Physicians Increasingly Support a Single-Payer National Health Insurance System
February 13, 2009
"US physicians increasingly support a single-payer national health insurance system, according to the results of a survey reported online January 29 in the Journal of General Internal Medicine.
“Many politicians may mistakenly believe that single-payer national health insurance lacks support among key stakeholders such as doctors,” lead author Danny McCormick, from Harvard Medical School and Cambridge Health Alliance (CHA), said in a news release. “Our finding that support for single-payer national health insurance now approaches that of tax-based incremental reforms suggests that a Medicare-for-all-type plan may be more politically viable than conventional wisdom suggests......”
"Of 3300 physicians sent the survey, 1675 (50.8%) responded; 49% prefer either tax incentives or penalties to promote the purchase of health insurance; 42% prefer a government-run, taxpayer-financed single-payer national health insurance program, which increased from 26% in a study 5 years previously; and only 9% prefer the current, employer-based financing system....."
I don't know how many people here want to get help but have a problem with health care coverage. I would say any form of coverage that is for all Americans but has a graduated premium is fair. Obviously health care reform is essential. It should be something that doesn't burden taxpayers and people can afford at the same time. As well physicians should want to accept this form of coverage. Clearly there will be negotiations and its of direct importance to me.
I am fortunate to have very good health insurance. I know my hospital/medical bill from 2000 to date is easily over 1 million and probably closer to 2 million. I didn't pay a cent.
So I am alright but so many people aren't that it's a national crisis and an issue I care very much about.
I was somewhat surprised to learn that physicians may be in favor significant reform because most of the blogs are about how we're going to be standing in lines and how we won't have any doctors left and how no one will want to go to medical school.
I found this encouraging.
I can only imagine that doctors and hospitals would support this. If all the people who don't have insurance now could go to the doctor, the doctors would end up very, very busy. Cha-Ching! The hospitals would also have much less unrecoverable debt. If you think of all the people that go to the emergency room and have no insurance, don't pay the bill. Along with all the unpaid bills from procedures done. I could only guess this would bring down the price of medical care since most bills would be paid. Hospitals and doctors carry unbelievable amounts of unrecoverable debt right now.
I'm curious how this would work in weeding out illegal immigrants abusing the American Medical system, with false names etc? If all US citizens had insurance and illegals didn't? Sounds good to me.
Its not going to be a problem. I well know for people who are undocumented that in applying for Medicaid that they demand extensive proof of documentation. If someone shows fake documents at the Medicaid office that's a federal crime. I've helped people who were not citizens yet recieve that but they all had a green card and were here legally and after the 5 year period of eligibility intended to apply for citizenship and many did. That's standard for all immigrants. Someone can't just come here and become a citizen. There's a waiting period and procedures. As of illegal immigrants all they are eligible for is emergency Medicaid. The main problem is that then they don't recieve medical care and this has not only detracted from their health but from the people around them.
Its a seperate discussion and one I wouldn't start as it would create antagonism but I prefer immigration reform where more people can come here legally to begin with but the express intentions that if they are coming to the United States they have to work and pay their own way. And most work at jobs Americans wouldn't take. Its a very complex issue to begin with but my same stance applies to legal immigrants. A person coming here should have the ability to work. All the people I know who immigrated here are working and as for the people I helped if they became too disabled to work it was because of an injury on the job while working in the United States that left them severely disabled.
In N.Y.C. what overburdens the health care system is not immigrants but people who don't have coverage in general as well as people who are homeless, many of whom with proper housing and psychiatric medication recover enough to stabilize and a good percentage of those people actually return to work and pay their own way. The main targeted goal of benefits should be to help someone up and then have them be self sufficient unless they have a severe disability in any case.
If you all want universal healthcare, you all can have it, but I don't want it.
Do you all really think that this is going to make things better. The only thing this will cause is more problems and more deaths. I guess if the government wants to lessen the population then I guess this would be good. The only thing I hear is that any other country that has this the patients suffer by waiting in line for healthcare, unless you are on your deathbed. A relative of mine told me a story about her friend that lived in Canada. She was diagnosed with cancer at the last stage. She went to the doctors for years but could not get them to do the tests since there was a waiting list. She waited 5 years and finally was able to get the biopsy and of course it was too late. She died waiting for care. Unfortunatley, this happens all too often in many other countries as well.
