70% Of Calfornia's Doctors Expected To Boycott Obamacare

Phelonious Ponk

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'Greed' is like gravity; ubiquitous and ignored at your own risk. I am always amazed that any one would believe that political self interest (aka 'greed') is somehow more noble than enlightened self interest. I see no evidence of such.

Obama has made a career of pride and envy. From NY Times' Jodi Kantor in her book "The Obamas"



Or as key advisor Valerie Jarrett observed



Obama is the law professor who never published, the community advisor who never organized anything, the state senator who voted 'present', a man who never worked a day in the private sector. He never built or ran anything in his life other than a campaign. Why would anyone be surprised that when he redesigned 1/6 of the economy, he discovers 3 years after the fact that "insurance is difficult"? He and his parties' leadership rammed this through without understanding it or reading it, because they could. Indeed, Obama can truly say "he built this". They own it and their cries for help now ring hollow. Oh for the halcyon days when "dissent was the highest form of patriotism"....

The stunning revisionism of that one phrase calls into question the credibiliy of anything else you could say, doc. Sorry. You got that from the right wing press, not history. I'll give you the beneifit of the doubt and assume you were awfully distracted when ACA was "rammed through."

Tim
 

jazdoc

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Tim, you are right. I was too busy scheming to poison the environment, stealing money from the poor, planning the next war for oil and planning the next war on [fill in the blank progressive talking point of the week]. With all that going on, I missed the "Cornhusker Kickback", the "Louisiana Purchase" and the "Baystate Boondoggle" -- all to purchase Democratic votes. Thank goodness I caught up via those right wing outlets like Politico, The Boston Globe and the Washington Post:

http://www.politico.com/news/stories/1209/30815.html
http://www.bostonglobe.com/editoria...-boondoggle/oiphdbGemMmHxtLqqKVPgL/story.html
http://articles.washingtonpost.com/...cus-democratic-moderates-landrieu-and-lincoln

The fact that Nancy Pelosi famously claimed "We had to pass the bill to find out what's in it", speaks to the deliberate, thoughtful, above board process that was the passage of Obamacare.

My mistake...
 

rbbert

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Nevertheless, Tim is mostly right. "Obamacare" isn't really Obamacare; the original proposal, whatever it was (there's no easy way to know now) was vastly different from what emerged after too many additions and "compromises" to count, about as many from Republicans as from Democrats, thus prompting Pelosi's statement. And how totally disingenuous of the Republicans to claim they had no part in it; worse, all they want to do now is to go back to the dysfunctional way things were, they have not made a single constructive proposal to improve our health care system only over 100 documented specific legislative proposals to repeal all or parts of the PCACA. Shame (and pretty naked greed).
 

MylesBAstor

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Apr 20, 2010
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Nevertheless, Tim is mostly right. "Obamacare" isn't really Obamacare; the original proposal, whatever it was (there's no easy way to know now) was vastly different from what emerged after too many additions and "compromises" to count, about as many from Republicans as from Democrats, thus prompting Pelosi's statement. And how totally disingenuous of the Republicans to claim they had no part in it; worse, all they want to do now is to go back to the dysfunctional way things were, they have not made a single constructive proposal to improve our health care system only over 100 documented specific legislative proposals to repeal all or parts of the PCACA. Shame (and pretty naked greed).

That is unless they rely on Faux News for their news. :(

The bottom line is these issues with Docs and insurance payments predates Obama. Hospitals are horribly run and then often saddled with paying the costs of the uninsured as mandated by law. So for years, we've been saddling them with the costs of paying for what the government should be doing. And you might as well add Medicaid into that also as that reimbursement is a joke.

Then again Obama caused WWII.
 

