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I guess one thing I missed saying in the last post was that if medicaid covered all people classified as poor, then it would be reasonable to say that there is no reason for individuals in America to be uninsured but, as I quoted in a prior post:

"Medicaid does not provide medical assistance for all poor persons. Even under the broadest provisions of the Federal statute (except for emergency services for certain persons), the Medicaid program does not provide health care services, even for very poor persons, unless they are in one of the designated eligibility groups."


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here is a recent booklist:

Health Care Reform (U.S.) Books


this looks particularly interesting, and comes as both a book and an ebook:

The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care


with all this talk, may make good christmas presents.

Last edited by Sue22; 12/19/09 12:05 PM. Reason: additional info


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As I stated in my previous post, I don't know what the qualifying criteria is and what the constraints of those programs are, but they exist for those without economic means.

Apparently there are multiple criteria in determining need beyond income. The article doesn't place a definition on poor, huh (e.g. poverty level, some multiple of poverty level)? Does the article document whether those 60% were even eligible, or were they eligible yet denied because they didn't fit one of the other criteria? Does it it document, categorically, why those 60% were turned away? Honestly, I'm just curious. I mean for instance, I have no income currently, but have savings from when was able to work that are sustaining my needs. Therefore, it is 99.99% likely that I wouldn't qualify.

Children should not suffer. It is really bothersome how people give little or no thought as to how they are going to provide or care for a child, yet ask society/others to shoulder that responsibility for them. Yet, too many children are brought into this world as an afterthought. Therefore, they do suffer, whether they have health insurance or not. So, what might the solution be? Take the children and put them in the hands of the state? I fail to see how health insurance is going to change the fact that a parent needs time away from work to take the child for dental care.

Yes, the bankruptcy issue. Honestly, I don't know enough about it to comment intelligently (not sure if any of my comments are intelligent though...no comments, please). Almost any individual can easily find themselves in catastrophic situation if a devastating health event suddenly strikes. It appears that chronic illness is just as devastating if not more so since it greatly impacts the ability to earn and provide. Therefore, I'd agree that this is one item that needs to be careful examined and addressed. At this juncture, I can only wonder about the numbers provided in the article then. While the bankruptcies were attributed to medical bills, I'd like to understand (and I imagine this is not something you can answer) what is split between catastrophic event, chronic illness, etc.? Also, I wonder in what percentage of those filings was the medical event the one that “tipped the scale”? I mean, how many filings, if any, might have been avoided if people had lived within their means? The whole well educated, middle class statement makes me wonder about that even more as those are the folks that I'd be inclined to believe might live outside their means. However, this middle class thing, may also be more prominent due the fact that it was the earner that was afflicted with the illness. Please don't misunderstand, I realize this is a weighty issue, but it'd be interesting to see more details behind those numbers.


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Was the government to prescribe to us our medicine and diet, our bodies would be in such keeping as our souls are now. - Thomas Jefferson
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Thank you for calling me good people. I appreciate it.

Additionally, like I posted to Stormy, I fail to understand what would be unfair about anyone stating an opinion on this matter. Also, I don't think you are dumb with too many opinions. Stoke the fire!

I too am glad that I can pay out of pocket for the time being. Understand that I avoid as many doctors, tests (especially the fancy ones), medications, etc., as possible due to this fact, but I'm able to manage the basics and am grateful for that. However, one serious incident (tumble down the steps, etc.), and I'm likely one of the bankrupt.

I fully concur that nothing else matters if an individual doesn't have their health. Healthcare as a right? Health? Yes. Healthcare? I disagree since that means another is forced to provide for the benefit of another. Sounds like servitude, yes. Health insurance? No.

Honestly, I don't remember all the rules regarding how an HMO works as I haven't had one since my first employer 14 years ago. All subsequent plans were PPO. However, I don't think it will be much, if at all, better under the government plan in contrast to an HMO. Instead of having a doctor direct your care, it sounds as though a high level government advisory panel will do this. Additionally, one individual I communicate with who had the same intestinal surgery as me had hers done under an HMO. She claims that if there is no one in network that can provide the appropriate service, they send you out of their network. I don't know if this is how they all work or not.