This is what happens when government thinks they can take over the health care system. There has to be a better way. I really wish that we could just figure it out because universal health care is not the answer.
I've heard the same stories about Canada from people who have been there. Universal health care as they have set it up does not work. I agree. What happens in the United States doesn't work now for sure. What is the first thing you see when you go to your doctor's office? Pamphlets for medications. Drug study ads. Do you want your doctor to pick what's the right medication or what is the most heavily advertised one by some pharmaceutical company? When I used to go to the doctor's office they said "may I may you?". Now they say "may I see your cards". I think the doctors I see are good people and I recieve good treatment but the insurance industry is pushing profit over people in a rampant manner. Its unnerving. "There has to be a better way. I really wish that we could just figure it out because universal health care is not the answer". I agree but what do you believe is the answer and if not what's the best way to figure it out?
Tired. That's supposed to read "May I help you" which they do after checking your insurance cards (tell me if this is not the truth). The doctors I've spoken to are not happy with this system btw but its enforced on them.
I do not know how to fix the healthcare issue since I am not an expert in this matter, but I do not think that the Government should be in charge. I am mainly concerned about how patients will be treated if they do go Universal. Many people who need the meds they are on now that actually work may be forced to switch because the Government only will approve the use of one specific med for each condition or there will be too few meds to go around.
I totally agree that there are alot of great Doctors out there. There are also too many drug pushers and money being offer to those Doctors from the pharmaceutical companies. My doctor recently just did this. I was on effexor xr for postpartum (10 years ago) and I told him that it was making me worse so he of course suggested that I go off effexor but take the new drug Cymbalta. I agreed but then i went home and thought about it and weaned myself off the effexor and have been off of depression meds for 1 month. I feel sooooooo much better. They are legal drugpushers at least some of them.
I just wonder if we could not find a way to make it affordable by having less medical insurance companies or combine them and making the premiums and copays affordable to all americans and not to illegal immigrants. We have a problem when there are people who abuse the welfare system by having more and more children than they can handle and too many children at one time which eventually have mental disabilities and the families cannot afford it. I do not believe abortion is right either. Our precious children will one day pay the price for evey mistake that this country is making. Why do our children have to suffer because the system is broke.
I totally fear for this country and what it is becoming. We all live in this world under 1 God but that seems to be forgotten. I would think God knows best since he created us and the world. What we really need is to Love thy neighbors as thyself and then alot of problems would be solved.
Here is an excerpt from an article that some of you may find interesting - well, perhaps not. This is just a portion but the entire article is at MedScape at the site listed below.
Fact and Fiction: Debunking Myths in the US Healthcare System
Posted 06/06/2008 See: http://www.medscape.com/viewarticle/573877_1
This idea has been called the alpha myth because it is fundamentally the root of all other myths. It is the straightforward belief that Americans have access to the highest quality healthcare available in the world. A different way to present this myth is to state that citizens in other countries experience long waits for healthcare, that they must rely on generalists, and that they suffer worse outcomes as a result.
This belief is widespread and well-entrenched in the American mindset. So it is perhaps surprising that in a 10-nation 1990 survey on the level of satisfaction with the national healthcare system, the United States ranked 10th. These results were then reproduced a decade later. Although Americans believe the US system is the best, clearly they are not as satisfied with the healthcare they receive as are citizens of other countries.
In fact, this disparity between perception and reality has been captured in several studies. In the year 2000, the World Health Organization (WHO) dedicated its annual World Health Report to a comparison of healthcare across the globe. In this exhaustive analysis, American superiority was not borne out: the United States ranked 32nd for infant survival, 24th for life expectancy, and 54th for fairness. The fairness ranking was derived from a comparison of the individual financial contribution required with the quality of healthcare received. The current US system is known as a regressive system; that is, the poor pay relatively more for healthcare. In fact, the poorest fifth of Americans spend 18% of their income on healthcare, whereas the richest fifth of Americans spend about 3%. In this type of regressive system, it is clear why about 50% of personal bankruptcies in the United States are related to medical bills. Tragically, 75% of individuals declaring medical bankruptcy had medical insurance at the onset of their illness. Overall, the WHO ranked the United States 37th in the world.
