming that the defensive medicine does add a lot to medical costs.Delete
There are all kinds of ideas about what to do about medical malpractice. Most take it for granted that a damaged party must have the ability to receive recompense for his damages. Here's something to consider. Before 1960 or so, it was almost impossible to sue for medical malpractice. Yet, people received medical care.
If I had the power, I'd pass a law allowing patients and doctors to negotiated in advance an agreement that the patient couldn't sue.
I don't know about Rachel Maddow, but I think the reluctance to really look at health care costs has to do with how big our health care system is and how interwoven into the economy it is.ReplyDelete
One can start with physicians, fine with me, but then you'd have to go one level deeper and look at all the middle class jobs that are also dependant on wildly inflated costs. For every physician who is ordering a test, there are three nurses and two technicians also working on it.
That's not even getting into prescription drugs and medical equipment manufacturers. Physicians are pulling this huge middle class job train behind them and I honestly think people are afraid to really address costs, because then we'd be talking about shrinking this giant workforce. It would be akin to the "quality revolution" in manufacturing in the 80's and 90's, where productivity went up but wages stayed flat and they dumped millions of jobs. I saw that happen. It was brutal in the rust belt.
That probably has to happen in health care, and it ain't gonna be pretty.
I don't know what to do about it myself.
Not to mention the millions of middle-class folk who work for health insurance companies. The "single-payer" advocates should remember -- as vital as it is to move toward that kind of system -- you can't do it overnight without a staggering loss of jobs.Delete
The "public option" especially that proposed by John Edwards was an interesting way to do it gradually, but even that would not come without the cost of jobs, and lots of jobs. You simply wouldn't move people from Blue Cross/Blue Shield jobs to government "Medicate for all" jobs.
There is no question that nations who have gone to "single payer" deliver quality health care at a much lower cost per capita. No question at all.
The question, however, is how do we move from the system we now have into a more efficient model without costing millions of health-care industry related jobs.
Our blogger needs to remember this when he looks at raw numbers and blames "looting." It is an over-simplistic answer to an extremely complicated issue.
Anon @ 7:46Delete
When one questions the word choice of the OTB one must expect the label of heresy to be applied. "Looting" has been the consistent term applied by BOB to those who charge people money which adds up to the dreadful chart
which always accompanies the word. Some say the notion
that simply saying "Let there be light" turned on a magic switch is simplistic. But simplicity is not a bad thing in simple times for simple folk. Therefore we admonish you
in the words of the loyal followers of the OTB, "go away and troll no more."
We must also consider the impact of Medicare, which has been a boon for the health care industry.Delete
Before 1964, Granny frequently gave us the courtesy of dying when she got sick. Now she goes to the doctor.
Bob might be tempted to call that "looting" since it drives up those nasty per-capita costs.
We, however, are kind of fond of Granny.
Grannies in other countries don't go to the doctor? I doubt that. Somerby is calling our high costs looting because they are so much higher than in other countries, not because of the necessity of paying for health care.Delete
We should also note that the nations on Bob's list pretty much seized the moment and took the initiative to create national health care plans right after World War II -- before the health care system could grow into the extremely complex beast it is today in the U.S..ReplyDelete
As pointed out previously when Bob tried to argue that no serious Democratic candidate had ever proposed a "single payer" system, that a rather serious guy named Truman attempted that very thing at the very same time other nations were moving toward national health care plans.
The American right wing screamed "socialized medicine."
That same scream was also heard from a rather famous host of "Death Valley Days" (not to be confused with "Sea Hunt") some 20 years later when another rather serious Democrat going by the intials of LBJ sought to create a "single payer" system to insure older Americans.
Hey,"Centralized Negotiation" is how Health Care prices are so high, not the latter. It is a simple problem with a simple solution. Deregulate and put the prices on the wall. The US is a world leader in cheap, high quality elective surgeries (procedures which aren't covered by insurance). "Centralized Negotiation" is how hospitals are torn down and centralized, how insurance companies are barred from practicing and how I'm prevented from buying insurance and medicine from across boarders.Thanks to all!!!ReplyDelete
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