I agree that there are things terribly wrong with our health insurance and healthcare system. Careful, measured reform is needed. Access needs to be improved. Those delivering healthcare (mainly doctors and hospitals) need to be held accountable. Those that enter into an agreement to provide a service (health insurers) need to be held accountable and not be able to rescind those services once they agree to the terms and that agreement commences. However, the bill for health care should not be the burden of the citizens of this country. Those who can't help themselves should get help, continue to receive help, or be rehabilitated. However, those that can contribute, must, regardless of their economic means. Since higher taxes will be needed at some juncture to pay for this (and other existing debt) at some time anyway, maybe this national sales tax, or something similar, is examined. The government needs to define realistic rules that protect the consumer but are also conducive to business participation and, in an ongoing manner, needs to be nothing more than a referee to ensure that the businesses play fair. I know this is a simpleton's view, but I don't appreciate unnecessary complications.


Kind Regards,
Jay

Almost all of us long for peace and freedom; but very few of us have much enthusiasm for the thoughts, feelings, and actions that make for peace and freedom. - Aldous Huxley

Was the government to prescribe to us our medicine and diet, our bodies would be in such keeping as our souls are now. - Thomas Jefferson
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Those are good questions, Jay, that I'd like to give further thought to.

For now, I thought I'd attach a link to the story of one woman who faced medical bankruptcy. I realize she may not represent all medical bankruptcies but my sense is that she is typical.

http://www.msnbc.msn.com/id/20201807/ns/us_news-gut_check//

I'm rushing off to do some last minutes Christmas shopping and will do a little more research later today.


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yes, good thoughts Jay

I don't have the exact numbers that would entitle someone for bankruptcy, but my understanding is that all assets are considered, if someone has savings, including a house or vehicles, anything of value, they would be counted

it varies from state to state, subject to budget fluctuations, and there is a waiting period as well

assets of a spouse are included, which sometimes can even suggest getting a divorce to qualify for medicaid

that's about all I know, maybe Stormy will have more on it.


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My dad oft cites the old “believe nothing you hear (or read) and only half of what you see” saying.

I don't doubt that are facts contained within this article. The problem I have with this article is there is also the agenda of the writer and/or of the publisher. This news media source is owned by GE which, conveniently, has a healthcare business. Now, there is nothing wrong with owning a media outlet or a healthcare business, but personally, I'm not inclined to assign much credibility to anything (healthcare related or other) they publish or broadcast. I find that all broadcast (ABC, CBS, NBC) and cable news (CNN, FOX, MSNBC, etc.) is more entertainment than anything that resembles real news. Also, in my opinion, asking the reader to believe everything cited in this story would be akin to asking someone to believe Rush, Beck, Hannity, or O'Reilly when they tell you unequivocally that there is no way that any health insurer has intentions of ever denying a claim. I see it as propagated to tug at people's emotions, rally against a general entity perceived to be nothing but evil, and to sway the audiences' opinions.

It's my perception that the supposed injustice in this case is less an issue with the health insurer than it is with the medical provider and possible errors in their billing. I fail to understand why it is the new health insurer's (Blue Cross) duty to inform the medical provider that the patient has new insurance, especially if automaton at a health insurer desk has no knowledge that she was previously a patient at that clinic. “Fisher (Aldrich's sister) believes the source of the problem was that the oncology practice had been paid more for the same services under Aldrich's previous insurance policy and did not change its billings to reflect the terms of its contract with Blue Shield, Aldrich’s new carrier.” I don't know how medical billing works, but would believe that the medical practice would either 1) contact the insurer when the amount of the claim paid did not match what was previously paid 2) ensure the patient did not have new insurance at each consecutive visit (such is done at nearly all doctors I visit who accept insurance). This is why I keep going back to accountability in the medical field (by doctors, hospitals, providers). Otherwise, I'm a little perplexed that the patient didn't voluntarily notify the medical provider at a consecutive visit that her insurance carrier had changed. Especially so after she realized that her share of the medical bill unexplicably increased.