Barry2013

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Thank you to all of you who responded to my post.
I am certainly better informed than I was and in particular by the information that Medicare applies only to those over 65. A far more limited measure than I had supposed from the reports over here of the controversy in the US over it.
My UK perspectives from what I have now read are set out below however helpful or unhelpful they may be.
If as I understand the current limited Medicare measures will need another 20,000 doctors to implement it would appear that even allowing for the relationship between age and illness there must be very substantial unmet medical need among the over 65s and the younger age groups with no or only limited insurance cover and access to medical care.That is there despite expenditure of 18 per cent of GDP on healthcare in the USA compared with 8/9 per cent in the UK.
Yes it is the case that in the UK our cancer survival rates are below the European average and almost certainly below those in the USA who can access the best treatments. That shortcoming is being addressed and improved and I am sure will change but leaving aside the privileged minority in the US how does the rest of the population fare. A friend has just finished several months of treatment including stem cell therapy on the NHS for lung and liver cancer and whose care to the best of my knowledge has not been in anyway constrained by cost or personal affordability. That is something I am proud of our NHS for.
Patients in the UK can now choose which NHS hospital they wish to be treated in for free and there are specified times for treatment that are largely but not yet met 100 per cent. Access to the newest and most expensive drugs is governed by an independent national evaluating body which does apply a cost benefit test to their effectiveness. Viewed objectively that is difficult to argue against but obviously for individuals concerned and their families it can be difficult if the drug they wish to access is not immediately approved for their treatment. It would be great if resources were not finite but they are and we all know don't we that drug company's claims do not always turn out to be valid or as valid as they claim. The extent of this problem is however very limited and affects only a very small number of patients.
The criterion for treatment over here is medical need irrespective of patients financial means and I like that. We pay higher taxes in the UK than you do in the US and in return we get universal healthcare free at the point of delivery.
In the US you have a lot of the best and most advanced medical care in the world if you can afford it but at twice the cost of our system and it seems to me,and please correct me if I am wrong, a significant if not majority of the population excluded or limited to more basic or pro bono care. If that is the case or largely the case then the critics of your present system including those responding to this thread have a very justifiable case for change.
I can well appreciate why the insurance companies and other elements of the US healthcare system want to maintain the pre Medicare system because an awful lot of people must be making a good living out of it, but for an expenditure of 18 per cent of GDP compared to ours of 8/9 per at the very most it does not seem to me that you are getting very good value for money.
Whether that UK perspective is helpful to your debate is for you over there to decide. but I am grateful for being able to contribute to your debate.
When I first joined your forum it was for the audio interest which has been well served but it is a real bonus to find such a wide variety of threads and topics and not least those videos of the giant domestic cats I found not long ago while browsing.
Keep up the good work !
 

jazdoc

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That is unless they rely on Faux News for their news. :(

The bottom line is these issues with Docs and insurance payments predates Obama. Hospitals are horribly run and then often saddled with paying the costs of the uninsured as mandated by law. So for years, we've been saddling them with the costs of paying for what the government should be doing. And you might as well add Medicaid into that also as that reimbursement is a joke.

Then again Obama caused WWII.

Always a sign that an argument isn't going well for a progressive when they start in on 'Faux News'. (An alternative is to scream 'racism' or '[fill in the blank] - phobic'.) Just for the record, I don't watch Fox News, I prefer to get my information from that source of erudite, even handed news and discussion that is MSDNC. Since I'm one of the few people watching it, it's the network that gives a platform to such deserving journalists and elevators of civil discourse such as Martin Bashir, Al Sharpton, and Alec Baldwin. And let's not forget Chris 'Tingles' Matthews. ;)

So how does Obamacare improve how hospitals are run? How does shifting the costs of people who can't afford healthcare from hospitals to the government save money? One of the real unintended consequences of Obamacare is the massive increase in Medicaid patients. In my home state of Washington, nearly 90% of the enrollees through the state portal (when it is up and running) are signing up for Medicaid. http://blogs.seattletimes.com/healt...er-enrollment-tops-175000-mostly-in-medicaid/

BTW, Obama didn't start WWII, but he did honor Pearl Harbor day with a pic of himself on his Facebook page.

obama-pearl-harbor-wh-photo.jpg

And his administration had the same amount of time to build a website for Obamacare as it took from Pearl Harbor to the signing the surrender agreement on the deck of the Missouri.
 

rbbert

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So jazzdoc what are some of your proposals for improving our health care system?
 

