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Re: Medicare's Coverage for Bad Debt

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Message 1 of 27

I'm glad you made a new post of this.  I'll follow up with the font and color bit for clarity.

@GailL1 wrote:

@umbarch64

Actually, it sounds like we might agree on some points.

 

I never doubted that at some point, we might just do that.

 

 - Adequate healthcare to be determined by professioinals - I'll add value-based to this, as well as scientifically proven - value based best practices.

 

Let's assume to begin with that any professional selected would have to have the credentials necessary to do just that AND to operate without oversight from someone outside the profession.  Without those, that person should not be put in that position.  Your point is well taken, but hopefully, that sort of thing would not be an issue...it adds to the overhead and is highly ineffective.

 

I guess I don't see the difference in having or not having the profit motive if we have already worked out specific adequate healthcare - seems the profit motive would have to be concentrated on other stuff outside of the realm of what's covered in the adequate healthcare - a something added type profit.

 

Profit, in and of itself, is not a bad thing.  It makes an economic system like capitalism function.  The problem arises when the profit is derived without the service that generates it contributing to the progress toward a goal.  Then it's counterproductive.  We  have too many of those built into our system, some through redundancy, some simply because, as the bumper sticker says, "_ _ _ _ happens".  That's not a 'deal breaker', though.  Candor and shared dedication to a common goal will indeed, "fix it all".  Trouble is....everyone involved has to have them.  Can't be done?  Yes, it can.

 

It seems many people think today that a government ran plan could compete with private insurers and for the betterment of the whole system.

What about the other way around - private insurers competing with a government ran plan - kind of like the way Medicare Advantage plans work.

 

Well, I like the second option better because it sets an absolute base or minimum to what is required....sort of like a minimum performance contract does.  You can come in with something that is equal to or better than what is specified.  To do that the Government plan must include allowances for industry profit, overhead and amortization of investments made.  That's possible and not at all a bad.  Of those items only profit is not essential to the longevity of what the Government provides and since there needs to be some sort of contingency fund, let's say that is a fair allowance for profit....just as is made for government procurance items....and the Government keeps that in a dedicated reserve.  I proposed such a system in detail long before the advent of the ACA.  It went nowhere then, but perhaps now it would have legs.

 

I do not think that under our current form of government and our current population that even defining a value-based best practices health care plan ran by some nonprofit entity would ever get passed.  I believe that everybody wants what they want when they want it and even proving to them that it is not good value based best practices is not gonna make them see things any differently.

 

Sure.  Everybody wants something for nothing.  That's not possible...they can't have it.

That does seem to be a wide-spead attitude with humans.  I think it's called greed.  EVERYTHING has to be paid for somehow by someone, sometime and somewhere.  Thing is, everybody wants the benefits of the society they live in, but nobody wants to own up to how much they owe for what they get, let alone pay their fair share.  I haven't got a good solution for that...it starts with being rational....and that's not popular most of the time, especially lately.

 

I could give you lots of examples but I bet you know some too.

 

Yeah, I suppose you could. So could I.   So it's better neither of us waste our time on detail that doesn't matter and thereby waste the time of the good folks reading this.  It is going on for a long time as forum topics go.

 

 No unwashed intended, remember this is about Medicare, not Medicaid - I am talking about everybody who fits the definition of deadbeats - those who are or have been measured as financially or intellectually able but renign on their responsibilities - in this case a monetary one creating an unnessary cost shift - doesn't involve care, only money.

 

Accepted that the issue on which we agree here are true dead-beats and angle-workers, no matter who or what they are.  IF we do, they I will suggest to you that on the issue of health care, you cannot separate out any component for attention as you have.  Nor do you need to if the approach to the solution is comprehensive....as it must be to be effective.  In my view adequate and effective health care is an essential part of contemporary existence.  Without it you die prematurely, with needless pain and discomfort.  There are no ifs ands or buts about that.  A person cannot really search for competitive alternatives that better suit their budget nor can they refuse to obtain it without unwarranted consequences neither you not I would find acceptable. So do me a favor and don't go there. 

