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  • #31




    If you feel tax rates aren’t high enough, you can always cut a check to the the General Fund of the U.S. Treasury for any amount that you feel you’re being under-taxed.
    Click to expand...


    This is not a personal jab at amphora but it makes a blood boil when the idiotic Warren Buffet ( he may be a great investor but thinks he is a spokesperson for everyone earning decent money) parrots out every time the stupid sentence of him paying less taxes than his secretary. My response:

    "Hey Buffet, you do pay less because you are getting all your money as capital gains, now W2. If I could do that, I would also do that.

    If you are so much bothered about the low amount of taxes you pay, give all the money to the US Treasury. No, don't say you gave it to the charity of Bill Gates. Bill Gates foundation does not fund the US Government and pay for the infrastructure you use. Give it to the US Treasury and shut your mouth on talk of increasing taxes on us hard workers."

    Comment


    • #32


      If you feel tax rates aren’t high enough, you can always cut a check to the the General Fund of the U.S. Treasury for any amount that you feel you’re being under-taxed.  You can send in extra money as an attending; you can even send in extra money as a med student!
      Click to expand...


      That's a great Republican like that's been trotted out a ton of times, and it is to put it mildly, a load of crap.

      I'm perfectly willing to pay slightly higher taxes (fuzzy definition of "higher" for everyone) and to ask others to do the same so that we can provide some healthcare for low-income Americans.

      However if I write an extra check to Uncle Sam, paying above and beyond my required taxes, I cannot force it to be spent on healthcare.  It will go towards whatever they want it to go to.

      The best I can do would be to donate to a local charity or someone's GoFundMe to help pay for one individual/family expenses.  Healthcare, like many other things, has become something that requires community support.  One person without insurance who gets hit by a car and is in an ICU for weeks and needs rehab will require millions of dollars of care.

      To someone's point earlier that there's no evidence that health insurance improves people's healthcare  ... if you really believe that insurance isn't necessary or helpful, you wouldn't pay for it yourself.  Even if you view health insurance like the rest of insurance products, as a "break in case of emergency" type utility, it's something the low-income person needs MORE than the high income person.  Ideally that's what it would be, except many people can't even afford the barebone policies anymore depending on where they live (and by "afford" I refer to out of pocket expenses and deductibles, not just premiums).

      Our system that has made it so that getting seriously ill REQUIRES insurance to avoid bankruptcy.  If *I* was hit by a car and didn't have health insurance and needed a million dollars of care, my family would not be able to cover it, and neither would 99% of the WCI readers or people in this country.

      Sure, having insurance won't make you take your DM meds or HTN meds -- personal responsibility is a factor in everything, but I frankly don't see that as the main reason that we need everyone to have some access to healthcare.

      Going back to WCI's original post -- I'm not sure at what point a tax has been around long enough to warrant mention in an article that it's repealing a relatively new tax, but I don't think it matters.  On one hand, that type of headline is clickbait.  On the other, it doesn't matter because repealing those taxes, regardless of how old, is made up for by slashing insurance coverage for millions of Americans.  I worry more about several million kids being kicked off Medicaid than I do about me or you paying extra in taxes.

      I think there were better ways for Obama to expand coverage besides more Medicaid and the half-assed exchanges, but it certainly was a step in the right direction.  It's factually off base to put it on par with the recent Republican plan.  Obamacare/ACA needs improving and some repairs, but repeal/replace was never a viable answer.  If it was, the GOP would've had half a dozen plans ready to pick amongst when Trump won, and they still have no idea what the ************************ they are doing.  Turns out, now that GOP runs everything, Mr. Everyman actually likes Obamacare.

      I'm *not* a Bernie Bro, but I'm way more upset at the government using my money to bomb the ************************ out of a lot of other countries (I had way more issues with Obama's foreign policy than his domestic ones) and subsidize Donald's golf trips than I am at using it to provide healthcare for Americans.
      An alt-brown look at medicine, money, faith, & family
      www.RogueDadMD.com

      Comment


      • #33
        Opinion piece on CNN agrees with WCI:

         

        Are the Obamacare repeal tax cuts just giveaways to the rich?