I do feel bad for this woman as I feel bad for anyone dealing with such life altering illness such as cancer or any chronic illness. It would be nice to enact measures to protect, at some level, people in such instances from complete financial ruin and the resulting effects (like the negative impact to the black magic credit score). However, again, this is a complicated issue that I profess not to know how assets are liquidated or allocated to creditors and how cause is assigned. This article doesn't get me any further to such an understanding. I also hope that the intent of this article is not a shot at the health insurers as it sounds like the root of the problem in this case lies primarily with lack of communication between the healthcare provider and patient. I'm not a health insurer cheerleader, I'm just weary of blurred journalism.

One other thing I can get my head around, and the article doesn't elaborate, is why this woman would change jobs leaving her open to (greater) economic uncertainty and possibly jeopardizing her ability to maintain healthcare coverage during such uncertain times with her health. I realize that she, or no one, should remain in a job in which they are unhappy, but sometimes the situation dictates it is what one must do, like it or not. However, I forgot, people are entitled to a good job just like they are entitled to health insurance. One wonders if she would have never been laid off if she hadn't switched jobs. The article also fails to mention if some of the protections offered under FMLA were enacted or if they couldn't fulfill her needs. It'd be interesting to know. Perhaps the government should look at reforming FMLA first.

Also, looking into the Senate bill, I can only find the word bankrupt once (on page 322) in 2,076 pages. The passage claims that “Half of all personal bankruptcies are caused in part by medical expenses. By significantly increasing health insurance coverage, the requirement, together with the other provisions of this Act, will improve financial security for families.” This woman had health insurance didn't she? She still found herself needing to declare bankruptcy. I don't understand how increasing health insurance coverage will stave off bankruptcy when, apparently, many of the bankrupt have health insurance. It didn't seem to help them. My guess is that it may provide a slight reduction in the numbers of folks needing to file, but I'd suspect that they majority of folks filing have had extremely, costly traumatic events or are managing chronic disease. I suspect that other spending factors, at least for those well educated middle class, might have more to do with it than is cited

One last thing is that the article mentions her needing to allocate 33% of her income to health insurance. One wonders what is an acceptable amount of one's income that should be allocated (I don't expect you to answer than)?


Kind Regards,
Jay

Almost all of us long for peace and freedom; but very few of us have much enthusiasm for the thoughts, feelings, and actions that make for peace and freedom. - Aldous Huxley

Was the government to prescribe to us our medicine and diet, our bodies would be in such keeping as our souls are now. - Thomas Jefferson
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[quote=WendyR]Stormy - your statements that there is no reason for children and average adults to be uninsured in America don't seem to jive with the statistics. [/quote

Wendy - As I said, it is much more complex then Wiki articles, the media, and (I have to add) politicians with agendas = on both sides of the aisle - would lead you to believe. There absolutely is no valid reason for any child in America to go without healthcare and health insurance. There are too many protections in place for this to justifiably happen. Does it happen? Sadly, yes it does. When it happens, it is an unconscionable failing on the part of the parents. Children should be protected by the availability of Medicaid and SCHIP. Health screenings, healthcare and immunizations are available at all local health departments on a sliding fee scale. As I mentioned in a previous post, it is pratcically impossible to do anything for my children without being bombarded by offers of assistance - in a decidely upper middle class to extremely wealthy community. What is the answer to the problem of uninsured and/or uncared for children? Should we remove them from the home and put them into the foster care system? Should we radically change the health system for the entire nation - with the CERTAINTY that currently insured children will suffer due to the inevitable reduction in health care coverage to many? This is the land of the free - unfortunately people do have the right to make poor choices even when if puts their children in harms way. We, as a nation, don't have to like it - and most of us don't. But can we stop it? That is a question that I don't feel capable of answering.

