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This month has a certain nostalgia for me. I am working the last two shifts in my home, Humboldt County. Nestled between pristine redwoods and dramatic cliffs overlooking the west coast of California, I want to stay here, but cannot. I am feeling the full force of the United States health care crisis. In the four years I have worked in this community of 135,000 people, eight of ten obstetricians in the southern half of the county have left, and now I find I am one of them. There are now only

Two obstetricians, far apart geographically and serving two different hospitals, are all that is left to see obstetric patients in the Southern half of the county. Both doctors are men over 60, who have a tough future ahead of them. Without outside help there is no way they can see all the patients that will need them. They have to remain within 30 minutes of the hospital and can be told to come to work any time of the day or night. They can never have a moment off, a full night’s sleep, a drink of alcohol to ring in the New Year. Watching a full length movie, or having a nice dinner with the spouse without interruption is a thing of the past. Neither of the remaining doctors can get sick or injured. This is really asking them to be super human and there is no cavalry on their horizon. In fact, if Catholic Health Systems is successful at closing one of the two hospitals, only one physician will remain.

As a young person, I wanted to take my medical skills to a disadvantaged third world nation. Looks like I got my wish—right here in the US. How did we get here?

Humboldt County illustrates many of the ills, both old and new, this broken system imposes on the citizens, and particularly the women, of the US. To really see the complexity, you have to look at all the levels putting pressure on this shattered system.

National:

If you were listening to American propaganda news casts last month, you heard the Affordable Health Care Act (ACA) or “Obamacare” shut down thousands of private health insurance plans and that President Obama lied when he made the campaign promise, “If you like your health care plan, you can keep it.”

The standard set by the ACA was so low any real health insurance plan could have stumbled over it dead drunk and in the dark. So why are some of the plans failing?

For decades, the health care system in America has been plagued with “Junk Insurance.” These are plans that call themselves insurance, but if someone on the plan actually got sick, the insurance would not cover anything. Companies get away with this, because all health insurance contracts read like real estate derivative scams; they are so complicated, no one can understand them. It is not legally fraud. The customer signs a contract that does actually say they won’t get coverage for their heart attack, stroke, appendicitis, car accident, etc. It says it in fine print, in ways no one is intended to decipher.

People enrolled in these plans pay monthly premiums that are slightly less than real insurance, believing they have a great deal. Sales people, who “explain” the plan to them, give them that impression. But should they actually become ill or have an accident, they quickly find their premiums were wasted. They have been duped into believing they actually bought something. The truth is, those people would have been better off uninsured than paying premiums for years for no real benefit.

Even if you had real insurance you are a victim of this sort of scam. As junk insurance became more profitable, legitimate insurance companies found they could cover fewer and fewer benefits for the same price. It has created a race to the benefit bottom.

So the Affordable Care Act got rid of all those types of insurance, right? Wrong. The ACA apparently was never meant to stop scam insurance. Those plans were still operating even before the President caved in to media pressure and allowed new fraudulent insurance plans to continue. You might even be enrolled in one right now. Turns out I am.

When my adult daughter, who is getting a graduate degree and still on my insurance, hedged at going to the doctor for a check up this year, I proudly told her that she need not worry. The Affordable Care Act guaranteed that as of August 1, she could go for her annual, get her birth control and her immunizations for free.

15 Covered Preventive Services for Adults
1. Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
2. Alcohol Misuse screening and counseling
3. Aspirin use for men and women of certain ages
4. Blood Pressure screening for all adults
5. Cholesterol screening for adults of certain ages or at higher risk
6. Colorectal Cancer screening for adults over 50
7. Depression screening for adults
8. Type 2 Diabetes screening for adults with high blood pressure
9. Diet counseling for adults at higher risk for chronic disease
10. HIV screening for all adults at higher risk
11. Immunization vaccines for adults--doses, recommended ages, and recommended populations vary:
   Hepatitis A
   Hepatitis B
   Herpes Zoster
   Human Papillomavirus
   Influenza (Flu Shot)
   Measles, Mumps, Rubella
   Meningococcal
   Pneumococcal
   Tetanus, Diphtheria, Pertussis
   Varicella
   Learn more about immunizations and see the latest vaccine schedules.
12. Obesity screening and counseling for all adults
13. Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
14. Tobacco Use screening for all adults and cessation interventions for tobacco users
15. Syphilis screening for all adults at higher risk

22 Covered Preventive Services for Women, Including Pregnant Women
The eight new prevention-related health services marked with an asterisk ( * ) must be covered with no cost-sharing in plan years starting on or after August 1, 2012.
1. Anemia screening on a routine basis for pregnant women
2. Bacteriuria urinary tract or other infection screening for pregnant women
3. BRCA counseling about genetic testing for women at higher risk
4. Breast Cancer Mammography screenings every 1 to 2 years for women over 40
5. Breast Cancer Chemoprevention counseling for women at higher risk
6. Breastfeeding comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women*
7. Cervical Cancer screening for sexually active women
8. Chlamydia Infection screening for younger women and other women at higher risk
9. Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs*
10. Domestic and interpersonal violence screening and counseling for all women*
11. Folic Acid supplements for women who may become pregnant
12. Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes*
13. Gonorrhea screening for all women at higher risk
14. Hepatitis B screening for pregnant women at their first prenatal visit
15. Human Immunodeficiency Virus (HIV) screening and counseling for sexually active women*
16. Human Papillomavirus (HPV) DNA Test: high risk HPV DNA testing every three years for women with normal cytology results who are 30 or older*
17. Osteoporosis screening for women over age 60 depending on risk factors
18. Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
19. Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users
20. Sexually Transmitted Infections (STI) counseling for sexually active women*
21. Syphilis screening for all pregnant women or other women at increased risk
22. Well-woman visits to obtain recommended preventive services*
Learn more about Affordable Care Act Rules on Expanding Access to Preventive Services for Women.
(Effective August 1, 2012)