        Comment


        • #34
          Maybe the solution here is to just stop allowing access to healthcare for people over, say 60? Or for babies under 34 weeks gestation? I imagine those two groups of people are utilizing most of the healthcare dollars, so if we just cut them out of the system, we'd be set. No one would have to pay much in taxes to cover health insurance (because most people born after 34 weeks and under 60 are pretty healthy), and we could all stop worrying about how much to budget for healthcare in retirement because we wouldn't be allowed to access it. Pretty sure I just solved the problem of two separate threads on the forum.

          Comment


          • #35
            I think majority don't mind paying their 'fair share', and have more issues with the appropriate distribution of those funds and being good stewards to those allocations.

            Medicaid is not one of them.

            Expansion of it to a healthy general population is a further poor implementation of a blunt instrument like medicaid.

            Being in Primary care, we had a front seat on the differences between Medicaid expansion healthy people and the exchanges subsidized who had 20% coshare costs.  The latter were more engaged, more active, and more discerning on their health care dollars and visits.   Quite the opposite on the medicaid expansion folk.  There is NO cost control/engagement vehicles in medicaid.  Nothing to drive value based care from either patient nor physician side....just a lot more spending.  The REAL winners were the health systems/ED that were doing charity work.

            The exchanges themselves could have supplied viable insurances for them, but it was chosen not to.  That is a correction that TrumpCare is trying to do AND taking it further by capping it (bad move IMHO--again see Doc Fix issue of years past on capping/indexing) .   Repeal the expansion and replace with expanded subsidies and a modified formula on the tax mitigation -- or just roll the whole tax relief up with tax reform as an omnibus bill since Congress loves Omnibus bills anyways.

            Comment


            • #36


              I think majority don’t mind paying their ‘fair share’, and have more issues with the appropriate distribution of those funds and being good stewards to those allocations. Medicaid is not one of them. Expansion of it to a healthy general population is a further poor implementation of a blunt instrument like medicaid.
              Click to expand...


              I agree that Medicaid expansion wasn't the ideal way to expand access to care.  I would've preferred everything went towards subsidized private plans.


              Being in Primary care, we had a front seat on the differences between Medicaid expansion healthy people and the exchanges subsidized who had 20% coshare costs.  The latter were more engaged, more active, and more discerning on their health care dollars and visits.   Quite the opposite on the medicaid expansion folk.  There is NO cost control/engagement vehicles in medicaid.  Nothing to drive value based care from either patient nor physician side….just a lot more spending.  The REAL winners were the health systems/ED that were doing charity work.
              Click to expand...


              I find this to be a bit of a distortion that likely comes down to personal experiences.  I work in the ED, but in a state that didn't expand Medicaid, so it didn't do much for me at all.  I am 100% for paying hospitals/doctors for their work and not forcing charity care.  EMTALA has its positives, however as an unfunded mandate it's harmed many hospitals (it hasn't harmed mine much since I'm at a childrens hospital and most qualify for some type of insurance).

              However while there is some reason to believe that having some skin in the game makes you more conscious of healthcare utilization (it certainly does for me), it also works on the other end of the spectrum as well. The very high earner that doesn't really worry about medical bills likely views healthcare utilization the same way as the low-earner who is 100% government subsidized.  I've had plenty of patients from military families, using TriCare, and rich folks in my ER, on fancy private insurance, be as demanding as the Medicaid patient or any other patient.  It's usually the rich ones who are demanding a plastic surgeon sew up the 1 cm chin laceration on their kids face instead of a lowly ER doctor. I've had plenty of parents whose kids were on Medicaid be upset with me about something in their care (appropriate care, but not to their liking, despite good communication.  Usually a result of long wait times); I think that makes them engaged, right?

              During my peds residency in Houston I also took care of plenty of kids at the public hospital, Ben Taub, whose families were undocumented immigrants and who had no insurance except the public insurance that Houston offered (the Gold Card, though not sure if that still exists now).  I did not find those families to be more demanding or less engaged than the rich people who came to the fancy, academic hospital down the street that I took care of. Quite the opposite -- usually they were nicer to me and a bit more appreciative of the care they received.
              An alt-brown look at medicine, money, faith, & family
              www.RogueDadMD.com

              Comment


              • #37







                If you feel tax rates aren’t high enough, you can always cut a check to the the General Fund of the U.S. Treasury for any amount that you feel you’re being under-taxed.  You can send in extra money as an attending; you can even send in extra money as a med student!
                Click to expand…


                That’s a great Republican like that’s been trotted out a ton of times, and it is to put it mildly, a load of crap.