I would like to point out that I NEVER said that I, or anyone else, could feed, clothe and shelter a family of four on $22,050. I did point out that the 2009 Poverty Line (as determined by by the US Department of Health and Human Services) for a Family of four was $22,050. This is a basic calculation of poverty based on the cost of basic nutritious food - see the link in my previous post for a more detailed calculation. Families (of 4) with young children making 133% of that amount qualify for Medicaid (WITH AN INCOME OF $29,326 - which I also could not manage on). http://www.themoneyalert.com/medicaideligibility.html Qualification guidelines vary somewhat by state. Some states allow higher incomes. No state can have lower income criteria. Families at this level also would qualify for food stamps, free school lunch - and breakfast, low income housing, possibly WIC vouchers, as well as the numerous offers that I find so annoying. (Does the school district really need to send two separate letters each semester times three children advising me of the availability of assistance? To meet federal law, they do.) Families at the income levels we are talking about are absolutely not expected to feed, clothe and shelter their families without help. Families (of 4) making 300% of the poverty line (OR $66,150) qualify for SCHIP. If they make $66,000 per year, they can afford to buy health insurance. They may wish to spend their money differently, they may plead poverty, they may have to adjust their lifestyle, but they most certainly can afford it.

I have seen all of the statistics you quoted. They are not necessarily accurate or complete representations. Beware of Wikipedia and McPaper (USA Today) - also the CNN iReports.

• The United States is the only wealthy, industrialized nation that does not have a universal health care system. Source: Institute of Medicine of the National Academy of Sciences
This is very true. I firmly believe that everyone should have health insurance coverage. I do not believe in, nor do I want, a government run universal health care system. The polling results that I posted to DOW certainly indicate that the majority of Americans Do Not Want a Government Run Universal Health Care System.

• In 2006, the percentage of Americans without health insurance was 15.8%, or approximately 47 million uninsured people. Source: US Census Bureau
This is mostly true. The statistic published by the Census Bureau actually said that the percentage of PEOPLE in America without health insurance was 15.8% or the 46.6 million number that was
President Obama repeatedly quoted during the campaign. This figure is derived from a monthly survey of approximately 50,000 households, The number is then extrapolated using statistical
techniques to come up with an estimate for the nation. That said, the Census Bureau numbers are generally accurate. Please note that Obama adjusted that number he talks about down to 30 million when it was pointed out (correctly) that the 46.6 million number included illegal aliens. Also included in that number are the approximately 10.1 million uninsured who make more then $50,000 per year, 5 million childless working adults age 18 to 34 who are eligible for either a group health insurance plan or eligible to purchase insurance but choose not to do so, 4.3 million who are eligible for Medicaid or SCHIP but do not choose to participate. This leaves us with 10.5 million people who are legitimately uninsured. These are the people we need to help. This number is unarguably too high, but at approximately 3.5% of the US population, not nearly so dire. Again, these are the people we need to help.

• The primary reason given for lack of health insurance coverage in 2005 was cost (more than 50%), lost job or a change in employment (24%), Medicaid benefits stopped (10%), ineligibility for family insurance coverage due to age or leaving school (8%). Source: National Center for Health Statistics
Also true. Keep in mind these numbers are self-reported. To some people any cost at all is "too much" for something they think they don't need.

• The United States ranks 43rd in lowest infant mortality rate, down from 12th in 1960 and 21st in 1990. Singapore has the lowest rate with 2.3 deaths per 1000 live births, while the United States has a rate of 6.3 deaths per 1000 live births. Some of the other 42 nations that have a lower infant mortality rate than the US include Hong Kong, Slovenia, and Cuba. Source: CIA Factbook (2008)
This is an often quoted statistic. On the surface it is true. Keep in mind, however, that the numbers used in the calculations are reported by the governments of the individual countries, then
calculated into a standard statistic. The problems with that are multiple. Accuracy - some governments deliberately underreport things like mortality rates due to a sense of shame or saving face -
think China and the underreporting and secrecy during the SARS and Avian Flu epidemics. Consistency - governments have different standards for what constitutes infant mortality. In many countries
seriously premature infants and/or infants with visible life threatening birth defects are not counted as they are not considered viable or even sadder, they are not yet considered people. In the US
every birth is counted. The US has a very high rate of fertility treatment babies. Because of the very nature of their conception, birth and risk of extreme multiples, these infants have a higher
mortality rate. Not too many poor people in Hong Kong, Slovenia and Cuba are undergoing fertility treatment, in-vitro fertilization, GIFT, etc.