 

 


 

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Re: Medicare's Coverage for Bad Debt

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@GailL1 wrote:

@rker321 wrote:



Gail  I am so glad that you are speaking about  costs involved in  an Medicare Advantage plan, and now what did we get?  That medical  cost deductions will not longer be available in 2019 unless they decide that they don't  want to  deal with that any longer.


I just shake my head sometimes at you - I thought you had an accountant to explain this to you.

YOU ARE WROMG

 

This is the way it goes -

A deduction is allowed for the expenses paid during the tax year for the medical care of the taxpayer, the taxpayer’s spouse, and the taxpayer’s dependents to the extent the expenses exceed a threshold amount.

That did NOT change -

OLD Law thru 12/31/2017:  To be deductible, the expenses may not be reimbursed by insurance or otherwise. If the medical expenses are reimbursed, then they must be reduced by the reimbursement before the threshold is applied. Under pre-Act law, the threshold was generally 10% of AGI.

The threshold rose to 10% of AGI from 7.5% of AGI for those over 65 at the beginning of 2017 - everybody else's changed to 10% of AGI a year or two back.

The New Law effective January 01, 2018 modified the Medical and Dental Deduction to this:
New law. For tax years beginning after Dec. 31, 2016 and ending before Jan. 1, 2019, the threshhold on medical expense deductions is reduced to 7.5% for all taxpayers. (Code Sec. 213(f), as amended by Act Sec. 11027(a))

Beginning in 2019 - the ONLY change is that the threshold amount reverts back to what it was - 10% of AGI.

 

Comprendo ?????

 

By the way Gail  is COMPRENDE.      lol


 

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Re: Medicare's Coverage for Bad Debt

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Gail wrote:  Do you think health care cost here can be any lower than the Medicare approved rate now?

 

Yes and it can still remain profitable for healthcare providers once we change our healthcare system of private for profit insurers to a system of Medicare for all.

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Re: Medicare's Coverage for Bad Debt

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Message 4 of 27

@rker321 wrote:



Gail  I am so glad that you are speaking about  costs involved in  an Medicare Advantage plan, and now what did we get?  That medical  cost deductions will not longer be available in 2019 unless they decide that they don't  want to  deal with that any longer.


I just shake my head sometimes at you - I thought you had an accountant to explain this to you.

YOU ARE WROMG

 

This is the way it goes -

A deduction is allowed for the expenses paid during the tax year for the medical care of the taxpayer, the taxpayer’s spouse, and the taxpayer’s dependents to the extent the expenses exceed a threshold amount.

That did NOT change -

OLD Law thru 12/31/2017:  To be deductible, the expenses may not be reimbursed by insurance or otherwise. If the medical expenses are reimbursed, then they must be reduced by the reimbursement before the threshold is applied. Under pre-Act law, the threshold was generally 10% of AGI.

The threshold rose to 10% of AGI from 7.5% of AGI for those over 65 at the beginning of 2017 - everybody else's changed to 10% of AGI a year or two back.

The New Law effective January 01, 2018 modified the Medical and Dental Deduction to this:
New law. For tax years beginning after Dec. 31, 2016 and ending before Jan. 1, 2019, the threshhold on medical expense deductions is reduced to 7.5% for all taxpayers. (Code Sec. 213(f), as amended by Act Sec. 11027(a))

Beginning in 2019 - the ONLY change is that the threshold amount reverts back to what it was - 10% of AGI.

 

Comprendo ?????

* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Medicare's Coverage for Bad Debt

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Message 5 of 27

@GailL1 wrote:

@MIseker wrote:

@GailL1 wrote:

@MIseker wrote:
Around here ( tri ounty area) if you have an outstanding bill they wont treat you. the system in my county makes people with no cash sign up for a credit card on the spot..like in the lobby of the ER.