Frank750

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So for years, we've been saddling them with the costs of paying for what the government should be doing.

Myles, you do realize that when you say government should be paying the costs you are referring to the working men and women of this country?
 

rbbert

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Myles, you do realize that when you say government should be paying the costs you are referring to the working men and women of this country?
And even the non-working men and women of this country, although in general they pay less of the tab.
 

jazdoc

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So jazzdoc what are some of your proposals for improving our health care system?

Off the top of my head:
1. Allow for low cost catastrophic insurance plans. These are specifically banned by Obamacare and would actually entice millenials to purchase insurance, especially if plans were permitted to have riders for non-cancellable renewals akin to disability and life insurance.
2. Allow for health insurance to be purchased and portable across state lines.
3. Tort reform. Something specifically excluded from Obamacare.
4. Eliminate the Stark Law loop hole for ancillary services. Imaging is the fastest growing component of Medicare expenditure and not surprisingly, the majority of the growth is from self-referral without evidence for improved patient outcomes.
5. Eliminate the tax exemption for employeer based insurance.
6. Make Medicare need based and build in higher deductibles and copays.
7. Provide sliding scale, need based tax credits (similar to the earned income tax credit) or vouchers to be used only for insurance purchase and/or funding of health savings accounts.
8. I see a potential role for the government and would prefer state rather than Federal solutions:
a. Each state is currently allowed to set up and run a 'public' option. If it is competitive, it will flourish.
b. Shared risk pools could be created offer insurance or payments for high risk pools, especially for significant pre-existing conditions.
9. I would invert the approach of Obamacare's Independent Payments Advisory Board. As envisioned by Obamacare, all regulations promulgated by the IPAB are effective unless voted down by a supermajority of Congress. I would propose reviewing and all existing healthcare regulations. All new proposed healthcare regulations would have to recieve an affirmative vote of 2/3's of Congress.
 

rhbblb1

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May 4, 2010
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Thank you to all of you who responded to my post.
I am certainly better informed than I was and in particular by the information that Medicare applies only to those over 65. A far more limited measure than I had supposed from the reports over here of the controversy in the US over it.
My UK perspectives from what I have now read are set out below however helpful or unhelpful they may be.
If as I understand the current limited Medicare measures will need another 20,000 doctors to implement it would appear that even allowing for the relationship between age and illness there must be very substantial unmet medical need among the over 65s and the younger age groups with no or only limited insurance cover and access to medical care.That is there despite expenditure of 18 per cent of GDP on healthcare in the USA compared with 8/9 per cent in the UK.
Yes it is the case that in the UK our cancer survival rates are below the European average and almost certainly below those in the USA who can access the best treatments. That shortcoming is being addressed and improved and I am sure will change but leaving aside the privileged minority in the US how does the rest of the population fare. A friend has just finished several months of treatment including stem cell therapy on the NHS for lung and liver cancer and whose care to the best of my knowledge has not been in anyway constrained by cost or personal affordability. That is something I am proud of our NHS for.
Patients in the UK can now choose which NHS hospital they wish to be treated in for free and there are specified times for treatment that are largely but not yet met 100 per cent. Access to the newest and most expensive drugs is governed by an independent national evaluating body which does apply a cost benefit test to their effectiveness. Viewed objectively that is difficult to argue against but obviously for individuals concerned and their families it can be difficult if the drug they wish to access is not immediately approved for their treatment. It would be great if resources were not finite but they are and we all know don't we that drug company's claims do not always turn out to be valid or as valid as they claim. The extent of this problem is however very limited and affects only a very small number of patients.
The criterion for treatment over here is medical need irrespective of patients financial means and I like that. We pay higher taxes in the UK than you do in the US and in return we get universal healthcare free at the point of delivery.
In the US you have a lot of the best and most advanced medical care in the world if you can afford it but at twice the cost of our system and it seems to me,and please correct me if I am wrong, a significant if not majority of the population excluded or limited to more basic or pro bono care. If that is the case or largely the case then the critics of your present system including those responding to this thread have a very justifiable case for change.
I can well appreciate why the insurance companies and other elements of the US healthcare system want to maintain the pre Medicare system because an awful lot of people must be making a good living out of it, but for an expenditure of 18 per cent of GDP compared to ours of 8/9 per at the very most it does not seem to me that you are getting very good value for money.
Whether that UK perspective is helpful to your debate is for you over there to decide. but I am grateful for being able to contribute to your debate.
When I first joined your forum it was for the audio interest which has been well served but it is a real bonus to find such a wide variety of threads and topics and not least those videos of the giant domestic cats I found not long ago while browsing.
Keep up the good work !