Similar results were found by the Commonwealth Fund in a recently released scorecard on the performance of the US health system. Outcomes in the United States were compared against those achieved by top countries or the top 10% of US states, hospitals, or other providers. The scorecard evaluated multiple indicators of health outcomes, including mortality, life expectancy, and the prevalence of health conditions that limit the capacity of adults to work or children to learn. The average ratio score for the United States was a 69 out of a possible 100. The United States ranked 15th out of 19 countries with respect to preventable deaths before the age of 75, with a death rate more than 40% higher than the benchmark countries of France, Japan, and Spain. The United States ranked last in infant mortality out of 23 industrialized countries, with rates more than double the benchmark countries of Iceland, Japan, and Finland. The United States tied for last on healthy life expectancy at age 60.
Despite these mediocre results in objective parameters of health outcomes, the United States spends far more than any other country for its healthcare. In 2000 the United States spent 13% of its gross domestic product on national health expenditures. The next highest spending countries were Germany at 10.6% and France at 9.5%. In a graph of life expectancy versus health spending per capita, the United States falls far off the curve, both spending more and gaining less than other countries. Another example of this contradiction is seen in the outcome of patients on hemodialysis. Although there are more hemodialysis centers per capita in the United States, when end-stage renal disease patients were matched for severity of disease in Canada and the United States, patients in the United States were less likely to receive a kidney transplant and also had a higher mortality rate while on hemodialysis.
Thank you for posting this. The truth is depending on your income and who you work for, depends on your quality of healthcare. Employers offer good insurance and then as the years go by, they start changing what they offer. When my husband went to work 6 years ago, he had great coverage. We paid a co pay and everything else was covered. That is why he took the job. 2 years later the employer changed the policy, a year later, again. Now his coverage is 50 percent, and that is after we each pay 1500.00 deductable each year first. Pharmacy is less than that and he pays 87.50 per week for this, with his employer covering his. So, we pay every week and still cannot afford to go to the doctor. We are just giving them money "in case", something terrible happens and we are not stuck with nothing. Other people I know do not even have that. So, all in all, I guess it depends on who you work for and how much money you got, as the article above suggests. I do not think national healthcare is great either, but at least all people would be covered. They put everything else on taxes, why not share a tax for everyone to have quality healthcare? The only people I can see disagreeing are those who already have it and do not have to worry daily about the floor falling out from under. IMO.
First healthcare needs reform but it needs to start with tort reform. People were for a while getting "sue happy". If anything went wrong during a Dr's visit or hospital stay or anything, people would sue the Dr's and hospitals. Now I will say some malpractice lawsuits are justified but a lot are not.
Now because of the lawsuits we have Dr's ordering every test to make sure they are not sued. What happens next...the bill goes to the Health Ins company who has to pay it. So Health Ins companies are now paying for tests that are not necessary. So the Health Ins company pays more money out and starts to lose money what is next...they raise the premiums for health coverage.
So if you want better health coverage and cheaper health coverage start with tort reform and work from there.
No, that is not the first step. I would like to see the basis upon which you base your opinion.
The article from which I posted the excerpt above contends that administrative costs is the primary issue.
"..... The administrative costs and lack of buying power that arise out of the existing multipayer system are at the root of the problem. The current system also directly contributes to the rising number of uninsured and underinsured Americans. This lack of insurance leads to poorer health outcomes, and a significant amount of money is lost into the system by paying for these complications. Experience from other countries suggests that tangible improvements can occur with conversion to a single-payer system. However, previous efforts at reform have stalled. There are many myths commonly held true by both patients and physicians. This inscrutability of the US healthcare system may be the major deterrent to its improvement. A discussion of these myths can lead to increased awareness of the inequality of our healthcare system and the possibilities for improvement...."
It is an essential step because malpractice insurance is a waste. Many of the claims are fraudelent and must go to court anyway and waste taxpayer's dollars. Then the money is paid out to a lawyer. Malpractice insurance is a bad idea. The very few cases of criminal negligence should be tried that way and in general if on occassion there is a complaint it should be done within the system. These are the two ones I've used but never misused:
The issues were addressed sometimes on a larger scale and as for the second since as it involved psych. hospitals (before my recovery) psychiatrists weren't even the basis of the complaint. It was some negligent staff. Now I don't encourage complaints but on occassion they are warranted but I'd rather see the medical profession address its own concerns, then somebody make a lawyer rich. I have advanced tardive dyskinesia to the point where I am homebound and it wasn't from malpractice. Its a long term side effect of current antipsychotics. And as I've posted I am on a new generation of antipsychotics in study, the glutamate antagonists, that will promote a fuller recovery and won't cause this neurological disability and pushing for them to be fast tracked through the studies. Provider agencies agree with me. But if you look up my disability online, some people want to misuse it for lawsuits. I can't make them stop but they should. Every settlement paid out is money wasted that could be used researching new treatments.