26 Covered Preventive Services for Children
1. Alcohol and Drug Use assessments for adolescents
2. Autism screening for children at 18 and 24 months
3. Behavioral assessments for children of all ages
Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
4. Blood Pressure screening for children
Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
5. Cervical Dysplasia screening for sexually active females
6. Congenital Hypothyroidism screening for newborns
7. Depression screening for adolescents
8. Developmental screening for children under age 3, and surveillance throughout childhood
9. Dyslipidemia screening for children at higher risk of lipid disorders
Ages: 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
10. Fluoride Chemoprevention supplements for children without fluoride in their water source
11. Gonorrhea preventive medication for the eyes of all newborns
12. Hearing screening for all newborns
13. Height, Weight and Body Mass Index measurements for children
Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
14. Hematocrit or Hemoglobin screening for children
15. Hemoglobinopathies or sickle cell screening for newborns
16. HIV screening for adolescents at higher risk
17. Immunization vaccines for children from birth to age 18 —doses, recommended ages, and recommended populations vary:
   Diphtheria, Tetanus, Pertussis
   Haemophilus influenzae type b
   Hepatitis A
   Hepatitis B
   Human Papillomavirus
   Inactivated Poliovirus
   Influenza (Flu Shot)
   Measles, Mumps, Rubella
   Meningococcal
   Pneumococcal
   Rotavirus
   Varicella
   Learn more about immunizations and see the latest vaccine schedules.
18. Iron supplements for children ages 6 to 12 months at risk for anemia
19. Lead screening for children at risk of exposure
20. Medical History for all children throughout development
Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
21. Obesity screening and counseling
22. Oral Health risk assessment for young children
Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years.
23. Phenylketonuria (PKU) screening for this genetic disorder in newborns
24. Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents at higher risk
25. Tuberculin testing for children at higher risk of tuberculosis
Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
26. Vision screening for all children

Health and Human Service

I was flabbergasted when she was actually charged for all those things in October of this year—long before the media ganged up on the President. I called Aetna, my insurance carrier, sure there had been some error. I was told it was no error, and if I had questions, I should contact the state. Since my employer is in South Carolina, I had to contact the insurance board for that state. Here is my conversation with the board:
Rosa Rivers
Senior Insurance Regulatory Analyst
Consumer Service Division

You requested clarification on the ACA law in regards to contraceptive and immunizations. A grandfathered health plan isn’t required to comply with some of the consumer protections of the Affordable Care Act that apply to other health plans that are not grandfathered.  If you have health coverage from a plan that existed on March 23, 2010 — and that has covered at least one person continuously from that day forward — your plan may be considered a “grandfathered” plan.

If your plan is a grandfathered plan it is not required to provide certain recommended preventive services at no additional charge to you.  This would include charges for contraceptives.  This would be the only reason the company is not paying for contraceptives.

The above also applies, but also the ACA requires coverage on vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) prior to September 2009 with no co-payments or other cost-sharing requirements when those services are delivered by an in-network provider.  The immunization vaccine you listed in your email is not on the recommended list. [Note from author: This is an inaccurate statement. HPV vaccine is covered. See the lists above.]

Sincerely
Rosa Rivers

TP: When can I expect the health care plan to cover contraception if it is "grandfathered?"

Rosa: There is no specific end date for grandfathered status.   When a company significantly alters its a health plan it can cause the plan to lose its grandfathered status.  Companies must send out notices advising if the plan is grandfathered or has lose its grandfathered status.

In other words, insurance that didn’t really insure anything, could seek “grandfather status” and completely ignore the ACA rules, as long as the insurance was created before the ACA went into effect August 1, the policy didn’t change too much after that, and they had at least 1 person enrolled.

So Obama went to extremes to honor his promise that you could keep your insurance, even to the point of giving insurers a way to keep junk insurance going indefinitely. Due to the grandfather clause, the ACA didn’t really guarantee Americans they would actually get anything out of their insurance. But, it did demand that its citizens enroll in something calling itself “health insurance” by the end of the year, delivering thousands of paying customers to the insurance companies and guaranteeing tax subsidies to these companies.

Even these concessions were not enough. People on these plans do eventually become ill, and realize they have been duped and drop the insurance. Or they complain to their employer that the insurance is worthless. So these plans must periodically shut down, change their names and enroll (fool) a new crop of customers. They needed to create “new” junk insurance plans every year. What the insurance companies are complaining about is that junk insurance plans created after August 1, or who did not go through the grandfathering process, will not be allowed to continue after January 1.

The real lie here is being perpetrated by Aetna, Blue Cross and Goldman Sachs (yep, they are in this too) and a host of other insurers who lead people to believe their premiums are going to cover a future health care crisis, which they will clearly never do. In fact, they are the ones who have been lying about their products for decades.

What these companies are peddling does not deserve to be called “health insurance” at all. They are the ones that should be held to account here, not the President. These plans don’t deserve to be “grandfathered,” rescued by the President or Congress, or supported by the Clintons. These plans deserve to die.

So what does this mean to the people of Humboldt county and thousands of other rural communities across the U.S? ACA will still support under insurance and high deductible insurance. That means people are sicker when they finally seek help, and they are still at risk for medical bankruptcy. In bankruptcy, or just nonpayment, it is the hospitals, labs and health care providers who foot the bill because they have already provided the service and won’t get paid.

Woman’s health care is hit the hardest by this betrayal. Supposedly, one of the hard won benefits of the ACA was the end of “separate but equal” health care for women. Women and men get charged the same or women get charged more for their health care, but cannot find health care that supports contraception and obstetric services. The grandfather clause, Obama’ s cave in to religious groups on birth control and abortion, and now his reversal on scam insurance means women will still face a barrage of insurance that does not cover their medical needs. Women will have to come out of pocket for these needs. That means more nonpayment for these services for doctors and hospitals and more pressure to decrease these services.

State:

Medicaid (state insurance for the poor) pays doctors very poorly in general. In California, it reimburses Gynecology less than it costs to provide the care. It pays a barely adequate amount for Obstetrics.  Most obstetric patients have Medicaid because they are young and have not had time to establish themselves financially. Commercial insurance, conversely, pays well for gynecology and poorly or not at all for obstetrics.