• Approximately 30,000 infants die in the United States each year. The infant mortality rate, which is the risk of death during the first year of life, is related to the underlying health of the mother, public health practices, socioeconomic conditions, and availability and use of appropriate health care for infants and pregnant women. Sources: CDC and National Center for Health Statistics.
Agreed and already addressed - see above

• Two-thirds of non-elderly people without health insurance have jobs, and the number of uninsured people is steadily growing — 46.6 million according to a 2006 Census Bureau Report.
Agreed and already addressed - see above

• Three-quarters of Americans who declare medical bankruptcy had medical insurance when they became ill.
This is true with an important caveat. Bankruptcy filings have more to do with the societal implications of people living beyond their means then it does the state of health coverage in America. In the recent real estate insanity that gripped America, it became common for Americans to live far outside their means - borrowing against their homes and credit cards at an alarming rate, purchasing homes and cars above their abilities to repay and plunging headlong "creative financing". Many people were/are so overextended that any unexpected cost at all sent the house of cards into free-fall. If you have health insurance and you are living within your means, an unexpected illness should not send you into bankruptcy. Most health insurance plans have annual caps on how much you will be required to spend out of pocket. In many cases, if medical bills had not been the catalyst for financial ruin, something else would have been - an unexpected home repair for instance.


• People with incomes that are more than 200 percent of the federal poverty level accounted for one-third of the recent increase in the number of uninsured adults, and half that growth was among young adults aged 19 to 34.
Agreed - see above. Also, this group is known as the "young invincibles". They are notarious for believing that it "can't happen to them". They are young, strong, bullet-proof and can leap tall buildings in a single bound. They generally have access and means to health insurance, but believe that they are young and healthy and do not need to spend their money in this way. If they were formerly covered on their parent's policy, they have the legal right to COBRA that policy. They also are exempt from pre-existing condition clauses in private health insurance under HIPAA. In Canada (and elsewhere), these individuals would not have the choice to skip health insurance. Their wages would be taxed regardless of their wishes. This comes down to choice and personal responsibility. I work for a Fortune 100 company. My employer offers above average health care coverage to all employees. Employees can opt out of coverage and receive a cash bonus equal to what the company would have spent on health insurance. This is intended for employees who have health coverage through another means (spouse, parent, other employer, government, etc). The employee is counseled on this and signs a statement that they understand this. An audit was conducted earlier this year. Of the employees who opt out of healthcare coverage 90% were in the "young invincible" category. Of that 90%, 22% had health insurance, 78% had NONE. The cash bonus was not offered for 2010. We still had a large percentage of "young invincibles" opting out of health coverage - quite a few are angry that they are not going to receive their health insurance opt-out check.

There are a couple of key points that I think are important to consider in this conversation:
* The Canadian Health System does not cover illegal aliens living within its borders. You must have permanent residency status to obtain a health card. Personally, I don't think that requirement is at all out of line. It is however, inaccurate to suggest that Canada covers everyone without exception.

* The Canadian Health System varies greatly from Province to Province. What is covered under the UK system varies from one Health Care Trust to another. How is that different from the variation in health insurance policies available in the US? Canadians have basic health care coverage through the Medicare system. Many people purchase supplemental policies privately or through their employers. People in the UK can and do go outside of the NHS system and pay privately to be seen quicker. What this really comes down to is the fact that regardless of where you live, the amount of money that you are willing to put into the healthcare system directly correlates to the quality of care you receive.

* The media and a number of politicians report that large numbers of Americans are dying due to lack of health care coverage. Death or exacerbation of illness due to lack of care is unacceptable - it also happens everywhere, not just America. In the US, hospitals have an obligation to treat patients regardless of insurance status. Emergency rooms triage patients and see them in order of severity of symptoms/illness. Sometimes mistakes are made, or people get frustrated and leave, and people die. This happens all over the world, not just in the US. Sometimes people with chronic illnesses or worrying symptoms fail to follow up with their doctors because of lack of health insurance. They do have the option to go to the Health Department or a free clinic or pay out of pocket - many doctors will offer a discount for uninsured patients. The majority of drug manufacturers offer free or discounted medications to those in need.