I am my brothers keeper.

You mean if a person has Medicare they make them pay (whatever) as their part of the out of pocket?

Remember with these folks, they have Medicare and Medicare will pay the Medicare part of the charges.

I don't think they would be turning people away that have Medicare as their primary insurance?

Am I wrong?


Yes you are for my locale. MediCAID requires a co pay. and they will not treat if you owe say, around a hundred bucks. Doctors just say no. so its back to emergency room treatment, and signing up for that instant approval credit card. My son is on disability for Ankylosing Spondylitis...cant be reliable enough for gainful empolyment. he does work when he can, and is off and on mediCAID, or at the least his co pay changes, often leaving him not paying enough at copay time. DOctors dont send out a monthly bill in our healthcare system.. they wait and turn it to a collection agency and cut you off. MY DOCTOR  did it..and i had no clue i had a bill. I told the bill collector to go pound sand, called the doc and paid by phone. Its a pretty good health system..it was ranked #15 2 years back. but, their billing  is trash. for at least 40 years i have had trouble with them off and on.

 


I am not talking about MEDICAID - This is about MEDICARE - NOT dual eligibles, NOT Medicaid, NOT ESRD beneficiaries - just regular Medicare beneficiaries with original coverage - heck some of them might even be high income beneficiaries - the "who" has not paid after collection efforts is not revealed.

 

Original Medicare Beneficiaries who don't pay this:

 

OUR CURRENT SINGLE PAYER ORIGINAL MEDICARE SYSTEM:

Original Medicare -Cost at a Glance

2018 Part A hospital inpatient deductible and coinsurance

You pay: 

  • $1,340 deductible for each benefit period
  • Days 1-60: $0 coinsurance for each benefit period
  • Days 61-90: $335 coinsurance per day of each benefit period
  • Days 91 and beyond: $670 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime)
  • Beyond lifetime reserve days: all costs (all costs in 2018)

Part B deductible and coinsurance

 


Gail  I am so glad that you are speaking about  costs involved in  an Medicare Advantage plan, and now what did we get?  That medical  cost deductions will not longer be available in 2019 unless they decide that they don't  want to  deal with that any longer.
So, when I was screaming about my medical deduction there is no doubt that I pay my bills and that I also want to be able to deduct those expenses. just like any corporation.
So,  let's be clear about all of this. no one should take advantage of any Health Care system and only a health care system that covers all citizens is the one that we need in this country.

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Re: Medicare's Coverage for Bad Debt

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Message 6 of 27

@umbarch64

Actually, it sounds like we might agree on some points.

 - Adequate healthcare to be determined by professioinals - I'll add value-based to this, as well as scientifically proven - value based best practices.

 

I guess I don't see the difference in having or not having the profit motive if we have already worked out specific adequate healthcare - seems the profit motive would have to be concentrated on other stuff outside of the realm of what's covered in the adequate healthcare - a something added type profit. 

 

It seems many people think today that a government ran plan could compete with private insurers and for the betterment of the whole system.

What about the other way around - private insurers competing with a government ran plan - kind of like the way Medicare Advantage plans work.

 

I do not think that under our current form of government and our current population that even defining a value-based best practices health care plan ran by some nonprofit entity would ever get passed.  I believe that everybody wants what they want when they want it and even proving to them that it is not good value based best practices is not gonna make them see things any differently.

I could give you lots of examples but I bet you know some too.

 

No unwashed intended, remember this is about Medicare, not Medicaid - I am talking about everybody who fits the definition of deadbeats - those who are or have been measured as financially or intellectually able but renign on their responsibilities - in this case a monetary one creating an unnessary cost shift - doesn't involve care, only money..

* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Medicare's Coverage for Bad Debt

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Message 7 of 27

@GailL1 wrote:

@umbarch64 wrote:

 The so-called 'compassionate conservative' has used the 'dead-beat' ploy for a long time now without really trying to come up with an effective way to separate that 'dead-beat' from the truly unfortunate...particularly in the health care system.  That tactic inevitablly causes that truly unfortunate soul real and consequential pain.