I think you are getting a skewed view of American Healthcare. Eighty-five percent of Americans get great healthcare and are happy with it. Yes, it is expensive. The issue is the 15% that are left behind. This 15% still get medical care since the laws require that hospitals not turn anyone away. Again, this is far from ideal since it is an expensive way to treat non-emergencies. Also, it is said that those who do not have insurance wait too long before obtaining care that could prevent worse problems. The argument in America is what to do for the uninsured 15%.
There are numerous reasons why US healthcare is so expensive. One of the most common reasons cited is defensive medicine. In America, every physician works under the fear of being sued. This leads to excessive testing which raises the cost of healthcare.
However, what is usually not discussed is the cost of therapies in America. As you know many drug therapies available in the US are not available in the UK. The UK takes into account the cost of a therapy before it approves it. In the US, the FDA (Food and Drug Administration) is NOT allowed to take price into consideration when it approves a new drug or therapy. If the new treatment is demonstrated to be superior to the current standard of therapy, it will be approved irrespective of price.
 

rbbert

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It will never happen with Medicare (and probably shouldn't, we owe our elders something regardless of how wealthy they are), but many of those others are quite reasonable suggestions. I haven't seen any of them seriously proposed by Congress or either of the two past administrations, though...
 

rbbert

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Dec 12, 2010
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I think you are getting a skewed view of American Healthcare. Eighty-five percent of Americans get great healthcare and are happy with it. Yes, it is expensive. The issue is the 15% that are left behind. This 15% still get medical care since the laws require that hospitals not turn anyone away. Again, this is far from ideal since it is an expensive way to treat non-emergencies. Also, it is said that those who do not have insurance wait too long before obtaining care that could prevent worse problems. The argument in America is what to do for the uninsured 15%.
There are numerous reasons why US healthcare is so expensive. One of the most common reasons cited is defensive medicine. In America, every physician works under the fear of being sued. This leads to excessive testing which raises the cost of healthcare.
However, what is usually not discussed is the cost of therapies in America. As you know many drug therapies available in the US are not available in the UK. The UK takes into account the cost of a therapy before it approves it. In the US, the FDA (Food and Drug Administration) is NOT allowed to take price into consideration when it approves a new drug or therapy. If the new treatment is demonstrated to be superior to the current standard of therapy, it will be approved irrespective of price.
actually probably no more than 50% get "great" health care, having health insurance in no way gurantees good health care. furthermore, Medicaid recipients aren't counted as uninsured but I would bet almost none of them get more than "barely adequate" health care. and of course a huge issue is the undeniable fact that the 50% that does get excellent care (BTW a relatively low percentage by First World standards) pay far more for it than those patients in most other developed countries who get the same level of care.
 