*Some people are happy with the health system in Canada. You appear to be happy with your care, However, the reality is that not everyone is happy. THE CANADIAN PRESS SASKATOON - The incoming president of the Canadian Medical Association says this country's health-care system is sick and doctors need to develop a plan to cure it. August 15, 2009 http://www.breitbart.com/article.php?id=cp_x081502A.xml&show_article=1

* Based on what I have observed on this forum, what I have observed in Family and friends living in Canada, and reports that cross my desk everyday (that I can't disclose here), wait times for care and services, as well as tests and procedures appear to be longer on average in government run systems then they are in most of the US and certainly longer then any wait time I personally have ever experienced. It is not unusual to read posts on this board about people getting appointments for things like MRI's and other tests many months into the future. One of my Canadian relatives became very ill Christmas time last year. He spent months going back and forth between the ER and his doctor. He was hospitalized multiple times. His doctor determined that he needed an MRI and referral to a specialist in February. Even though he was hospitalized several times after that, no MRI or specialist consultation took place. He finally got the MRI in July, saw the specialist in August, and had surgery in September. Recently, one of my kids needed an MRI. The pediatrician ordered it on a Monday, insurance approved it on a Tuesday, it was done in Wednesday and I discussed the results with the doctor on Thursday. I don't want to wait under a government run health care system.

Things are not as dire in the US as many have been led to believe. Do sick people suffer and sometimes struggle to get the care that they think they need, want, deserve? Undoubtedly YES. Is that fair? Absolutely not. Do sick people in Canada suffer and sometimes struggle to get the care that they think they need, want, deserve? Undoubtedly YES. Is that fair? Absolutely not. Do sick people in France, the UK or Japan suffer and sometimes struggle to get the care that they think they need, want, deserve? Undoubtedly YES. Is that fair? Absolutely not. I think you know where I am going with this. You can't please all of the people all of the time. There is not one system that will meet everyones needs or make everyone happy. Polling data suggests that most Americans don't want to live under a government run system.

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Originally Posted By: Dow
that's about all I know, maybe Stormy will have more on it.


I have some knowledge of bankruptcy law, but it is somewhat limited. I am a finance geek, not an attorney.

Bankruptcy laws do vary greatly from state to state. Many states protect your home and one vehicle in bankruptcy - others do not (I believe), still others limit the value of the protected asset. (So you don't get to keep your Mansion.

From what I have seen, most people who file for bankruptcy for the stated reason of excess medical bills, probably would have ended up in bankruptcy anyway. Often, they are living beyond their means and the additional medical bill is the straw that breaks the camel's back. If not for the medical bills, something else would have eventually broken them.

I did not quite understand the reference to state budget fluctuations - or were you referring to Medicaid eligibility there?

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Originally Posted By: Jaybird
I don't know what Stormy's point was, but mine was simply to highlight the fact that in comparison to some of the "industries" mentioned in Stormy's post, the health insurers aren't making "fat" profits as the current administration has stated. The CEO salaries of those organizations, while hefty, are definitely not out of line with other big businesses/corporations.


Originally Posted By: Wendy
I'm confused as to why the entertainment industry or the cigarette and and brewery industries are relevant.


My initial point was simply that the restrictions and limits that DOW's wife and her students were chafing under were most likely imposed on them by University Administration, not by an insurance company. I am annoyed by the constant references to egregious profits by insurance companies as that is simply untrue. The insurance company bashing is getting old. The Democrats and liberals do it constantly...but just try to mess with their profits in their chosen professions. I listed several industries whose profit margins are much higher then the profit margins of insurance companies. I think that is valid and relevant in this discussion. I really was not picking on DOW - I actually have never paid attention to what he does for a living. I really had the Michael Moore's of the world in mind when I originally posted. His recent interview with Sean Hannity was very telling. He visibly paled when Hannity questioned if he was willing to give up much of his exorbitant income like he was expecting corporate CEO's to; or if he would give up large portions of his income to pay for healthcare for the disadvantaged. Apparently, Mr Moore does not view himself as one of the wealthy who should pay for this health care monstrosity. (That struck me a pretty typical.)

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