 

It is way past time to solve this problem by making adequate and effective health care available to all citizens of this country.  I've lost patience with the self-serving nay-sayers using complexity to grind a political axe and enable fraud in the process.  We, as citizens of this nation, and partcipants in the society that is the very reason for its existence, pay for all of it in the end...even to keep the guys in the slammer alive while they pay for the fraud that put them there. 

 

So...let's do it in the most effective, economic way possible.  Saying we don't know how to do that or that it can't be done or throwing up the "yeah, well what about......" is pure BULL in service to a political agenda crafted to get out of paying a fair share of its cost.  Drop the charade..it really is getting stale.    

 

 


This is how it has been done since the beginning of Medicare - they have tweeked this, then they have tweeked that just to save a buck.  We have whole government agencies working non-stop trying to discover new ways to cut cost.  MEDPAC comes to mind.

 

What part of "I couldn't care less" don't you understand?  Facile excuses go nowhere.

That kind of scatter-shot approach doesn't work and never has. It only increases costs at what approaches a geometric rate.   have said so ad nauseum right here on this forum

 

You are right we do not have a sound health care system but it is not just private insurers or providers causing all the problems. It is government itself.

 

Yes indeed, government is complicit.  And you are part of the reason why.  The infrastructure needed to support all the multiplicity of function and needless bureaucratic complexity serves the bottom line of the people resisting simplification.  That's true and you know it. 

 

Government exists to serve the public welfare.  Says so in our Constitution.  The entire Health Care System should do the same.  Extraneous profiteers have no place in it.  Now...however you want to slice it that means placing both Systems into a non-profit category and simplifying in the extreme. 

 

There really is no excuse for advocating otherwise because, as you said, we want what we want when we want it.  That being so, figure out how to pay the least you need to.  As I said, we [all of us] pay the entire bill anyway in some manner.  The costs are NOT picked up by any of the other players in the game. They only pass it through, add another line into the ledger and inflate the bottom line. What those folks don't like is any sort of reduction in profit margin.  You OK with that way of saying it?  Now, the way it is, there are way, way too many players in this game...all taking a rake-off from your bank-account.  Adequate health care costs what it costs no matter the system.  Are you suggesting we should do away with it for economic reasons?

 

This Medicare Bad Debt thing came about in the 70's when hospitals complained that their Medicare beneficiaries weren't paying their share of the cost.  So instead of doing something like going after the Medicare debtors, Medicare began paying this Bad Debt after collections by the hospital proved futile. At that time, Medicare paid 100% of the amount of the Bad Debt - thru the years it has been reduced - now it is down to 65%.

At times they fooled around with doing different % for different sectors - then it all got down to 65% of the Bad Debt.

 

All irrelevant.  I take it you feel that is a reason for something or other....or not.   I'm not sure what that might be.  Obfuscation would be my best guess.  That's past history, not something we should even contemplate as an excuse to do nothing.  Get past stuff like that, recognize both reality and the problems it poses.  Then get on with life.  At least the part you have left.

 

President Obama in his 2013 budget proposal wanted it to go to 25% - but that went no where then.

 

OK  So What?  There was a reason for that and the voting records in Congress at that time clearly indicate what they were. IF you voted for a Republican congress-critter, you were part of the reason.  So, beyond further obfuscation, what's your point?

 

Personally, if you want the most effective, economical way possible for health care - somebody is gonna go away mad.  Patients - Hospitals - Providers - cause we aren't gonna please everybody.

 

Yeah....that could well be.  So what?  That is why I have proposed what I proposed the way I proposed it.  The profit motive has to be removed from this equation. 

 

It is the cost that it has gotten to and the money to pay for it - public or private systems - doesn't matter.  Seems we need to make some rules on both side of the fence - those that are providing the (whatever) medical and those receiving it.  It has to be: 

the best care that we can afford - that's different from the best care we can give -

the best care for the health related circumstances - that may mean we re-evaluate some care that is now given because it may not be the best value.