MylesBAstor

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Apr 20, 2010
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Always a sign that an argument isn't going well for a progressive when they start in on 'Faux News'. (An alternative is to scream 'racism' or '[fill in the blank] - phobic'.) Just for the record, I don't watch Fox News, I prefer to get my information from that source of erudite, even handed news and discussion that is MSDNC. Since I'm one of the few people watching it, it's the network that gives a platform to such deserving journalists and elevators of civil discourse such as Martin Bashir, Al Sharpton, and Alec Baldwin. And let's not forget Chris 'Tingles' Matthews. ;)

So how does Obamacare improve how hospitals are run? How does shifting the costs of people who can't afford healthcare from hospitals to the government save money? One of the real unintended consequences of Obamacare is the massive increase in Medicaid patients. In my home state of Washington, nearly 90% of the enrollees through the state portal (when it is up and running) are signing up for Medicaid. http://blogs.seattletimes.com/healt...er-enrollment-tops-175000-mostly-in-medicaid/

BTW, Obama didn't start WWII, but he did honor Pearl Harbor day with a pic of himself on his Facebook page.

View attachment 12903

And his administration had the same amount of time to build a website for Obamacare as it took from Pearl Harbor to the signing the surrender agreement on the deck of the Missouri.

You mean the News company that televised Rove's meltdown on TV when Anonymous blocked his attempt to rig the Ohio voting machines? Or has the Queen of all Pea Brains Sarah Palin.

http://www.huffingtonpost.com/2013/12/09/fox-news-brian-lewis-payment_n_4414656.html
 

rhbblb1

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We are a firm believer in that too :). Good comments and I expect folks to engage constructively. I am very curious in comparisons of the UK system to US. Let me tell a personal story.

My mother was diagnosed with lung cancer. She did not have insurance. When the results of the biopsy came, the doctor pulls me and my brothers aside and delivers the bad news. We ask what treatment there are. He said if we had insurance he would put her immediately on chemotherapy. I said we will spend our last dollar if we had to give her the treatment she needs. The oncologist says that is not necessary since statistically it does not result in any kind of improvement and she would be subjected to a lot of discomfort.

My other brother lived in UK so we flew her there to see him. Understandably he was very upset and would not accept the diagnosis and insisted that we see their private doctor there. We did and they sent her to get some additional ultrasound/scans done. We went to the hospital there and I was amazed how old the hospitals were there compared to US. We sat on $2 chairs for hours before she got the test even though she was scheduled to come then. We walked through all of these old hallways and went into a room with a modern scanning system. Had I not seen that, I would have thought we were in some third world country hospital compared the US! Now the good part. No one asked us for a dime. Here she is as a visitor and no one even stopped to ask us to pay for the tests. I recently did a CT scan in US and my deductible was something like $1,500!

Anyway, the results of the test come back and we see the private doctor again. He immediately agrees with the US diagnosis and says that the only thing we should do is keep her comfortable with pain killers. I mentioned to him what the US doctor said about using Chemo if we had insurance. He gave me this shocked look and said "that is inhumane. There is no data that says there will be any improvements and it would just bring her misery."

To me the UK system worked right. The US one also did but for a non-insurer that got the real message. Had we had insurance we would have been subjected to useless and painful situation for my mother.

Amir,
With all due respect, do you think that it is inhumane to treat people with advanced lung cancer. I do not know the details of your mother's case, but many of those with advanced lung cancer do receive benefit from some type of therapy.
There are randomized studies comparing "supportive care only" with "active therapy" for advanced non-small cell lung cancer which I assume is what your mother had. These studies demonstrated not only improved survival, but, more importantly, improved quality of life. Now, your mother may have been elderly and had many other medical problems, but to state that UK healthcare got it correct when some Doc said that treatment would be inhumane is, well, you get the idea.
 

rbbert

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Whatever the specifics of Amir's case, there is NO doubt that a large percentage of our health care dollar goes to care which is (and is predictably) futile. Estimates range from bottom barrel 3-4% up to 30+%, but even if it is only in the middle of that range it's a huge number of dollars.