                I’m perfectly willing to pay slightly higher taxes (fuzzy definition of “higher” for everyone) and to ask others to do the same so that we can provide some healthcare for low-income Americans.
                Click to expand...


                This verb "ask" that you're using ... I'm not sure it means what you think it means.

                If you ask and I politely say "no", then that ought to be the end of things.  However, the IRS does not "ask".  Interest and penalties accrue and eventually men with guns will come to take your money and your property.  If you still refuse, they may take your life.  The government hardly "asks".

                If you think the federal government rather than private charity is the best way to achieve desired social ends, then so be it.  Heck, if you think tax rates should be higher on your current income, I would ask you to have the courage of your convictions and voluntarily send in that bigger check before your preferred legislators make the rest of us pay that higher rate voluntarily or otherwise.

                Comment


                • #38
                  @wideopen --   "half a life" Star Trek:  TNG .    http://www.denofgeek.com/us/258669/revisiting-star-trek-tng-half-a-life   Will support your claim on health cost containment.

                  @Rogue -   Not comparing the concierge/boutique folk to any thing as they are 3+ Standard deviations.

                  Let's talk about the medicaid expansion vs bronze level exchange folk that represents the bulk of the ACA/AHCA reforms and how to provide affordable coverage for those healthy folk while finding a way to be cover the SICK traditionally uninsurable folk and balance their premiums.

                  ACA took the route of forcing bloated plans on healthy to balance the books against the sick and load average the premiums across that board and forcing the individual mandate as the stick to get healthy folk to buy bigger plans.

                  AHCA takes the route that giving a wide array of options with variable subsidies will open the exchanges to more viable insurance products and willingness of insurers to step into the arena with that (along with better premiums aligned to appropriate needs and wants of the age groups).    Heck, we here talk about leveraging HSA all the time!

                  Medicaid just wasn't the vehicle to accomplish long term affordable and did nothing to stabilize the exchanges (in fact took out even more healthy candidates and placed them in a very inefficient medicaid program).

                  Comment


                  • #39


                    This verb “ask” that you’re using … I’m not sure it means what you think it means. If you ask and I politely say “no”, then that ought to be the end of things.  However, the IRS does not “ask”.  Interest and penalties accrue and eventually men with guns will come to take your money and your property.  If you still refuse, they may take your life.  The government hardly “asks”. If you think the federal government rather than private charity is the best way to achieve desired social ends, then so be it.  Heck, if you think tax rates should be higher on your current income, I would ask you to have the courage of your convictions and voluntarily send in that bigger check before your preferred legislators make the rest of us pay that higher rate voluntarily or otherwise.
                    Click to expand...


                    Lol -- ok, I used the word "ask" to soften my commentary.  But it is an "ask" when you get to vote people in/out of office and have them change things.  Obama was voted in and re-elected, so I think it's fair to say people "asked" for the taxes. I voted for him twice knowing it could increase my tax bill.  When Donald was elected (with a minority of the popular vote), that was in effect some people asking for something else.

                    Regarding extra taxes, as I have stated, the government isn't going to take my extra money and apply it to healthcare, as you well know, so your ongoing argument doesn't seem relevant here.  As you already likely know and understand the healthcare marketplace, health insurance, as do ALL types of insurance, requires money from all types to be sustainable.  That's literally how insurance companies make money and stay in business.  So I can donate 100% of my income to the government and it will not be enough to help, so yes, I am "asking" others do give as well, to create a sustainable system.

                    have (and still do) donate to groups like the Red Cross and MSF, and have also donated to individual people who needed assistance.  However what I want is for everyone to have access to at a bare minimum the basics of healthcare and not to have to consider bankruptcy or hope for a charitable donation to cover their costs if they have bad luck and get sick/get in an accident.  That is the role of our government in this situation.  If the private sector wants to come in and create a better system, then by all means they can do it.  I don't see UHC and Aetna doing it without the government pushing them.