To summarize you are correct, wasteful lawsuits and medical malpractice insurance as a concept should be ended and tort reform is essential.
I didn't say that tort reform and medical malpractice reform aren't important steps. To the contrary I believe they are . I tried to say that they aren't the primary driver of the rising cost of healthcare. And I also believe that Vance is right when he mentions that the doctors practicing defensive medicine is a significant cost - needless tests and procedures to CYA. So it is a significant factor. I just don't think it is the primary driver of rising heath care costs but there is no doubt in my mind that it's a significant contributor.
I struggle paying healthcare as well as everybody else. We pay $600 a month for a family of 3, pay 20% for our prescriptions, have a $2000 deductible and do not have a choice as to who we go to. I own my own business cleaning residential homes. I do this business by myself noone helps me and I surely do not make alot of money. My husband works for a company that does computer security for our medicare and medicaid system. The issue is that he gets really crappy insurance while the rest of the others get great healthcare. He was supposed to get a $17,000 raise this year but decided to give it to someone else. My husband works his a** off every day of the week. He travels for his company and they refuse to pay for his trips but do pay for others trips.
You know why my husband get screwed over, it is because we did not vote for Obama and are Republicans. He has been told this so we are not exaggerating.
We are getting calls everyday for our bills that we cannot pay. We also have only one car right now, because we decided that we need to be a steward of what we do have not for what we want. The mains issue with are economy has to do with the Credit system and banks giving too much credit to people that do not know how to control their spending. We were one of those people, but now realize that we do not want to give our son our debt. We all must make sacrifices in life to better our world, but that does not mean we throw our principles out the window. So, to say that my family does not want Universal healthcare because we have great insurance and it works, is totally wrong. My son and I both have ADD and ADHD. Our prescriptions are expensive. But, I do not want anyone telling me what meds I may take and what I am restricted from doing with my health.
I agree that we need healthcare for most people, but what about the people that come to this country illegally and we do not even question them. And if you all really think that illegals are not going to use this system you all are wrong. They already do this and get away with it. Look, I want people to be responsible for their own actions and be able to decide what they want. I just do not see why I have to work even more hours to be able to afford my taxes and pay for my healthcare as well as everyone elses.
You know, I am a very compassionate person and would do anything to help someone, but I need to look out for my family as well. We have many people that sue our doctors for outrageous issues and people that really have gotten hurt by them. Lawyers will always find ways to beat the system no matter what we do with healthcare. It is just going to cost us way more money in the long run and you will still have people getting rich from lawsuits.
Some doctors are also very greedy and just care about making a 6 figure income and using patients to their advantage. If you really think that this new healthcare system will help you mayble then we should at least have a choice whether we want to participate or not as well as the physicians. This may be what they are proposing now, but we will all eventually no longer have a choice.
Why can't those very intelligent non-taxpayers that are creating this idea figure out what will really work for us. They seem to have no problem forgetting to pay their taxes and wanting the american people to just look the other way so I guess that we can trust them with our healthcare.
I do not want to see anybody suffer for not having healthcare. My earlier message regarding my Aunt's friend whom lived and died in Canada was NOT a myth and also is not for many others who have suffered from a Universal healthcare policy. Studies are done for alot of things and do not always reflect the majority of people's views and truth. They usually get paid to do these studies and benefit from it in some way or another. Unless it involves research into a specific disease or ailment, studies are not very accurate.
"You know why my husband get screwed over, it is because we did not vote for Obama and are Republicans. He has been told this so we are not exaggerating."
This is work place discrimination and your husband should file suit against his company. As republicans we can not stand for this kind of treatment. I know if I ever faced discrimation for my conservative beliefs I would have my employer's head spinning in about 2 mins from a law suit.