In California, the playing field for doctors is uneven. The more established doctors in town are getting three times as much for every Medicaid patient, due to previous programs the state offered to rural doctors that new doctors cannot enter. When I came to Humboldt, I had to compete with these more established practices while getting lower rates for everything I did with Medicaid patients (about half of my practice). I did this by joining a large group. But when all the other doctors in the group moved or retired, I found myself having to pay all the overhead on my own. One of the ways I survived was to stop seeing obstetrics and Medicaid patients. This shifted my patients to gynecology with commercial insurance—the highest reimbursement profile. It allowed me to continue practicing for six months and gave my staff time to find work elsewhere. But it also decreased the physicians seeing obstetrics in town by one.

Multiple times the state has voted to open Medicaid to all the state citizens. This may have leveled the playing field and increased the reimbursement to doctors and hospitals because Medicaid would have had more funding. Right now, Medicaid in most states covers more than most private insurance and could be provided to a state’s citizens for less than commercial insurance. Unfortunately, the law the people voted for was vetoed by the Governor each time.

County:

Santa Rosa, Ukiah, and Crescent City, cities in other counties surrounding Humboldt, are also recruiting for obstetrics for similar reasons. At least in our area, the crisis is wide spread. Santa Rosa can afford to pay more and clearly offers bigger practices and more city. It is likely to divert candidates from the smaller hospitals.

Humboldt and the surrounding counties are finding it very difficult to recruit, because reimbursement is so poor. With 50% Medicaid, a new physician may not be able to meet overhead demands. They could make more on Medicaid if they joined an existing practice with their special reimbursement rates, but the surviving practices in Humboldt both have issues. Catholic Health Systems is considering closing the obstetrics ward in the southern half of the county, where one of the practices is based. Another practice is headed by a person who has a history of multiple partnership rifts. The third practice only sees gynecologic patients and not obstetrics. Catholic Health Systems could recruit into their own clinics, which also have a higher reimbursement, but this would mean the new doctor could not prescribe ANY birth control, further limiting birth control availability within the county.

Catholic Health Systems made a bid for Crescent City hospital. Crescent City is suffering its own lack of obstetric services. If the Catholics did buy Crescent City’s hospital, that would stop sterilizations in all hospitals along the Northern Coast of California except for the one small hospital in the north end of Humboldt that remains secular. Doctors from other cities along the coast would have to leave their practice area to do sterilizations on their patients in Northern Humboldt. Something they cannot do without partners to cover their practices in their absence.

Then there is a question about what the Catholics would do with Crescent City’s labor and delivery unit. Would it close that obstetric unit as it threatens to do with the labor and delivery unit at the southern end of Humboldt County? How far is too far to drive in labor?

This situation could be helped by a county-run health system. After all, the Health Department is county run. It’s not such a stretch to expand the Health Department’s responsibilities to meet the health needs of all the inhabitants of a county if they can not be met by commercial and private industry. I tried to set up a county run health care system in Arizona eight years ago and then network the various counties to provide care throughout the state. This is how universal health care in Europe first got started in the early 1900’s. Unfortunately, I discovered there is a federal law preventing counties from doing just that, because it would compete with commercial insurance. The federal law has never been tested and in the age of ACA, might be outdated. I would love to see a movement to organize single payer health care, county by county, in this country and right now, that might be the best solution.

Hospital:

As I mentioned earlier, Medicaid is the biggest payer of obstetric services in the rural sector. Although it pays physicians adequately for obstetric care, it pays hospitals poorly. Hospitals can only break even on obstetrics if they do very large volume or are in an affluent area where Medicaid is not such an issue. All the rural hospitals I have served lose money on obstetrics and that makes it the lowest service on the totem pole. Obstetrics is the last to get new equipment, always runs lean on staffing and is the last for recruitment. Right now, the staffing in Humboldt’s obstetrics wards is so sparse, the nurses are calling around to beg other nurses to come in and work, every time I am on call. The last time I was on the ward, a nurse actually broke into tears on the phone to one of her colleagues, begging her to come in and help.

If this was any other type of business, the solution would be to close the department, and consolidate the work into another department. And Catholic Health Systems is considering doing just that. They are trying to close the obstetrics ward in the southern half of the county and force women to drive the extra 21 miles to the middle of the county. For women at the far end of the county that is 70 miles total. Unlike other nations, there are no rules or laws to prevent Catholic Health System from closing a ward and limiting access.

In fact, because our health care is owned by private for profit interests, closing obstetrics at BOTH hospitals and letting obstetrics patients find their own solution outside of the hospital system is not out of the question. Only strong public objection and the communities withdraw of charitable contributions has stopped Catholic Health Systems from closing the southern obstetrics ward so far.

Health Care Provider:

My case illustrates the difficulties of making a living at this profession. I am not the first doctor to be driven out by financial difficulties. It is also not the first time for me to leave an area due to the financial collapse of a group. This is a recurring theme in all of rural America for Obstetricians. My troubles started back in Arizona when my group adopted Electronic Med Records (EMR).

One of the first elements of the ACA to go into effect was the requirement for doctors and hospitals to use EMR. Technology that is marketed naturally, has to be convenient and useful so people will buy it. If the government forces you to buy something, there is no pressure on the manufacturer to make it work for the user whether it is a computer program or a health insurance plan.

The ACA asked doctors to invest in technology that was unproven, expensive, and takes about 2 to 5 times longer per patient than pen and paper. It is the poster child for inappropriate technology. Additionally, it is prone to errors and has a terrible safety profile. Orders are incorrect more often than pen and paper, they end up on the wrong patients, and labs get missed due to the difficult to read screens.

My former group in Arizona went under due to EMR and the expense and slow down in seeing patients that came from the conversion. The company that sold the program to us went out of business and so we invested in a $250,000 program that became junk after the company folded, taking our patient records with it into oblivion. It was a disaster we never quite recovered from and eventually I took the new job in Humboldt, only to find the older physicians in the practice unwilling to commit finances to EMR. One by one they retired, rather than invest in the available systems, or take the decrease in compensation Medicare and Medicaid threatened if we did not convert, leaving me without partners to share costs.

If EMR does not make health care cheaper or more safe, one might wonder why the government was so hot to trot to convert all the US to these untried software programs. One of the main requirements of the EMR programs is that they are able to provide the government with statistical information. That, in and of itself, is not concerning and might actually be useful to track types of care that decreases disease over large populations. But remember, this is a government that colluded with corporations to collect huge volumes of information on everyday people illegally--and then lied to Congress about it. A few months ago, I became much more concerned about the data collection EMR is performing.