Medicare's own statistics show that several years ago the average Medicare expenditure during the last year of a person's life was $600,000. And that's Medicare recipients, so we're only talking about people likely nearing the end of their natural life anyway, not some catastrophe occuring in a younger healthier person.
 

Phelonious Ponk

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Tim, you are right. I was too busy scheming to poison the environment, stealing money from the poor, planning the next war for oil and planning the next war on [fill in the blank progressive talking point of the week]. With all that going on, I missed the "Cornhusker Kickback", the "Louisiana Purchase" and the "Baystate Boondoggle" -- all to purchase Democratic votes. Thank goodness I caught up via those right wing outlets like Politico, The Boston Globe and the Washington Post:

http://www.politico.com/news/stories/1209/30815.html
http://www.bostonglobe.com/editoria...-boondoggle/oiphdbGemMmHxtLqqKVPgL/story.html
http://articles.washingtonpost.com/...cus-democratic-moderates-landrieu-and-lincoln

The fact that Nancy Pelosi famously claimed "We had to pass the bill to find out what's in it", speaks to the deliberate, thoughtful, above board process that was the passage of Obamacare.

My mistake...

From uninformed to irrelevant in one fell swoop. I think you're smart enough to know that what I was referring to was, well, the part I highlighted. Nobody "rammed ACA through." Nobody got the bill they wanted. The thing is a garbage pail of bad compromises because a naive president wanted bipartisanism and because a cynical legislature wanted to keep the insurance and pharma lobbies happy. The only thing worse than the web site is the law itself, but make no mistake, regardless of the final vote count, that one is bipartisan. It's a bipartisan turd in the punchbowl. The really scary part? There's a pretty decent chance it will still end up better than what we have.

And all we had to do is let individuals and small businesses buy into Medicare...

Tim
 

rhbblb1

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May 4, 2010
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actually probably no more than 50% get "great" health care, having health insurance in no way gurantees good health care. furthermore, Medicaid recipients aren't counted as uninsured but I would bet almost none of them get more than "barely adequate" health care. and of course a huge issue is the undeniable fact that the 50% that does get excellent care (BTW a relatively low percentage by First World standards) pay far more for it than those patients in most other developed countries who get the same level of care.

About 15% of Americans receive Medicaid. This number will increase after January 1 due to the ACA. In Georgia, patients with Medicaid receive healthcare which is indistinguishable from insurance paid care except that some doctors refuse to see medicaid patients because of poor reimbursement.
I do agree, that the cost of American medical care is expensive compared to other countries, but Americans demand private rooms, good food, short waits for procedures, and all of the latest and greatest therapies. Americans demand aggressive therapies in the last 6 months of their lives. Americans accept hospice days, not months, before they die. Reducing the cost of American healthcare will require a change in our cultural expectations. Something that is rarely dicusssed.
 

Phelonious Ponk

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About 15% of Americans receive Medicaid. This number will increase after January 1 due to the ACA. In Georgia, patients with Medicaid receive healthcare which is indistinguishable from insurance paid care except that some doctors refuse to see medicaid patients because of poor reimbursement.
I do agree, that the cost of American medical care is expensive compared to other countries, but Americans demand private rooms, good food, short waits for procedures, and all of the latest and greatest therapies. Americans demand aggressive therapies in the last 6 months of their lives. Americans accept hospice days, not months, before they die. Reducing the cost of American healthcare will require a change in our cultural expectations. Something that is rarely dicusssed.

I think the only question there is did Americans demand all of that or was it sold to them by a private healthcare system, driven only by profit and growth and struggling to differentiate themselves from their competitors? I'm old enough to have seen the cultural shift that got us where we are, and I know the answer. Put it to Americans straight -- would you trade private rooms above a lobby that looks like a luxury hotel for your neighbor's ability to afford basic care -- I think Americans would make the right choice. And I don't think that speaks to my politics. I think most decent Americans, liberal and conservative, would make the right choice.

Tim
 

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