                    In other countries I wouldn't trust the government to do that, and our government certainly has many areas of inefficiency, but as currently constructed, we need our government to push for some type of healthcare access.  That does  not mean Medicaid for all, but it requires more than just federal regulation.
                    An alt-brown look at medicine, money, faith, & family
                    www.RogueDadMD.com

                    Comment


                    • #40





                      This verb “ask” that you’re using … I’m not sure it means what you think it means. If you ask and I politely say “no”, then that ought to be the end of things.  However, the IRS does not “ask”.  Interest and penalties accrue and eventually men with guns will come to take your money and your property.  If you still refuse, they may take your life.  The government hardly “asks”. If you think the federal government rather than private charity is the best way to achieve desired social ends, then so be it.  Heck, if you think tax rates should be higher on your current income, I would ask you to have the courage of your convictions and voluntarily send in that bigger check before your preferred legislators make the rest of us pay that higher rate voluntarily or otherwise. 
                      Click to expand…


                      Lol — ok, I used the word “ask” to soften my commentary.  But it is an “ask” when you get to vote people in/out of office and have them change things.  Obama was voted in and re-elected, so I think it’s fair to say people “asked” for the taxes. I voted for him twice knowing it could increase my tax bill.  When Donald was elected (with a minority of the popular vote), that was in effect some people asking for something else.

                      Regarding extra taxes, as I have stated, the government isn’t going to take my extra money and apply it to healthcare, as you well know, so your ongoing argument doesn’t seem relevant here.  As you already likely know and understand the healthcare marketplace, health insurance, as do ALL types of insurance, requires money from all types to be sustainable.  That’s literally how insurance companies make money and stay in business.  So I can donate 100% of my income to the government and it will not be enough to help, so yes, I am “asking” others do give as well, to create a sustainable system.

                      have (and still do) donate to groups like the Red Cross and MSF, and have also donated to individual people who needed assistance.  However what I want is for everyone to have access to at a bare minimum the basics of healthcare and not to have to consider bankruptcy or hope for a charitable donation to cover their costs if they have bad luck and get sick/get in an accident.  That is the role of our government in this situation.  If the private sector wants to come in and create a better system, then by all means they can do it.  I don’t see UHC and Aetna doing it without the government pushing them.

                      In other countries I wouldn’t trust the government to do that, and our government certainly has many areas of inefficiency, but as currently constructed, we need our government to push for some type of healthcare access.  That does  not mean Medicaid for all, but it requires more than just federal regulation.
                      Click to expand...


                      The government doesn't do that with anything.  All money is fungible.  You seem to be arguing for a tax increase "to pay for healthcare" while at the same time pointing out that extra tax money won't necessarily be applied in the fashion you advocate.  It's the same thing with social security (which many people consider to be the only government program that "works")--FICA taxes are supposed to fund it and only it but instead are spent on general expenditures and replaced in the trust fund with S-bonds which essentially are intra-governmental IOUs.

                      Its seems a little weak to me to rebut Hank's invitation that you send in an extra check to the IRS and back up words with money by claiming the only reason you don't is that "the money won't be used right".  Uh-huh....you can say that of most federal taxation and expenditures.  If you want to construe Obama's 2 electoral victories as "asking for higher taxes" (a dubious claim in my mind as there's lots of reasons people vote for one candidate over another), then let's also remember that BO repeatedly promised he "wouldn't raise taxes on anyone making under $250k a year".   That right there is what drives me crazy----it's funny how those always pushing for higher taxation conveniently target most or even all of the increases onto someone else. Again, feel free to pay extra if you want.  When that invitation is made, out come the excuses all of a sudden.

                      I understand there are compelling reasons to consider a national/single-payer healthcare system.  I also understand there are reasons to be skeptical.  Federal programs, including those specific to healthcare (Medicare/Medicaid/VA system), have a long history of massive cost overruns, inefficiency, and/or poor quality service.

                      Comment


                      • #41




                        @wideopen —   “half a life” Star Trek:  TNG .    http://www.denofgeek.com/us/258669/revisiting-star-trek-tng-half-a-life   Will support your claim on health cost containment.

                        @Rogue –   Not comparing the concierge/boutique folk to any thing as they are 3+ Standard deviations.

                        Let’s talk about the medicaid expansion vs bronze level exchange folk that represents the bulk of the ACA/AHCA reforms and how to provide affordable coverage for those healthy folk while finding a way to be cover the SICK traditionally uninsurable folk and balance their premiums.