Women of Humboldt County:

This all filters down to women in Humboldt and the rest of rural America. Routine care is likely to be delivered by a less specialized provider—Midwives and Family Medicine physicians. The remaining obstetricians in Humboldt have both hired multiple midwives to assist them. This is probably alright, as these providers are qualified to give routine care and they do spend more time with patients. Patients requiring a more specialized level of care are going to have little or no choice about who provides the care and their visit will be crammed into a schedule that is already too full.

Birth control remains an issue. The only place offering sterilization is one small hospital in the north end of the county. Even though some of the doctors have privileges to do sterilizations in the north, the doctors who are left might not have coverage for their practice in order to get away and do their sterilizations in the North.

It also puts into question quality issues. Recently, lactation (breast feeding) counseling and home health visits for new mothers have been cut and I think other very good programs will also be cut soon. The nurses and physicians who are left are not enough. They are being run ragged. Patients who need a critical level of care will soon face a doctor and a nurse who are much more stressed and less supported than previously.

Patients in the South end of the county could be facing the closure of their obstetrics ward and a longer drive in labor, or in an emergency, putting them at increased risk. I think it is a matter of time until disaster happens.

And for all that chaos, I would stay if I could. I like it here. I like the people and the family of bears that live in my neighborhood. I love the calm of the redwoods and the moodiness of the ocean. But, financially, I’m beaten. I have been working 2-3 jobs to recover. Next year, I am moving to Washington State, and starting over . . . again.

Originally posted to T. P. Alexanders on Sun Dec 01, 2013 at 03:00 PM PST.

Also republished by Sexism and Patriarchy, Feminism, Pro-Feminism, Womanism: Feminist Issues, Ideas, & Activism, Anti-Capitalist Meetup, and Community Spotlight.

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Comment Preferences

  •  excellent diary (13+ / 0-)

    I would wager that more is spent in that county on drug enforcement than policing junk insurance inequity (WTF is the State Insurance Commissioner doing about this)

    My case illustrates the difficulties of making a living at this profession. I am not the first doctor to be driven out by financial difficulties. It is also not the first time for me to leave an area due to the financial collapse of a group. This is a recurring theme in all of rural America for Obstetricians. My troubles started back in Arizona when my group adopted Electronic Med Records (EMR).

    Warning - some snark may be above‽ (-9.50; -7.03)‽ eState4Column5©2013 "I’m not the strapping young Muslim socialist that I used to be" - Barack Obama 04/27/2013

    by annieli on Sun Dec 01, 2013 at 03:05:17 PM PST

    •  Nothing is done about junk insurance. . . (13+ / 0-)

      It is not illegal and the "grandfather" loop hole and Obama's recent reversal on shutting down inadequate insurance supports junk insurance.

      •  like usury isn't illegal either (9+ / 0-)
        LOUIS DUFFY (born c.1925)
        Christ Turning out the Money Lenders (c. 1944 England)

        Warning - some snark may be above‽ (-9.50; -7.03)‽ eState4Column5©2013 "I’m not the strapping young Muslim socialist that I used to be" - Barack Obama 04/27/2013

        by annieli on Sun Dec 01, 2013 at 03:23:17 PM PST

        [ Parent ]

        •  they eliminated the usury laws in Britain (6+ / 0-)

          in the 19th century; it seems like they have forgotten that they ever existed ... but it certainly helps that payday lenders are big donors to the Tory party (and I am certain others as well) ...

          "Hegel noticed somewhere that all great world history facts and people so to speak twice occur. He forgot to add: the one time as tragedy, the other time as farce" Karl Marx, The Eighteenth Brumaire of Louis Bonaparte .

          by NY brit expat on Sun Dec 01, 2013 at 03:36:00 PM PST

          [ Parent ]

      •  It's even worse than that (0+ / 0-)

        There is another loophole that allows junk "indemnity" plans, even new ones, to indefinitely skirt all the coverage requirements of the ACA. I posted a comment on another diary when I discovered this, but I don't think anyone saw it:

        I work for a clinic. Verifying insurance benefits is part of what I do. In the past week alone, two patients have come in with cards for "indemnity life insurance" from companies I have never heard of. The first is this piece of crap,
        Transamerica Transchoice Plus

        This link is from their own website, and explains, among other things, that the plan will pay up to $200 per year on a "Wellness Benefit" aka all preventative care. Meaning if a woman wants her annual checkup, this will cover either the physicial exam or the mammogram or the pap smear testing. But not all three because $200 barely covers the first one. The plan recipient, meanwhile, pays over $100 a month for this "coverage" - more if the recipient has family.

        Also, if you have a heart attack, the incredibly generous $2,000 reimbursement doesn't even kick in until 30 days after you are diagnosed with a heart attack. Same with cancer, end-stage renal failure, stroke, organ transplants.

        If your employer adds a "death and dismemberment rider" (which costs extra), and you only lose hearing in both your ears, 50% of your care is covered. However if you lose hearing in both or your ears and lose a limb or lose your ability to speak, 100% is covered.

        Hospital stays are only covered up to 30 days.

        In addition to having to tell a patient her mammogram won't be covered, I also couldn't tell her it will be covered by law starting January 1st 2014, because this bullshit plan is legal under the ACA. There is a loophole that allows these indemnity plans as long as they specify a benefit paid per period rather than per service. So you know damn well all the "per service" plans just switched to equally useless "per period" plans.

        Important: Transamerica is a Life Insurance company, not a health insurance company.

        Second example is from the mysterious "American Heritage Life Insurance Company" which a quick search reveals is a cutesy cover name for a plan for Allstate employees. Also not a health insurance company. I have no link because they have been very careful not to publicize their benefits. When I called to ask for them to fax me the benefits for a particular patient (which is a standard request) - they refused. They said I could inquire about a specific benefit and that's it.

        I am horrified that people continue to be sold these plans by their employers instead of real insurance. Most people have no idea that indemnity insurance means a specific, set time period will be covered, and nothing after that, because normal insurance does not work this way. I'm not even sure if employees with plans like this are eligible to shop on the exchange, because technically these are "employer sponsored health plans."