I believe in healthcare with a graduated premium for everyone who is able to work. I've already posted about the Medicaid Buy in for Working People with Disabilities. That encourages people to go back to work and will have a premium. If your husband works for the Medicare and Medicaid administration he could tell you more and except for emergency Medicaid there is nothing else illegal immigrants are entitled to as regards public benefits and no comprehensive healthcare plan that is being addressed has any intentions of changing this. I know something about public benefits but if he works directly for the system you can ask him about the regulations and there is no proposal to change them from any politician.
The Government Push for Electronic Medical Records
Nancy R. Terry
The economic stimulus plan currently being considered by Congress allocates $20 billion to health information technology such as electronic medical records (EMRs). Recent postings on Medscape Physician Connect (MPC), a physicians-only discussion board, offer frank opinions about the utility of EMRs in clinical practice -- opinions that are decidedly mixed.
"EMR is the worst thing that has happened to me professionally in over 25 years of practice. My care of patients is impeded and the quality of my care is worse as a direct effect of the introduction of EMR," says a MPC contributor who championed the installation of an EMR system for his physician group.
"I absolutely love our EMR," says a nephrologist. "It has improved the quality of our practice immensely. I spent a lot of time customizing for our practice, but it was worth it. Everything is point and click. To improve care and cost, all patients need a Web-based collection of medical records that include hospitalization, lab reports, x-rays, as well as office notes. That would be the ultimate care."
Physicians who are dissatisfied with EMR systems cite loss of productivity, the negative impact on patient care, and high maintenance requirements. Physicians who have embraced EMRs cite the increased efficiency the systems have brought to their practices. EMRs tend to get high marks from subspecialists and low marks from primary care physicians.
Some of the MPC physicians least satisfied with their EMR systems are those practicing at large healthcare companies or medical centers. "My hospital solicited medical staff support for EMR," says one MPC contributor. "After implementation, administration took over and now EMR is solely for the benefit of medical records as a storage device. To hell with the medical and nursing staffs. RNs are input clerics rather than beside nurses."
"The very few efficiencies were all on the administrative side," says a regional medical director who helped bring an EMR system to a nationwide healthcare company. "A good sales pitch with nice graphics and testimonials sell it, then the clinical staff is left to suffer."
"EMRs need to address work flows and clinical efficiencies and not seek to provide administrative support," says a general practice physician. "Unfortunately, the administrators are the ones with the time and energy. The rest of us are seeing patients."
In smaller practices, issues of EMR maintenance and support infringe upon patient care. "In my clinic," says a family medicine physician, "provider meetings are completely dominated by EMR issues and problems. There is virtually never time left for discussing topics pertinent to improving patient care."
In speaking about their day-to-day experience with EMRs, primary care physicians complain that entering patient information is cumbersome and time consuming, often because of a template-based system that does not reflect the patient encounter.
"The assumption of the EMR is that you already know the diagnosis when the patient arrives." says an MPC contributor. "This may be better for specialty care, but in primary care, patients come in with fatigue, rash, insomnia, diarrhea, and cough. It's difficult to enter all this until after the visit."
An internist who describes herself as "tech savvy" says that her system's scripted entries for patient information are inadequate. "If you free-text, it is much more time consuming. And we are discouraged from free-texting by our administration because it doesn't trigger adequate billing codes. Not only has it reduced my time with patients, it has added an extra 2 to 3 hours of work each night from home."
The Choice of Systems
"My advice to practitioners," says one MPC contributor, "is wait for a decent EMR that produces useful notes that accurately describe a patient encounter in a way that helps a clinician."
Waiting may not be an option for much longer, however. One provision of the government stimulus plan would impose reduced payments on physicians who are not "meaningfully using" information technology. Whatever is meant by the provision's phrasing, one thing is clear: the push is on to go electronic. Physicians must learn how to make information technology work for them. One EMR expert says that it starts with the choice of systems. "Primary care practices should stay away from templates and stick to a new program by Praxis® [Infor-Med Medical Information Systems, Inc., Woodland Hills, California] that uses pattern recognition of similar cases as well as rare cases. It decreases the workload immensely. For specialty practices, I recommend templates, and Visionary™ Dream EHR [Visionary Medical Systems, Inc., Tampa, Florida] is excellent in being very user friendly," says an MPC contributor whose research in medical management focuses on EMR systems.
