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  1. #1
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    ARPs Healthcare Reform

    ...This thread is an attempt to prevent the rash of healthcare discussion in other threads. Carry over from Civility thread...

    What is the mission statement of ARPs Healthcare Reform? Funny name, but I'm being serious. High quality accessible healthcare for all? Less money in politicians pockets, more in ours? Freedom to choose? Safety net for the elderly and people in need?

    The deregulation of insurance was brought up. Let's call it Step 1 in the ARPHR?

    Why was insurance regulated in the first place? What problems were trying to be solved with regulation? How can we ensure we don't end up at the same place we are now in another 50 years?

    We have a starting point, the system sucks. We have options to fix it. But there is alot of detail in the middle I'm trying to work through.

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    The subject of regulations is so complex. Novels could be written on the subject. It's extremely intricate and pervasive.

    Here is just a couple examples in a well written piece. Some of the laws/regs passed were done for good intent, but many were done by lobbyists and activist groups who knew what they were doing. And willing politicians gleefully joined in. The piece talked about the beginnings of MCOs and how they showed some success. But then the lobbyists moved in. Forcing laws through many of them to enrich providers and insurance premiums. This is only one example of thousands where government weakness and corruption let these groups control the healthcare system to their mutual benefit.

    Many left leaning(and many right leaning) are very sensitive to backroom deals between bankers, Wall St and financial institutions. But they are blind to the backroom deals between healthcare players and politicians. Makes no sense to me. Both types of shady backroom deals cost them their money. Why don't they care about the progressives politicians and the large healthcare power players and their lobbyists. It's irrational the way they stick up for them.

    https://www.nationalaffairs.com/publications/detail/the-perils-of-health-care-federalism

    "As with any purchaser, the ability of MCOs to demand good prices from physicians and hospitals depends upon their ability to threaten to walk away from a deal. Health plans have traditionally struck bargains by limiting membership in their networks to providers who agree to meet cost targets. But state legislation since the late 1990s has frequently undermined this bargaining leverage. "Any willing provider" laws in 22 states require health plans to reimburse equally all providers that comply with pre-set terms and conditions. These prevent managed-care insurers from driving hard price bargains with providers. Similarly, "freedom of choice" laws in 23 states limit the ability of MCOs to channel patients toward in-network physicians and hospitals that provide services at lower cost.

    In addition to imposing such restrictions on "selective contracting," state laws also undermine utilization-management systems  with 30 states imposing bans on financial incentives for physicians to constrain the provision of costly health services and 47 states prohibiting MCOs from restricting physicians' recommendation of high-cost treatment options. Gatekeeping rules that require patients to obtain referrals from primary-care physicians before they are allowed to claim reimbursements for visits to costly specialists have similarly been targeted by state legislatures across the country.

    Following this legislative backlash against managed care  which saw more than 1,000 bills sponsored and 56 laws passed in 1996 alone  health-care spending began to rise again, at an annual rate of 8% to 10%. A study by economist Michael Vita in 2001 found that health-insurance costs fell as managed care became more prevalent but increased precisely where selective-contracting laws were created; spending levels then rose significantly as laws constraining utilization management were tightened. More recently, research by Maxim Pinkovskiy examining variations in these anti-managed-care laws found that the regulatory backlash explained much of the disproportionate growth in U.S. health-care spending between 1993 and 2005.

    Health-care providers have also sought to guarantee themselves higher incomes by pushing state legislation to mandate that coverage of a variety of non-essential treatments be incorporated into health insurance. No advertising campaign is as effective at generating revenue as a lobbying campaign to get states to mandate the purchase of one's products. As a result of such campaigns, more than 40 states prohibited the selling of health insurance that does not pay for services like visits to chiropractors or psychologists. Fifteen states require all insurance policies to cover in-vitro fertilization treatments, which can cost from $50,000 to $200,000. Several states even require catastrophic insurance plans, meant to cover basic medical needs, to also pay for the purchase of cosmetic items such as hair transplants and acupuncture.