        This is an outrage, and this loophole needs to be closed immediately.

        Is fheàrr fheuchainn na bhith san dùil

        by bull8807 on Tue Dec 03, 2013 at 10:17:21 AM PST

        [ Parent ]

        •  loopholes (0+ / 0-)

          the reason these loopholes exist, is the "for profit" industry was responsible for a lot of the writing and influencing of the ACA law.
          http://speakout-now.org/...

          Quote"Essentially the bill is the same as the Heritage Foundation plan from the 1990s. Under the ACA, all individuals must either buy insurance, get it from their employer or pay a fine every year. Health care companies will be able to make billions more off of the millions of people who will now be forced to buy health insurance. The original plan proposed a so-called “public option” plan to compete with private insurance plans. But quickly the public plan was eliminated to protect the private insurance companies from competition. The ACA also imposed no price controls on prescription medications, guaranteeing that drug companies could continue to charge outrageous prices for prescription drugs."

          Heritage Foundation is a front for Koch brothers.

          "Public option plan" was the "Co-op insurance" that was forbidden from participation in the healthcare market place.

          In essence the ACA is really a forcing by the financial elite,to force Americans to hand over money to the financial elite under the cover of health coverage.

          While minimizing how much they would actually have to pay out.

          The only fault of Obama was signing off  on the ACA as written now, which was written mainly by the "for profit industry."  He was only allowed to veto or approve the whole thing.   and veto would have harmed those who did not have insurance or had junk policies. due to the former not permitting any pre-existing conditions, etc.

          basically he was given 2 bad choices to choose from. Which personally I believe the republicans and for profit industry maneuvered him into so they could blame any of the fallout on him.

  •  The ACM has been reposted to: (9+ / 0-)

    "Hegel noticed somewhere that all great world history facts and people so to speak twice occur. He forgot to add: the one time as tragedy, the other time as farce" Karl Marx, The Eighteenth Brumaire of Louis Bonaparte .

    by NY brit expat on Sun Dec 01, 2013 at 03:10:35 PM PST

  •  ACM Schedule (6+ / 0-)

    December

    8th: NY Brit Expat
    15th: ?
    22nd:
    JayRaye
    29th: Annieli

    January 2014:

    5th: Geminijen
    12th:
    19th:
    26th:

    We need someone to write for the 15th of December and then we are open for the month of January after the first week! Please, can anyone please volunteer for the 15th of December and/or be willing to take a slot in January?

    "Hegel noticed somewhere that all great world history facts and people so to speak twice occur. He forgot to add: the one time as tragedy, the other time as farce" Karl Marx, The Eighteenth Brumaire of Louis Bonaparte .

    by NY brit expat on Sun Dec 01, 2013 at 03:20:15 PM PST

  •  Wow! just wow. (16+ / 0-)

    This is just incredible.

    Junk insurance...only in America.

    They take your money when you're well,
    and dump you when you're sick.

    The President could have said:
    "It just never occurred to me that anyone would want to keep their Junk Insurance." But no, he caves to these thieves. Murdering thieves really, because people have died due to their legal swindle. They should be in prison for depraved indifference homicide.

    And then the President caves, and gives them a big break, and more people will die.

    Why am I not surprised?

    God spare me the Heart to fight them... I'll fight the Pirates forever. -Mother Jones

    by JayRaye on Sun Dec 01, 2013 at 03:27:07 PM PST

    •  About 40,000+ die each year due to. . . (18+ / 0-)

      lack of insurance or under insurance. And yet, as a country, we pay twice as much for our "uniquely American" health care system.

      Stunning really.

      •  Yes it is stunning. (12+ / 0-)

        It should also be seen as a crime against humanity that a nation as wealthy as ours should have ever allowed this to happen in the first place, and then at long last provide only a band-aid fix for such a terrible calamity.

        And that "fix" further designed to transfer yet more wealth from the working class to the ruling class. Does there ever come a time when we are simply tapped out?

        God spare me the Heart to fight them... I'll fight the Pirates forever. -Mother Jones

        by JayRaye on Sun Dec 01, 2013 at 03:44:34 PM PST

        [ Parent ]

        •  I'm still wondering why Americans . . . (9+ / 0-)

          don't have outrage. All these things happen to them and still we don't see them upset in large enough numbers to matter. That seems odd to me. We see protests in all these other countries but no mass movement in the US.

          Is it just my perception because I watch the protests in other countries on the news and they are not covered by US media, or is this really the case. Are Americans abnormally passive?

          •  Well we didn't used to be. (10+ / 0-)

            But something happened along the way...it does seem strange. Banks steal homes, insurance companies steal money then leave us to die, pension plans stolen...the list goes on. ...and

            crickets.

            I could only guess at the reason, anything I would guess would sound like CT, so I'll just leave it right there.

            God spare me the Heart to fight them... I'll fight the Pirates forever. -Mother Jones

            by JayRaye on Sun Dec 01, 2013 at 04:37:03 PM PST

            [ Parent ]

          •  Because they don't know. (5+ / 0-)

            Not everyone reads these blogs, and most are spoonfed their news via the MSM that is also corporate controlled. Even as much as I love Rachel Maddow, does she have the time to cover this stuff with everything else going so wrong in our country right now?

            It is every person's obligation to put back into the world at least the equivalent of what they takes out of it. - Albert Einstein (edited for modern times to include everyone by me!)

            by LeftieIndie on Sun Dec 01, 2013 at 11:19:25 PM PST

            [ Parent ]

          •  I was reading a popsci (8+ / 0-)

            article on existential depression in gifted children and was struck by this passage:

            Traditions are questioned or challenged. For example, why do we put such tight sex-role or age-role restrictions on people? Why do people engage in hypocritical behaviors in which they say one thing and then do another? Why do people say things they really do not mean at all? Why are so many people so unthinking and uncaring in their dealings with others? How much difference in the world can one person’s life make?
            and
            When gifted children try to share these concerns with others, they are usually met with reactions ranging from puzzlement to hostility. They discover that others, particularly of their age, clearly do not share these concerns, but instead are focused on more concrete issues and on fitting in with others’ expectations.
            I would argue with the article in saying that social perception is a function of intelligence; some of the most intelligent people I've known have been socially blind. However, there does seem to be a critical viewpoint that some of us have but many don't, even in childhood.