Another MPC contributor notes that the technologically adventurous can customize an EMR system by using open-source software. In open-source systems, he explains, the source code needed for programming is included in the software, making the program infinitely adaptable. "When you buy most proprietary software, you have to accept the functions that come with it, as designed by the developers. With open-source systems, you can modify the software to your heart's content."
Is a Choice of Systems Really a Choice?
For some physicians, however, EMR systems remain a nonissue, and the heavy government funding of healthcare information technologies is nothing more than a smokescreen obscuring the real issues in primary care.
"The government and the public are not able to deal with the real problems facing medical practice and the real solutions necessary to turn it around (ie, reasonable reimbursement rates, malpractice reform, regulation of the unscrupulous practices of the insurance industry)," says an otolaryngologist. He adds that once healthcare information technology is "fully implemented and solves nothing, we can start to talk about real reform and real answers."
My husband explained to me that Electronic records are great as long as you have people like me who know exactly how to use the system. Most doctors will need alot of training to know how to run it and then it will probably work well. But, you still have to deal with the security side of it as well so noone can access the information but the doctor and patient. This is why my husband still has a job. My husband thinks that having records available to each and every patient and doctor make it alot easier for them to access info and to be more efficient. This should help cut down on error, when it comes to drug interactions and medical treatment.
Personally I'm not concerned about privacy but I work for myself. I might feel differently if I didn't.
I was surprised to read some of the doctors' comments. I think the concept is great but the implementation and use seems to be the problem.
This disturbed me:
An internist who describes herself as "tech savvy" says that her system's scripted entries for patient information are inadequate. "If you free-text, it is much more time consuming. And we are discouraged from free-texting by our administration because it doesn't trigger adequate billing codes. Not only has it reduced my time with patients, it has added an extra 2 to 3 hours of work each night from home.
When you see doctors saying that they have less time for the care of patients something needs fixed and fixed fast.
Yes, this concerns me as well, alot of doctors now do not spend much time with their patients.
I work for myself as well, but am under my husband's health insurance plan so they already have access to my medical history. I do worry about privacy when my husband is accepted for a higher pay and then all of a sudden is rejected and then they hire someone else at a higher salary with less qualifications. Obviously, they can access info regarding many things, such as credit history, medical and personal. This is what disturbs me as well as patient care.
I really think this is another way for the Government to have more control over all americans and what type of care they can and cannot receive. Yeah, this might help with saving the trees but what about helping the people of this great nation and keeping their privacy.
Everyone should have access to affordable healthcare. That would mean affordable not "free" because in countries that tried that it, it didn't work out. There has to be a judicious solution where people pay a graduated premium as I said. As for "government control" its hard to say. Right now the insurance industries heavily regulate the limitations on people's coverage. A "pre-existing condition" that can deny a person is actually a disability and should not even be considered. Its blatant discrimination. A version of mental health parity was signed by George Bush as part of the economic stimulus act and will go into effect in January 2010 but until then there can be seperate premiums on mental health care and physical health care although there is no reason there should be. I'd rather that the government be involved than for profit insurance companies who will go out of their way to deny people because with government benefits there are specific laws and regulations that can be appealed (and that includes making sure people who are not eligible don't recieve coverage). As for privacy, due to HYPAA and other regulations that's actually increased but it makes it harder for someone to obtain their records from a doctor when they need them. So it all depends.
I agree with you that everyone should have access to affordable healthcare. As long there are regulations so that my and your tax dollars do not go to specific medical treatments that are inhumaine or against our beliefs. I think that we have the right to choose what to do with our bodies, but I do not want to pay for their abortion out of my tax dollars. It comes down to what your morals are as well. So, I just hope that we can figure out a way to make it affordable for all without comprimising certain religious or moral beliefs that some may have.
I agree that there should not be separate costs for mental health and Primary care physicians. It is ridiculous that I pay $35 every 3 months for my son and I to go to a mental health professional since a physician can not give us our prescriptions for our ADD and ADHD meds but I only pay $15 for our primary care physician. This is why Psychiatrists make so much more money with the copays and also with the Pharmaceutical industry. It is really ashame when we spend more time sometimes with a Physician than a Psychiatrist. As far as HIPAA is concerned, alot of doctors and schools have a serious problem with following this, and it is very hard to fight at least in Pennsylvania.
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