    When such mandates are in place, price considerations are generally left out of purchasing decisions. It ought to be no surprise that spending soars when costs are deliberately hidden, and the spending increases caused by these state mandates are not trivial. Gail Jensen and Michael Morrisey have estimated that chemical-dependency treatment coverage increases health-insurance premiums by 9% on average; psychiatric-hospital-stay mandates increase premiums by 13%; and psychologist-visit mandates increase premium costs by 12%.

    Instead of openly appropriating and honestly budgeting to subsidize mental-health care, for instance, states (and, more recently, the federal government) have mandated that it be packaged into the cost of purchasing health insurance. But these requirements  ostensibly meant to expand health benefits  may, perversely, be limiting access to health care. Frank Sloan and Christopher Conover have estimated that a fifth of those Americans without health-care coverage would purchase insurance were it not for the premium-price inflation caused by such laws.

    Attempts to directly remedy the problem of the uninsured by adding even more regulations have been similarly counterproductive. Even before the passage of the Affordable Care Act, "guaranteed issue" regulations in 19 states required insurers to sell coverage to all comers, while "rating" requirements in 48 states limited to varying extents the prices at which they could do so. Such laws frequently obligate insurers to cover patients at prices substantially lower than the expected costs of treating them.

    By preventing insurers from charging actuarially fair premiums for health coverage, rating regulations have tended to impose massive spikes in insurance prices on low-risk individuals. When New York state enacted community-rating requirements, premiums for men under the age of 30 soared by 170%. Controlling for the terms of health insurance, a 2008 study by Amanda Kowalski, William Congdon, and Mark Showalter found the combination of guaranteed-issue and community-rating regulations to increase premiums in New Jersey by 108% to 227% for individual and family policies."

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    Every time I try to stay out of the health care discussion I hear stuff that I just completely disagree with so I just have to jump in. I can't argue that government intervention into the health care industry has caused both healthcare costs & insurance premiums costs to increase, but I can argue that there was a need for the intervention. When we have millions of people in this country that do not get health care treatment only because of the costs involved then we have a serious problem. A lot of those people might even have health insurance but still don't get treatment because of the out of pocket costs. We have doctors & hospitals that actually get money up front before they'll do procedures that are not considered emergencies. They even check your insurance policy & find out how much you have left unpaid on your deductible & out of pocket costs to come up with the figures they want you to pay. Also allowing insurance to cross state lines is not going to help the problem at all & could even make things worse for a lot of people. The HSA account is another myth that will only help a small section of the population. Too many people are not going to put any money into an HSA no different than the number of people that don't put any money into savings. If saving money on our tax bill could solve the problem then why not just make anything we spend on healthcare tax deductible to begin with. We can argue about how we got here but no matter what we do, this is where we have to start from & the greed & insensitivity of the market is not going to go away.
    Gary
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    Quote Originally Posted by garyed View Post
    Every time I try to stay out of the health care discussion I hear stuff that I just completely disagree with so I just have to jump in. I can't argue that government intervention into the health care industry has caused both healthcare costs & insurance premiums costs to increase, but I can argue that there was a need for the intervention. When we have millions of people in this country that do not get health care treatment only because of the costs involved then we have a serious problem. A lot of those people might even have health insurance but still don't get treatment because of the out of pocket costs. We have doctors & hospitals that actually get money up front before they'll do procedures that are not considered emergencies. They even check your insurance policy & find out how much you have left unpaid on your deductible & out of pocket costs to come up with the figures they want you to pay. Also allowing insurance to cross state lines is not going to help the problem at all & could even make things worse for a lot of people. The HSA account is another myth that will only help a small section of the population. Too many people are not going to put any money into an HSA no different than the number of people that don't put any money into savings. If saving money on our tax bill could solve the problem then why not just make anything we spend on healthcare tax deductible to begin with. We can argue about how we got here but no matter what we do, this is where we have to start from & the greed & insensitivity of the market is not going to go away.
    The intervention from government shifted the problem from a handful of those people to everyone.

    Let's say you have a cafeteria full of 100 hungry people. Lunch costs $10 and 5 people don't have $10 so they can not eat.

    How do you fix that problem?