            "The 'Middle' is a crowded place - that is where the effective power is - the extreme right and left might annoy governments, but the middle terrifies them." Johnny Linehan

            by northsylvania on Mon Dec 02, 2013 at 02:15:00 AM PST

            [ Parent ]

          •  we are afraid to loose what we believe we do have (0+ / 0-)

            its a combination of things surrounding "we are afraid to loose what we do have."

            mainstream media owned by the finacial elite, know this. So they feed us stories that perpetuate the illusion that we are not loosing anything.

            Also mainstream media portrays problems on an individual isolated basis, example : shootings, OJ simpson, etc.    Another example: When Enron collapsed.  They were careful on how they fed it to us, trying to make it sound as if it was an individual issue and that it did not effect a lot of people, and also that it wasn't a big deal. That way the population doesn't think of problems on a large scale group level, like America being the worlds bully. Or America is consuming to much of the earth resources. Or America goes to war for resources under the cover of "war on terrorism" and other issues.

            The above example makes it easier for us to be in denial of Abuses that effect "all of us"

            Then there is the desensitization problem. The abuses did not happen overnight, it happened over decades starting around Regan.(I was in fourth grade at this time)  It was gradual like the slowly boiling pot of water that gradually heats up while your sitting inside it.  By the time you even realize your in danger its too late.

            Personally because I was in the pot from the beginning And I was acutely aware of the boiling pot issue I stopped watching mainstream media news about a decade and a half or so ago.

            For the younger generation its harder, because they were born into the abuse by the financial elite. They have nothing to compare it too. Their parents are too busy working, trying to put food on the table. They don't have time to sit down and explain to their kids that there was a better way once upon a time before. when heavy regulation reigned in the financial elite and that family came first before work. Now days everything takes back burner to work.

            And because Americans WORK TO MUCH, they don't have time to keep up on events. think divide and conquer.

            religion is a big part of it too. That its gods will, that we suffer, because we are getting to end of days and the faithful will be saved by god no matter what hell rains down on their heads.    This way of think basically causes the person into inaction, because they think that they need to suffer "because its gods will" and that they are too small to change anything and that god will save them, if they don't do anything to save themselves.  I am not religious at all, but I talk to people who are, including my Aunt I no longer talk too.

  •  Wonderful piece TPau! (12+ / 0-)

    Thank you for doing it and allowing us to post it!!

    As always, women and their health care are the ones who are sacrificed, this is such a depressing read:

    Woman’s health care is hit the hardest by this betrayal. Supposedly, one of the hard won benefits of the ACA was the end of “separate but equal” health care for women. Women and men get charged the same or women get charged more for their health care, but cannot find health care that supports contraception and obstetric services. The grandfather clause, Obama’ s cave in to religious groups on birth control and abortion, and now his reversal on scam insurance means women will still face a barrage of insurance that does not cover their medical needs. Women will have to come out of pocket for these needs. That means more nonpayment for these services for doctors and hospitals and more pressure to decrease these services.
    I am just so disgusted by the constant betrayals of us, our human rights and our civil rights! Thank you so much for writing this piece. Have republished to the women's groups that I am a member of on dkos! Welcome back (and as always with a bang!)!!

    "Hegel noticed somewhere that all great world history facts and people so to speak twice occur. He forgot to add: the one time as tragedy, the other time as farce" Karl Marx, The Eighteenth Brumaire of Louis Bonaparte .

    by NY brit expat on Sun Dec 01, 2013 at 03:34:01 PM PST

  •  So many issues here. (12+ / 0-)

    The ACA debate is beyond the scope of my knowledge. Aetna was the gold plated plan when we were over there. It's stunning to see that they are promoting junk insurance, though it makes sense from an anti-capitalist standpoint. Unregulated free markets are a dead-eyed sharks eating anything they comes across.
    I can speak from experience to the software issue, and say that government mandated software tracking is poor in the UK NHS as well as in the States. The abuse of second line health care providers such as nurses and med techs is also similar. While anecdotal evidence leads me to believe that doctors are in a somewhat better financial position, they are equally overworked. The two tier system between older practitioners and younger ones that you have described seems similar as well.

    "The 'Middle' is a crowded place - that is where the effective power is - the extreme right and left might annoy governments, but the middle terrifies them." Johnny Linehan

    by northsylvania on Sun Dec 01, 2013 at 03:44:55 PM PST

  •  This is a rare non partisan analysis of ACA (12+ / 0-)

    More appreciated because of the actual involvement of the writer being a physician.  It is both laudatory of the goals of the law, but detailed in the criticism, such as Electronic Medical Records.  I have attempted such an effort myself, including an article in a national magazine that got little response except for one international researcher on this issue of dementia who agreed with my perspective.

    Sadly, ACA is very much a product of the American Political System, one defined by entrenched power groups.
    So the goal of universal rational healthcare had to be subordinated to political reality, benefiting diverse, often conflicting gourps.  What I find deeply disturbing, is the compromises came in the form of benefits to destructive elements of our society.  One was a sop to those who will suborn fraud in the IRS subsidies by eliminating prosecution for such crimes.

    We must look at what special interestes will benefit from this bill and I'll start with my list--hospitals (capital worth increased),  low ethics physicians who will have a larger pool of patients as I described in my article above-Pharmaceutical companies, who were not put under any mandate to cease charging the American public more than any other country.  

    The large list of new responsibilities in this diary, also represents a greater number of errors that will be made by doctors, along with the increased law suits.  Perfection would be nice, but it's not an option.  We are experiencing a shortage of physicians to treat the increased patients of ACA, and this will be exacerbated by those who will simply leave the profession rather than risk all on the whims of a jury.  The Republican solution of a judgement cap is not the way to go, but a specialized court would be reasonable.

    While the hope was that insurers on the exchange would compete by saving of efficiencies,  in reality they are lowering their prices by limiting hospitals and providers, which will mean longer waits, which could be fatal.  There are no standards on these medical asset availability.