 

If you've read what I've proposed without blinders, you will see there are no sides here.  I've proposed putting the matter of what is or is not adequate health care into the hands of the professionals we can trust to objectively approach the issue.  That ain't all of them, for sure.  You equivocate once more...to no worthwhile purpose.  Now...to make myself perfectly clear, bean-counters are invited to take a hike in that regard.

 

Now who is gonna tell all the doctors, hospitals, skilled nursing facilities, labs, dialysis clinics, etc. that they have to all abide by the rate of pay we are gonna be setting for them.

Who is gonna tell the patients.

 

Why....you are.  You are part of the voting public are you not?  It is up to you to decide which congress-critter does that job for you since you lack the qualifications to do it.

That's the way our government works....right?

 

Yea, right !

 

Well, OK then.  Belly up to the bar and toss one down.

 

We want what we want when we want it - who cares who pays.

 

I presume you mean the great unwashed when you say that..  I'd like for you to broaden your scope just a bit to include all of those who really are 'dead-beats' and don't meet their obligations.  Fair?

 

 

 

 

 

 


 

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Re: Medicare's Coverage for Bad Debt

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Message 8 of 27

@GailL1 wrote:

@MIseker wrote:

@GailL1 wrote:

@MIseker wrote:
Around here ( tri ounty area) if you have an outstanding bill they wont treat you. the system in my county makes people with no cash sign up for a credit card on the spot..like in the lobby of the ER.

I am my brothers keeper.

You mean if a person has Medicare they make them pay (whatever) as their part of the out of pocket?

Remember with these folks, they have Medicare and Medicare will pay the Medicare part of the charges.

I don't think they would be turning people away that have Medicare as their primary insurance?

Am I wrong?


Yes you are for my locale. MediCAID requires a co pay. and they will not treat if you owe say, around a hundred bucks. Doctors just say no. so its back to emergency room treatment, and signing up for that instant approval credit card. My son is on disability for Ankylosing Spondylitis...cant be reliable enough for gainful empolyment. he does work when he can, and is off and on mediCAID, or at the least his co pay changes, often leaving him not paying enough at copay time. DOctors dont send out a monthly bill in our healthcare system.. they wait and turn it to a collection agency and cut you off. MY DOCTOR  did it..and i had no clue i had a bill. I told the bill collector to go pound sand, called the doc and paid by phone. Its a pretty good health system..it was ranked #15 2 years back. but, their billing  is trash. for at least 40 years i have had trouble with them off and on.

 


I am not talking about MEDICAID - This is about MEDICARE - NOT dual eligibles, NOT Medicaid, NOT ESRD beneficiaries - just regular Medicare beneficiaries with original coverage - heck some of them might even be high income beneficiaries - the "who" has not paid after collection efforts is not revealed.

 

Original Medicare Beneficiaries who don't pay this:

 

OUR CURRENT SINGLE PAYER ORIGINAL MEDICARE SYSTEM:

Original Medicare -Cost at a Glance

2018 Part A hospital inpatient deductible and coinsurance

You pay: 

  • $1,340 deductible for each benefit period
  • Days 1-60: $0 coinsurance for each benefit period
  • Days 61-90: $335 coinsurance per day of each benefit period
  • Days 91 and beyond: $670 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime)
  • Beyond lifetime reserve days: all costs (all costs in 2018)