    If the scheme you come up with results in that lunch price going up to $50 and now 40% can't afford it without assistance, have you made a bad situation worse? And the 60% who are forced to pay the $50 but can afford it are being financially penelized for a system that does more harm than good.

    I personally know 3 families right now without insurance who had insurance for decades. The consider all the middle class families you know who pay $15k a year and more for healthcare. The shrinking middle class is die to the middle class being financially squeazed. And the healthcare racket that was allowed to happenie a major cause.

    All this because we couldnt figure out a better way to help the 5% of the population that needed help.

    Gary, did you read what I posted? Did you go to the link and read the rest? It not only went over the programs and regs that were in tented to help but backfired, it also went over the blatent scheming, arm twisting and bribes to pass laws that did noting but enriched the insurance corps, the corporate providers and physicians.

    And the link only touched on one aspect of how government has negatively affected the market. There are hundreds of more. They have all added up over the decades to where I am going to have to shell out $20k this year and guys with small businesses can't afford insurance for themselves and their families.

    It's illogical to do something just for the sake of doing something. That one drives me nuts. The left and liberals seem to be slaves to this illogical mentality. They see a problem and instead of analyzing what their actions will lead to, their drive to "do something" is all that matters. They may even be fully aware they are doing more harm than good, but emotional irrationality takes over.

  7. #5
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    Quote Originally Posted by Brian8383 View Post
    The subject of regulations is so complex. Novels could be written on the subject. It's extremely intricate and pervasive.

    Here is just a couple examples in a well written piece. Some of the laws/regs passed were done for good intent, but many were done by lobbyists and activist groups who knew what they were doing. And willing politicians gleefully joined in. The piece talked about the beginnings of MCOs and how they showed some success. But then the lobbyists moved in. Forcing laws through many of them to enrich providers and insurance premiums. This is only one example of thousands where government weakness and corruption let these groups control the healthcare system to their mutual benefit.

    Many left leaning(and many right leaning) are very sensitive to backroom deals between bankers, Wall St and financial institutions. But they are blind to the backroom deals between healthcare players and politicians. Makes no sense to me. Both types of shady backroom deals cost them their money. Why don't they care about the progressives politicians and the large healthcare power players and their lobbyists. It's irrational the way they stick up for them.

    https://www.nationalaffairs.com/publ...are-federalism

    "As with any purchaser, the ability of MCOs to demand good prices from physicians and hospitals depends upon their ability to threaten to walk away from a deal. Health plans have traditionally struck bargains by limiting membership in their networks to providers who agree to meet cost targets. But state legislation since the late 1990s has frequently undermined this bargaining leverage. "Any willing provider" laws in 22 states require health plans to reimburse equally all providers that comply with pre-set terms and conditions. These prevent managed-care insurers from driving hard price bargains with providers. Similarly, "freedom of choice" laws in 23 states limit the ability of MCOs to channel patients toward in-network physicians and hospitals that provide services at lower cost.

    In addition to imposing such restrictions on "selective contracting," state laws also undermine utilization-management systems  with 30 states imposing bans on financial incentives for physicians to constrain the provision of costly health services and 47 states prohibiting MCOs from restricting physicians' recommendation of high-cost treatment options. Gatekeeping rules that require patients to obtain referrals from primary-care physicians before they are allowed to claim reimbursements for visits to costly specialists have similarly been targeted by state legislatures across the country.

    Following this legislative backlash against managed care  which saw more than 1,000 bills sponsored and 56 laws passed in 1996 alone  health-care spending began to rise again, at an annual rate of 8% to 10%. A study by economist Michael Vita in 2001 found that health-insurance costs fell as managed care became more prevalent but increased precisely where selective-contracting laws were created; spending levels then rose significantly as laws constraining utilization management were tightened. More recently, research by Maxim Pinkovskiy examining variations in these anti-managed-care laws found that the regulatory backlash explained much of the disproportionate growth in U.S. health-care spending between 1993 and 2005.