    Optimism is a fine quality, but because those opposed to this who were the other party, any objection was dismissed as not being substantive.  I could support all of these arguments from articles in the very liberal and pro-ACA New York Times, and I have done so on many articles in  own website.

    We are a complex patchwork of counties, states, professions, powerful  interests, social classes and religions   This is exacerbated by unprecedented advances in medical treatments, that also will be costly and of limited  availability initially.  The challenge of universal health care was great, perhaps too great for a single political party to achieve, even with the very best of intentions.

    •  can we have a link to your article? (8+ / 0-)

      I would love to read it and I am certain that I am not the only one here.

      I find the shortage of doctors argument to justify the lack of universal health care an odd one as an understatement; it has rather serious implications that health care and sufficient doctors are available only for those that can actually afford it; good luck if you are not one of these people. Doctors can be trained of course, schools should be free ... but that of course is an additional problem in a country where healthcare for all is simply not seen as a priority of politicians and where the health insurance industry makes so much money as an intermediary where they are really unnecessary and their only purpose is to make a profit. I am lucky to live in Britain and to have access to the NHS; that is why I supported single payer ... but, of course, political expediency and an economic system solely run on the profit motive take priority and that is whose interests the mainstream political parties. Americans deserve better ... every time I  hear that the NHS is socialist I want to bang that person's head into a wall ... it is not, it is common decency that all people have access to health care (and that is a very different thing altogether from health insurance).

      "Hegel noticed somewhere that all great world history facts and people so to speak twice occur. He forgot to add: the one time as tragedy, the other time as farce" Karl Marx, The Eighteenth Brumaire of Louis Bonaparte .

      by NY brit expat on Sun Dec 01, 2013 at 04:06:36 PM PST

      [ Parent ]

    •  My articles on ACA (7+ / 0-)

      This one was in The Humanist:
      Normal Aging or Disease? The Demarcation Fades

      Several essays on ACA on my personal website,
      Introduction

    •  The media has been nothing but propaganda . . . (11+ / 0-)

      on this issue. I am stunned by the insanity over glitches in the website, while the actual meat of the bill is overturned or eaten through with loop holes.

      I did give this very article and more to my local journalist who was doing an article on the ob crisis in the county. Very little ended up in the article.

      When the health care debates were in full swing before Obama was elected, I also did a full analysis of all the purposed plans that was ignored by my local paper.

      I think you may be right, in that some of my criticism is dismissed out of hand, because I am a physician and therefore I must be a Republican and be against universal health care. The fact that I might have something objective to say given my experience is never even considered.

      The Republican solution of a judgement cap is not the way to go, but a specialized court would be reasonable.
      While specialized courts is an option, specialized witnesses might be a less expensive and easier to implement option. Witnesses certified to give a neutral professional opinion who are not paid by either side in a court case.
      While the hope was that insurers on the exchange would compete by saving of efficiencies,  in reality they are lowering their prices by limiting hospitals and providers, which will mean longer waits, which could be fatal.  There are no standards on these medical asset availability.
      I would also point out that the original plan was to include a public option so insurance had to lower their rates to the point of competing with Medicare/Medicaid. That option was immediately removed by the President. Since commercial insurance routinely checks other companies rates, there will be little competition on price without the public option. That was the first concession to the less savory elements in our society that cost all of US citizens.
      The challenge of universal health care was great, perhaps too great for a single political party to achieve, even with the very best of intentions.
      Sadly, you may be right. But I think some of the issue is that we no longer have a two party system. Both major parties are being run by the 1% and that means insurance companies. It was unlikely for either of them to solve the problem under those circumstances.

      Thank you very much for these wonderful and thought provoking comments. I agree with NY Brit. We should like to your article as well.

    •  As far as those specialized courts are concerned (3+ / 0-)
      Recommended by:
      Lencialoo, arodb, JayRaye

      perhaps what is really needed is for courts (specialized or otherwise) to be able to impose penalties other than monetary ones for sufficiently bad cases.  For example, a doctor who leaves a patient on the operating table in the middle of surgery because he wants to go cash his paycheck knowing that "so what if he/she dies, the worst that can happen is that my malpractice insurance will go up and the hospital pays for most of that anyway".

      You have watched Faux News, now lose 2d10 SAN.

      by Throw The Bums Out on Sun Dec 01, 2013 at 11:01:32 PM PST

      [ Parent ]

  •  Well, great diary, one of the best in a while (5+ / 0-)

    But never mind that now. Let's all do this again in 2016. I'm sure H. Clinton, or Mr. Biden, or some other "most promising candidate of our lifetime" will fix all this.

    Count on it! GOTV!

    "In times of universal deceit, telling the truth will be a revolutionary act." -George Orwell

    by ZhenRen on Sun Dec 01, 2013 at 04:33:27 PM PST

  •  Welcome back TP! That's what happens when you (5+ / 0-)

    let the fox (insurance companies) back into the henhouse (us chickens) instead of holding out for Single Payer.  I know there are several countries in Europe that have a combination of a public and private plan (Germany, Switzerland, Netherlands?) but somehow they have a very strong regulatory systems which compensate for some of the problem, but it certainly is much harder to reign in abuses than the single payer plan.

    One point you made confused me -- that Catholic hospitals don't do sterilizations.  Way back when (1970s) when I was young and worried about faulty birth control,   Many young women many of my Latina friends who came from Latin American countries (and Puerto Rico) told me that young women in those countries could get sterilizations but not abortions because the Catholic church considered abortions murder but not sterilizations. So many  young women got sterilized it just became known as La Operacion.  What are the distinctions on this issue? Has it changed over time or what am I missing?

    •  Good to see you again! . . . (10+ / 0-)

      In many Latin American countries and in Europe, it is the state that owns the hospitals. They have truly socialized medicine. The voters indirectly decide what will and will not be covered. Even though most of the population is Catholic, apparently birth control has enough support to get coverage. It is not surprising abortion does not have enough support.

      In the case of the US, hospitals are owned by private entities except for public health and military hospitals which are owned by the federal government. In Humboldt's case, three of four hospitals were bought by the Catholic church. One of the hospitals was closed. The other two hospitals were allowed to do sterilization for the health benefits of the mother until a little over a year ago. Then the Catholic hierarchy decided that no woman would get a sterilization within a Catholic hospital anywhere in California. This was a unilateral decision. For our remote area, where people have little choice about where to go, that is an issue.