                        ACA took the route of forcing bloated plans on healthy to balance the books against the sick and load average the premiums across that board and forcing the individual mandate as the stick to get healthy folk to buy bigger plans.

                        AHCA takes the route that giving a wide array of options with variable subsidies will open the exchanges to more viable insurance products and willingness of insurers to step into the arena with that (along with better premiums aligned to appropriate needs and wants of the age groups).    Heck, we here talk about leveraging HSA all the time!

                        Medicaid just wasn’t the vehicle to accomplish long term affordable and did nothing to stabilize the exchanges (in fact took out even more healthy candidates and placed them in a very inefficient medicaid program).
                        Click to expand...


                        haha, glad to know my suggestion is truly 'out of this world'. :-)

                        I was joking of course. Don't really have good ideas but clearly the US sucks at healthcare and something needs to be done. I'm personally into a single payer system but who knows where we'll go with healthcare.

                        Comment


                        • #42







                          @wideopen —   “half a life” Star Trek:  TNG .    http://www.denofgeek.com/us/258669/revisiting-star-trek-tng-half-a-life   Will support your claim on health cost containment.

                          @Rogue –   Not comparing the concierge/boutique folk to any thing as they are 3+ Standard deviations.

                          Let’s talk about the medicaid expansion vs bronze level exchange folk that represents the bulk of the ACA/AHCA reforms and how to provide affordable coverage for those healthy folk while finding a way to be cover the SICK traditionally uninsurable folk and balance their premiums.

                          ACA took the route of forcing bloated plans on healthy to balance the books against the sick and load average the premiums across that board and forcing the individual mandate as the stick to get healthy folk to buy bigger plans.

                          AHCA takes the route that giving a wide array of options with variable subsidies will open the exchanges to more viable insurance products and willingness of insurers to step into the arena with that (along with better premiums aligned to appropriate needs and wants of the age groups).    Heck, we here talk about leveraging HSA all the time!

                          Medicaid just wasn’t the vehicle to accomplish long term affordable and did nothing to stabilize the exchanges (in fact took out even more healthy candidates and placed them in a very inefficient medicaid program).
                          Click to expand…


                          haha, glad to know my suggestion is truly ‘out of this world’. ????

                          I was joking of course. Don’t really have good ideas but clearly the US sucks at healthcare and something needs to be done. I’m personally into a single payer system but who knows where we’ll go with healthcare.
                          Click to expand...


                          Yeah, count me out of single payer.  Not a fan of a program that enlists physicians and all other caregivers against their will to work for the government.  That's immoral.  Say what you want about our current system being immoral or not, but there are solutions here that don't involve big government single payer.  Advocating for single payer is a lazy solution and a crude, blunt instrument that has significant downsides (without the desired upsides liberals advocate for - see prior evidence cited earlier).  At times like this I advocate for channeling Dr. Seuss who stated "Think left and think right, think low and think high.  Oh the thinks you can think up if only you try."

                          I'd like to address another point here.  On the previous page the Republicans were lambasted for lying and that this plan won't reduce costs.  It is disingenuous at best to unilaterally slam one party on the cost issue, particularly since it was the Dems' policies that got us into a deeper quagmire than we were before.  Obama and the Dems promised reduced costs.  We've had nothing of the sort.  Out of pocket spending, premiums and deductibles have all gone through the roof.  So if anyone is going to slam one side for "not getting it" when it comes to fixing the cost issue, let's at least slam the other side too.  Both are trying to figure out ways to pay (or not) for it rather than addressing the underlying structural problems leading to increased costs.

                          Comment


                          • #43


                            Its seems a little weak to me to rebut Hank’s invitation that you send in an extra check to the IRS and back up words with money by claiming the only reason you don’t is that “the money won’t be used right”.  Uh-huh….you can say that of most federal taxation and expenditures.  If you want to construe Obama’s 2 electoral victories as “asking for higher taxes” (a dubious claim in my mind as there’s lots of reasons people vote for one candidate over another), then let’s also remember that BO repeatedly promised he “wouldn’t raise taxes on anyone making under $250k a year”.   That right there is what drives me crazy—-it’s funny how those always pushing for higher taxation conveniently target most or even all of the increases onto someone else. Again, feel free to pay extra if you want.  When that invitation is made, out come the excuses all of a sudden.
                            Click to expand...