    Health-care providers have also sought to guarantee themselves higher incomes by pushing state legislation to mandate that coverage of a variety of non-essential treatments be incorporated into health insurance. No advertising campaign is as effective at generating revenue as a lobbying campaign to get states to mandate the purchase of one's products. As a result of such campaigns, more than 40 states prohibited the selling of health insurance that does not pay for services like visits to chiropractors or psychologists. Fifteen states require all insurance policies to cover in-vitro fertilization treatments, which can cost from $50,000 to $200,000. Several states even require catastrophic insurance plans, meant to cover basic medical needs, to also pay for the purchase of cosmetic items such as hair transplants and acupuncture.

    When such mandates are in place, price considerations are generally left out of purchasing decisions. It ought to be no surprise that spending soars when costs are deliberately hidden, and the spending increases caused by these state mandates are not trivial. Gail Jensen and Michael Morrisey have estimated that chemical-dependency treatment coverage increases health-insurance premiums by 9% on average; psychiatric-hospital-stay mandates increase premiums by 13%; and psychologist-visit mandates increase premium costs by 12%.

    Instead of openly appropriating and honestly budgeting to subsidize mental-health care, for instance, states (and, more recently, the federal government) have mandated that it be packaged into the cost of purchasing health insurance. But these requirements  ostensibly meant to expand health benefits  may, perversely, be limiting access to health care. Frank Sloan and Christopher Conover have estimated that a fifth of those Americans without health-care coverage would purchase insurance were it not for the premium-price inflation caused by such laws.

    Attempts to directly remedy the problem of the uninsured by adding even more regulations have been similarly counterproductive. Even before the passage of the Affordable Care Act, "guaranteed issue" regulations in 19 states required insurers to sell coverage to all comers, while "rating" requirements in 48 states limited to varying extents the prices at which they could do so. Such laws frequently obligate insurers to cover patients at prices substantially lower than the expected costs of treating them.

    By preventing insurers from charging actuarially fair premiums for health coverage, rating regulations have tended to impose massive spikes in insurance prices on low-risk individuals. When New York state enacted community-rating requirements, premiums for men under the age of 30 soared by 170%. Controlling for the terms of health insurance, a 2008 study by Amanda Kowalski, William Congdon, and Mark Showalter found the combination of guaranteed-issue and community-rating regulations to increase premiums in New Jersey by 108% to 227% for individual and family policies."
    Good post, thanks.

    In another post you said (think it was you), "It's not the insurance companies fault for lobbying government for their benefit. Companies are just doing what they should do, maximize their growth".

    I don't agree. The way I see it, companies and politicians are at fault.

    From the outside looking in, there is too much money in US politics. From the election campaign donations to the lobbying. They are buying favour to push an agenda beyond what is best for the country! It's all about power and profit.

    My point, to truely change something like healthcare, everything has to change. Limiting corporate political donations is a good place to start! Unless this issue is solved, history will just repeat itself.

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    Gary, here is another way to think about it. You, I'm sure recognize, government "help" has decimated inner cities and the black community in particular.

    If you went back to the turn of the century and the trajectory of the black community and see what happened after the Great Society you can see doing nothing would have been better. The financial trajectory and the strength of the black family unit was VERY strong and actually far outpacing all other groups.

    The stated goal of The Great Society was "The total elimination of poverty and racial injustice."

    Not only has that lofty goal not happened, things have gotten relatively much worse.

    How is that at all different than governments goal of providing cheap universally attainable health care to everyone? Has that made any progress? Or has it only further burdened the vast majority of the country?

    You can recognize the failures of government using leftist philosophies in attempts to fix poverty, fix racial inequality, fix the drug epidemic, fix gun violence, fix public education, fix rising college tuition, etc.

    Haven't you noticed a pattern? Those problems get worse. And good people pay the price and improvements are few if any.

    I'm thinking you recognize the Great Society has hurt the group is was primarily designed to help, right? It's negatives far outweigh any benefits. You probably also recognize the the entire scheme was designed to create a class of dependent voters and not really to "help". That's how they sold the scheme to the public. Tjey used emotion to sell a scheme to the public that was primarily a plan to ensure votes. Want me to pull up quotes of politicians to remind you?