      Since the hospitals are privately owned, they can choose which services to offer. If they were owned by the State or the Federal government, they would have more of an obligation to meet the needs and wants of the public they serve.

      •  Thanks for the info, dep[ressing as it is. Hope (6+ / 0-)

        you will continue to write for us. We miss you. Also, I'm doing an article on the bankruptcy proceedings of Fagor (the largest of the Mondragon coops and why it happened and what it means for our organizing for coops in the future).  it will be on January 54th and would love your input.  

      •  Great diary TPau... (2+ / 0-)
        Recommended by:
        wintergreen8694, JayRaye

        Thank you for your work on this. Sorry to hear about your decision to move from a place you obviously love.

        I work for a Catholic Health System as a float pool RN in a metro/suburban area but your diary gave me insight into some of the decisions I have been seeing here.

        As far as the taboo on sterilization in catholic hospitals I can attest to that fact (coming from a large but non-catholic family I have never agreed with their practices surrounding it). One interesting fact, in one new hospital they added a satellite building with a covered walkway to the hospital complex....from all appearances it looks part of the hospital....however, I was told the walkway has a gap (1-2in) covered by a strip of rubber....the hospital can now schedule sterilizations at the satellite while a Mom is in the hospital.  I guess they found a way to serve the patients & profit while still upholding the tenets of the faith.

        Also, I agree with you on the EMR problems, the software is clunky, expensive and takes time away from patient care even for nurses, many of the older nurses (I'm one, only my prior employment was with a computer company so that helps) absolutely hate it. But, it may in fact be better for statistical information & I have to say for nurses it makes reading a Doctor orders sooooo much easier.  :-)

        Take care, hoping your move goes well!

        Confucius say: "Man who want pretty nurse, must be patient."

        by Lencialoo on Mon Dec 02, 2013 at 07:25:22 AM PST

        [ Parent ]

      •  Years ago, I remember my mother on the (0+ / 0-)

        phone talking with her friends about hysterectomies, and which doctors would do them as a 'medically necessary' for Catholic women who had decided they didn't want any more children.    

        Most of the doctors in our small town were Catholic at the time, but just about all the Catholic women had "complete' hysterectomies by the time they were 40.  

        Sad and drastic, but effective.  

  •  EMR suffers from the Shiny Gadget sounds like (4+ / 0-)

    I used to be a director of technology for secondary schools, and the amount of outright crap peddled to schools is astounding. I went to one school where they were paying $10,000/year to stay "enrolled" in a back-end that was dBase III for DOS. They had to have "special updates" for it (batch files to get it to run on Windows). Blackboard, which is an enormously popular system, offered a service that could have been duplicated by anyone with a simple intranet in the early days, and it could be ours for the low, low, low cost of $15,000/year.

    When, on the other hand, I would ask for releases to actually design an intranet space, that wasn't possible. I.e. the shiny package from the people with brochures and business degrees was obviously worth it because it cost so much, and it had a cool name.

    I've seen some of the price gouging for EMR, and the amount of ripping off is astounding. The difference, of course, is that government adds that special layer of "licensed to be TP9000Q12 compliant," which means that someone else got a pocket lined first.

    I do suspect, though, that your story really shows a particular nexus along which rural populations are starved of health care, between the tax-starved state, the rapacious market, and the religious providers who are seeking to enforce social policy by force.

    Everyone's innocent of some crime.

    by The Geogre on Mon Dec 02, 2013 at 03:58:34 AM PST

    •  The new software is sickening (0+ / 0-)

      The coding changes mandated for diagnosis codes in 2014 have given the EMR companies an excuse to release shiny new versions of their software, plus all kinds of "nifty" new things like an extra service (for more money, of course) that lets doctors access all of the info on their cell phones or tablets outside of work. Because we all know doctors aren't allowed to have a life outside of work:

      Is fheàrr fheuchainn na bhith san dùil

      by bull8807 on Tue Dec 03, 2013 at 10:11:46 AM PST

      [ Parent ]

  •  Lots to explore in EMR. (2+ / 0-)
    Recommended by:
    NY brit expat, Lencialoo

    I don't have nearly enough time to write what I want on this, but I couldn't let this pass uncommented.

    If EMR does not make health care cheaper or more safe, one might wonder why the government was so hot to trot to convert all the US to these untried software programs.
    EMR in theory has great promise.  One should always question why that promise is not being realized.

    Personally, I do not track my own medical records. They are scattered in multiple states with whichever doctor I saw at the time, several of whom I cannot name.  I have no idea what drugs I was ever prescribed, and only mostly remember the year of certain treatments.

    EMR, either in a Big Brother mode or in a "here's a copy for you to keep" mode, could completely eliminate intake questionnaires, or at least significantly reduce the ambiguity.

    We need to figure out where we can properly provide value.

    -7.75 -4.67

    "Freedom's just another word for nothing left to lose."

    There are no Christians in foxholes.

    by Odysseus on Mon Dec 02, 2013 at 06:37:19 AM PST

  •  tracing money (0+ / 0-)

    there is still the paradox of where all of this money is going. People are paying 15% of the economy for medical care (or so), but Humboldt county has only two obstetricians. There are many other things that pay a lot less for per year, where I bet hundreds in the county are employed - for example 7-eleven clerks, artists, yoga studios. How does the payment for the hospital parcel out?

  •  As long as (0+ / 0-)

    as long as "For profit" insurance is part of the solution, we will never truly have a working healthcare reform.

    Medical health/Illness is one area I personally view as areas, they need to regulate heavily, so that NO one can profit off other's misery. So that way those in this field are there for the purpose of helping people.

    I mean making them take a wage that, matching the service rendered.  and the price of the service is not based on the so called quality of life improvement it currently is.

    Our health system is suppose to be part of the "social responsibility safety net" we have towards all of us.

    I also view for profit insurance as a "ME OR YOU" (I win you lose) business model

    people can prosper with a non profit insurance because the gain is based on effort put in 1:1 ratio for service rendered.

    Old saying to minimize abuse is "keep it simple stupid"

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