                            I'll try to spell my views out a bit more.

                            I pay the taxes required by the government.  I'm willing and advocating for a higher required tax to provide a service that some people currently cannot receive, however sending the Treasury extra money will NOT provide that service, and without many people contributing to that specific service, my contribution is meaningless.

                            Nothing "weak" about that in any fashion.  It's a series of factual statements that have a logical connection -- it's not an opinion.  It's also a factual statement to state that the healthcare system requires contributions across the spectrum to work, so again, I can donate my entire salary and it won't go very far.

                            I've already clearly stated is that as an individual trying to help, I make donations to groups or people needing or providing healthcare -- so again, you're factually incorrect, as I already am giving away money to provide for other people's healthcare that I could keep in my pocket.  I am sending it to charities instead of the government, but again, it's money I am voluntarily sending away that I receive no benefit from.  At the present time, that's more effective in helping people than just sending the same amount of money to the government.

                            As a country, we need a broad system that encompasses everyone, not a bunch of random one off donations helping individual causes.

                            As someone who has voted multiple times FOR people who will raise my taxes, and even this morning called our local Republican Senator's office asking him to vote against the healthcare bill, and thus vote AGAINST lowering my taxes, in addition to making focused charitable contributions, I am already putting my money where my mouth is, so I am not sure what about this constitutes an excuse in your eyes.  I'm backing up my words w/actions already.

                            You and Hank's insistence that sending in extra tax money is a solution just doesn't hold water, because that isn't how the system works.

                            If I want the US navy to build a new battleship, sending an extra $1k check to the general fund isn't going to get them to build a battleship, even if I write "For Battleship Use Only" in the memo.  It requires a conscious effort by the government to choose to do that and to appropriate the money, either from its existing budget or from new revenue sources.  If they don't have money in their existing budget, then I would tell them to either cut spending in one place and re-appropriate the money or raise taxes and require the new money be spent to build a battleship.  Right now Donald and Congress are trying to take healthcare money away and build us new battleships (or whatever).

                            While we can disagree on individual budgetary focuses and platforms of the parties, I've made one of my priorities clear.  Healthcare isn't my only priority, and I voted for Obama and HRC despite having reservations about other aspects of their views/approaches/plans.

                            But it's time to let go of pithy one-liners -- election season is over.

                             
                            An alt-brown look at medicine, money, faith, & family
                            www.RogueDadMD.com

                            Comment


                            • #44
                              I don't think Dems sold ACA as reduced costs or even capped costs; but access to care first, and an 'affordable' cost on the second.  Of course, they went ahead to steamroll without bipartisan support (their choice) and then the untimely demise of Sen Kennedy and win of rep in MA lost the 60 votes in the Senate leading to the Senate to abdicate and adopt the House measure in full without modification.    THAT is what happened and caused an error that exists to this day.

                              The Republicans are doing the exact same darn thing and ramming another one sided legislation that's dialing back huge chunks of ACA AND capping medicaid (which I think is a HUGE mistake on the latter --again see Doc Fix issues that plagued medicare for 20 years resulted from just budget maneuvers.

                              Medicaid works at the edges, just like boutique medicine works at the edges.  It's not for the masses as it is structured now.

                              Can expansion of Tricare Prime work?  Perhaps.  It's an option that should be considered as a balance to true private insurance.   That was the insurers' primary concern with ACA though and once Obama took that off the table, insurers' were all for ACA since there was no counter-weight.

                              The US society doesn't need/want a single payor nor single employer model.  There are too many industry sectors affected and seeing that type of evolution/revolution simply isn't there.

                              We can see reasonable adjustments IF we can get bipartisan influence on legislation.  Ironically, it may actually be good to have the Senate bill fail and 'only Nixon to China 'like Trump cobble together a bipartisan bill to pass.  That would be his legacy; which I doubt will happen for I don't see that in his nature to date to do that type of compromise (or in his words 'art of the deal').

                              So most likely episode is we will get another large pendulum swing to other direction and see yet another correction needed 4-6 years down the road.

                               

                               

                              Comment


                              • #45
                                StarTrekDoc -- I think you have a lot of reasonable thoughts and good perspective.  I'll vote for you next time around.

                                 
                                An alt-brown look at medicine, money, faith, & family
                                www.RogueDadMD.com

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