    You recognize what they did with the war on poverty and its catastrophic results because you are not emotionally attached to it like you are with healthcare. But I promise you, as a person who looks at both situations without emotion clouding my opinion, there isnt any difference. You(and guys like GC) are emotionally attached and aren't seeing clearly. No different that the leftist black activists saying government needs to do more when government was the cause of the majority of their present day struggles.

    Gary, you need you to understand that last point I made. Unfortunately it will likely have no effect in exactly the same way as me trying to explain it to a leftist black social activist. They would not(could not) logically recognize that government is the problem. Not the solution.

    Understand? They can't open their minds to have an honest look at the reality of government "help". But you see the damage done to black communities and inner cities, right? You can see how closed mined they are to the truth. That's because you aren't emotionally crippled by the subject. It's no different with healthcare. I rarely get emotionally blinded. It's a gift and a curse at times. And I'm sincerely telling you, you aren't recognizing the cause of healthcare's decline. No different than black social activists demand for more government "help".

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    I'm not arguing about how the gov. has screwed things up in a lot of different ways beyond health care. I'm only arguing that none of the alternatives I've heard mentioned so far are going to work & that is my reason for promoting a government single payer system. If I was convinced another system would work better then I would probably abandon my support for a gov. single payer system.
    Gary
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    Wrong Gary...an HSA IS the answer. Everyone should get an HSA account, just like they get a Social Security number. We can leave what should happen to Social Security to another thread.

    This account may be funded by the person tax-free. All monies paid from the account will be taxed at normal rates, unless proven by a medical invoice/receipt. This will destroy the "preferred" provider networks, re-introducing choice and reasonable, competitive costs for the consumer.

    We have been led to believe that insurance is a necessary evil, but it's only really needed if you can't pay for something(or gov't mandated). There should still be supplemental insurance plans offered.

    People will see the true cost of procedures, not the inflated cost. Illegals and freeloaders will not receive the tax-free benefit. We can set up or utilize the Medicaid or Medicare model for those in poverty. Am I missing something?

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    Quote Originally Posted by GorillaTight View Post
    Wrong Gary...an HSA IS the answer. Everyone should get an HSA account, just like they get a Social Security number. We can leave what should happen to Social Security to another thread.

    This account may be funded by the person tax-free. All monies paid from the account will be taxed at normal rates, unless proven by a medical invoice/receipt. This will destroy the "preferred" provider networks, re-introducing choice and reasonable, competitive costs for the consumer.

    We have been led to believe that insurance is a necessary evil, but it's only really needed if you can't pay for something(or gov't mandated). There should still be supplemental insurance plans offered.

    People will see the true cost of procedures, not the inflated cost. Illegals and freeloaders will not receive the tax-free benefit. We can set up or utilize the Medicaid or Medicare model for those in poverty. Am I missing something?
    Are you saying we should be allowed to have an HSA with no insurance or just that everyone should have an HSA now? I'm all for HSA's but really all they do is help you for tax purposes. You still have to have the money to put in there plus pay your insurance premiums with other money. For people living from paycheck to paycheck it's useless & there's a lot in this country in that position. I think it would be better if any money spent on healthcare would be completely tax deductible & not just money contributed to or spent from an HSA.
    Gary
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    Quote Originally Posted by Lahrs View Post
    Good post, thanks.

    In another post you said (think it was you), "It's not the insurance companies fault for lobbying government for their benefit. Companies are just doing what they should do, maximize their growth".
    My take on this part is a little different than how you explained it. I don't think that companies aren't to blame.

    Companies/bussines/corps main goal is to make money. If the business sector is presented with a way to make more money and capture more market share, they will take that opportunity. Even if 99% of every business in that market refuses to take advantage of a red carpet role out presented by a politician on moral grounds, one or more will. Then they will gain the advantage over their competitors and gain more market control. You cannot effectively stop 100% of what businesses do. And in a twist of tragic irony, the only avenue to do that is the same thing that presented them the immoral opportunity in the first place: more government meddling. So you think the same people that presented them an advantage to exploit and get leg up on their competition will then limit their ability to do so? Or will both sides continue the mutually beneficial scheme and just cloak it under an emotional banner of more government "help". The link I posted above explains step by step how this works. They will not nor can not control the morals or a market. Trying to do so both sides of the equation get corrupted.