Part B deductible and coinsurance

 Gail, my son is on MEDICARE AND MEDICAID. Lets say his co pay is 20$. then they raise it to 100, and he doesnt get notification for 2 weeks. Now he is paying 20 for 2 weeks, and starts racking up a bill. under the poor accounting system here, this will go back and forth until he owe the docs 100$.. with noting said until..we cant see you. Its happened to me like i said. One time this system applied my insurance payment ( thousands) to another patients bill and told me I had to fix it. I did fix it, by sending a bill to the accounting dept for my time, with a letter refusing to pay the bill, and notifying i would charge them 75 an hour to straighten it out. yes their billing is that bad. they fixed it.  Another time, i had gotten laid off from a major factory along with many others, but we still had insurance for a while. I had an ER visit for my back going out..no clinics here yet. FIVE YEARS LATER i get a call from a collection agency.. a nasty one too. i called the agency back and told them i was reporting them, because i had NO CLUE what they were talking about. he manager was nice, and come to find out..the system NEVER BILLED anyone from that employer and turned it over after 5 years. i said hy man, i was insured for 2 years and any notice would have paid it. The collection agency dropped EVERYONES account from that workplace. SO yeah..i doubt im the only one this happens to.


So it begins.
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Re: Medicare's Coverage for Bad Debt

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Message 9 of 27

GOP and their water carriers are demanding Genocide - because debt reduction is always more important than humanity.    (also not that the CBO info does not match the author's opinion weaved into the thread).

PRO-LIFE is Affordable Healthcare for ALL .
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Message 10 of 27

@ReTiReD51 wrote:

@GailL1 

I disagree Medicare has some strict guidelines these hospitals are required to follow before Medicare will agree to pay that 65%, and I think soon to be 25% according to your links of a person’s deductible. I mean they have to go beyond the norm of reminders, dunning letters, collection agencies and threats to try and collect these deductibles so these people have to be indigent or not have a pot to p-ss in as they say on these boards.

 

We’ve been kicking healthcare costs down the road since Hillary forewarned us in 1992 that we had better do something soon or else we’ll be in the pickle we are today. No one listened.

 

Single-payer lowers the cost of healthcare as we see from your chart. Less administrative fees, better efficiency.

 

Like Bernie says “Medicare for All: Leaving No One Behind”

https://berniesanders.com/issues/medicare-for-all/


You are right that there are lots of hoops for the provider to jump through before 65% of these bad debts are covered but if the people are indigent then they would already be a dual eligible on Medicare/Medicaid and thus the amount would be minimal.  There are certain out of pockets which a dual eligible person would have to cover perhaps based on the state rules but these are minimal so even if they had to cover them, it certainly would not be 30 billion over 10 years.

 

Do you think health care cost here can be any lower than the Medicare approved rate now?  I think about what would have to be covered for all people - like I asked previously - what would be the cost of a pediatric surgeon, his staff, and facility to perform heart surgery to save the life of a child not yet born?  Or a preemie that has to stay in neonatal ICU for months and months and then possibly continuing care for their life.  These are high cost things that are not now really thought about in our current Medicare approved charges and there are many, many of those and not just for kids.

 

There is a lot of differences in those other countries and us than just administrative overhead.  Those other countries also do other things to lower their cost as I have pointed out in many other threads on the subject.  Are we ready to tackle those too?  Global budgets, value-based medicine and care, a negotiated (limited) national formulary, to name a few.  If we can't even come up with a way to make people pay their part of our already in place Medicare single payer system, how do you think we could ever get tough on some of these other areas.

 

Are we ready to put a price on quality of life rather than just existing in extreme cases - pulling the plug, so to speak?  Somebody is probably gonna have to describe "living" in a national single payer health care plan.  We seem to have decided that at the beginning of life, now we need to decide it at the other end.

 

Medical ethics decisions will have to be fought out but maybe there will be a positive side to all of this - maybe they will let me decide in advance when I want my life to end - saving time and money.

 

How much do you think it cost to keep a person on life support when they have been declared brain dead but whomever has the decision to make just wants to wait for a miracle.  How long?  How much?

When you get down to an entire country of 300 + million people, and the cost associated with all extremes of health care - how much of it is gonna be left up to the individual to decide and how much of it is gonna be decided by society based on finances and the value of (whatever) care?

* * * * It's Always Something . . . Roseanne Roseannadanna
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