    The best(not perfect) way to control the morality of business(if that's actually a thing) is to keep consumers in charge. It's the only way to keep tabs on it.

    Do places like Altas MD have better consumer morals than your local corporate provider? The ones that are besties with politicians, leftist activist groups, the media and lobbyists?

    It's no coincidence that the founders of places like Altas MD and the Sugury Center of Oklahoma are staunch economic conservatives. Think about that. Those guys that are actually putting people who are in need of healthcare first. They are the guys who run a "moral" business do so using the solutions I've been talking about. It's still profit motivated. That's not the problem. But it's the providers that run under the cloak of government management who are the villains due to the highlighted words.

    Read that last paragraph again, please. Don't skim over it and not let that reality sink in. It needs to be recognized to move forward with ideas that actually work. Good and effective ideas need to be founded in basic truths. Not idiolistc theory that has been proven incorrect countless times. I can't explain how important it is for people to recognize that. It needs to be a "Oh, wow. That's actually true!" moment.

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    Quote Originally Posted by garyed View Post
    Are you saying we should be allowed to have an HSA with no insurance or just that everyone should have an HSA now? I'm all for HSA's but really all they do is help you for tax purposes. You still have to have the money to put in there plus pay your insurance premiums with other money. For people living from paycheck to paycheck it's useless & there's a lot in this country in that position. I think it would be better if any money spent on healthcare would be completely tax deductible & not just money contributed to or spent from an HSA.
    YES...every US citizen will be issued an HSA at birth or at legal adult age. NO insurance coverage requirement. The money everyone pays for a premium could instead be used to fund the HSA. Companies could offer to match your contribution, just like a 401k, or just agree to put a certain amount in every year.

    I have an HSA now, it's tax-free going in and out when used for medical expenses. You have the option to invest it in the market. The gov't should be empowering people to make their own decisions, not enslaving them to the insurance model.

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    Quote Originally Posted by Brian8383 View Post
    ............................
    It's no coincidence that the founders of places like Altas MD and the Sugury Center of Oklahoma are staunch economic conservatives. Think about that. Those guys that are actually putting people who are in need of healthcare first. ....................
    If you really believe that then try to see if the Surgery Center of OK. will do a knee replacement for you if you don't have the $15,000 & your credit is not good enough to borrow the money. They've already partnered with a credit company to make their services affordable for those who don't have the cash. A lot of people in this country can't come up with $1,500 let alone $15,000. It's definitely possible that these surgery centers could have the opposite effect on the system & cause healthcare prices to rise for those who can't afford to pay up front. Don't get me wrong, I like the idea of the all inclusive prices up front but I'm just saying that it's not going to make any major changes to the system in the end.
    Gary
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    Quote Originally Posted by GorillaTight View Post
    YES...every US citizen will be issued an HSA at birth or at legal adult age. NO insurance coverage requirement. The money everyone pays for a premium could instead be used to fund the HSA. Companies could offer to match your contribution, just like a 401k, or just agree to put a certain amount in every year.

    I have an HSA now, it's tax-free going in and out when used for medical expenses. You have the option to invest it in the market. The gov't should be empowering people to make their own decisions, not enslaving them to the insurance model.
    Is it going to be a voluntary contribution or will it be funded with a tax similar to social security? If it's voluntary then I don't see it making much difference because a lot of people are not going to voluntarily fund it no matter how much they save in not paying insurance premiums. A lot of employers already pay a substantial amount of healthcare premiums tax free for their workers so I don't see how switching money to an HSA is going to help those employees. The only reason HSA's are funded voluntarily now is for the tax benefit & employees get a better tax break because they don't even have to pay FICA on the employer sponsored healthcare portion. I think the HSA is a good idea but I just don't see it working for everyone as a sloution.
    Gary
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    The best things in life are free but not everyone is willing to pay the price.

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