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Source: (consider it) Thread: Medical treatment--who gets what, who decides, who pays?
Boogie

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# 13538

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quote:
Originally posted by quetzalcoatl:
Wow, just reading through some US social media, the NHS is basically murdering a child, that's what you get with socialized medicine, whereas good old US private health would bring him back from the brink, provided there's enough money.

Twisting the story to suit their own ends - to be expected.

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Garden. Room. Walk

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Lyda*Rose

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# 4544

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quote:
Originally posted by mdijon:
It might not be realistic. It's pretty difficult transporting babies on ventilators.

Also what they reportedly want (to spend time with him at home) might not match up to the reality of death as soon as the ventilator is disconnected.

There's a big mismatch between the portrayals of the delivery of care people often have in mind and the actual blood, sweat and tears of reality.

For instance, there is an element of barbarism involved in repeatedly stabbing a babies body for a vein after months in intensive care with bruises over all available spots that doesn't fit well in the imagery available to most of us.

Okay, I see the sense of this.

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"Dear God, whose name I do not know - thank you for my life. I forgot how BIG... thank you. Thank you for my life." ~from Joe Vs the Volcano

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Karl: Liberal Backslider
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quote:
Originally posted by Bishops Finger:
Notwithstanding all the medical arguments for and against, there is still the basic (IMHO) Christian belief that death is the ultimate form of healing.

I thought it was the last enemy to be conquered. It never seems to be referenced positively in Scripture, and that concurs with how most people see things.

The ultimate healing is resurrection, the opposite of death; its undoing.

Were death healing, it would be logical for Christian tradition to be in favour of euthenasia - "medicine can't cure you, so we're prescribing the ultimate healing for you" - and it generally isn't.

[ 03. July 2017, 17:36: Message edited by: Karl: Liberal Backslider ]

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Might as well ask the bloody cat.

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quetzalcoatl
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quote:
Originally posted by mdijon:
quote:
Originally posted by quetzalcoatl:
It sounds too medically uncontrolled to me. You take him off life support, then transport him through London traffic, for how long? Then he starts to die? Poor kid.

You'd have to take him on a ventilator. Or he'd be dead in the lift otherwise.

quote:
Originally posted by quetzalcoatl:
My Sufi mates call death the wedding night, or something. I sort of get it.

Good call. Grenfell is very anger-provoking for me too.

It's very raw. I don't want to hear any more pastors saying that God will answer if you pray sincerely, because I bet some of those people at the top of Grenfell were praying very sincerely. And I live near it.

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no path

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Soror Magna
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quote:
Originally posted by quetzalcoatl:
Wow, just reading through some US social media, the NHS is basically murdering a child, that's what you get with socialized medicine, whereas good old US private health would bring him back from the brink, provided there's enough money. ...

To be fair, I've started to realize that Americans have never had a government that seriously wanted all its citizens to have health care. It's only natural for them to have more trust in the private market, where at least they pretend to deliver health care. Private health care which costs an arm and a leg and includes gouging, but again, it's still better than what the Republicans want to do.

Someday, Americans might figure out that a health cares system is supposed to deliver health care, not just corporate profits. In the meantime, they can pretend to care about one little kid in the UK while ignoring the fact that the USA has the highest infant mortality of any developed nation.

Have I mentioned that health care is not a free market, and that free market health care is only economically viable for the wealthy?

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"You come with me to room 1013 over at the hospital, I'll show you America. Terminal, crazy and mean." -- Tony Kushner, "Angels in America"

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quetzalcoatl
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# 16740

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Good post, Soror Magna. The right wing view seems to be that Charlie is being regimented by a death panel, consisting of bureaucrats, probably something to do with Europe. In fact, all the decisions are informed by medical advice. If the doctors say that Charlie will not get better, and is living in pain, are the judges supposed to say, never mind that, his parents must have supremacy? Maybe that is part of US law, dunno.

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no path

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Doublethink.
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Possibly worth noting that the definition of death is different in the UK and USA - it is not clear to me that Charlie Gard is alive, in the sense of; would pass a brain stem test.

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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell

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Boogie

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Oh for goodness sake.

Donald Trump has offered to help the parents of a terminally ill baby who lost a legal fight to take him to the United States for treatment.

How low will this man stoop for political capital?


[Tear] [Tear]

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Garden. Room. Walk

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quetzalcoatl
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Trump and the Pope produce a kind of Barnum's circus. Very undignified.

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no path

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Boogie

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quote:
Originally posted by quetzalcoatl:
Trump and the Pope produce a kind of Barnum's circus. Very undignified.

And cruel.

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Garden. Room. Walk

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Doublethink.
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To be fair to the Pope, he made no call for outlandish provisions - just offered his support and hope for the parents to be able to with their son during his palliative care. (Not that I'd have thought that's likely to be an issue. They're not banned from the hospital or anything.)

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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell

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Ohher
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A pity 44.3 can't muster a bit of support for his own citizens threatened with loss of life when they lose their Medicaid.

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Formerly Foolhearty. Back after somewhat less than 40 years in the wilderness.

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mdijon
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quote:
Originally posted by Doublethink.:
To be fair to the Pope, he made no call for outlandish provisions

I saw his statement and thought that if I was a doctor or nurse who'd just had an angst-ridden conversation explaining to the parents why we couldn't let them take their child home I could feel somewhat accused by the statement. There isn't anything in the statement to reflect what might be standing in the way of taking the child home, the implication could be that someone isn't allowing it who should allow it.

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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon

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Soror Magna
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quote:
Originally posted by quetzalcoatl:
... The right wing view seems to be that Charlie is being regimented by a death panel, consisting of bureaucrats, probably something to do with Europe. In fact, all the decisions are informed by medical advice. ....

And yet they are totally ok with an insurance company, concerned only with maximizing profits, making these decisions instead. [brick wall] Somebody please tell them that if wee Charlie lived in pre-Obamacare USA, he would have blown through his lifetime cap in his first few days of life, if by some chance his parents had insurance. Even if an experimental treatment saved him, he could never get health insurance. How eager would these right-wingers be to pay for Charlie's home care so he can be with his family then? His family would be crowd-funding for the rest of their lives to keep him alive. If they have to declare bankruptcy - also not uncommon in pre-Obamacare USA - and sell everything they own, what happens to Charlie then?

And the ubiquity of crowd-funding of health care in the USA should be another sign that it isn't a free market ...

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"You come with me to room 1013 over at the hospital, I'll show you America. Terminal, crazy and mean." -- Tony Kushner, "Angels in America"

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chris stiles
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# 12641

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quote:
Originally posted by Soror Magna:
And yet they are totally ok with an insurance company, concerned only with maximizing profits, making these decisions instead. [brick wall] Somebody please tell them that if wee Charlie lived in pre-Obamacare USA, he would have blown through his lifetime cap in his first few days of life, if by some chance his parents had insurance.

The problem is that the US media have - for the most part - bought into the rhetoric of 'death panels' and that this idea only applies to government provision, rather than insurance companies.
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Amanda B. Reckondwythe

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quote:
Originally posted by Soror Magna:
Even if an experimental treatment saved him. . . .

No insurance company I'm aware of would even consider paying for an experimental treatment.

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"We're not in Wonderland anymore, Alice." – Charles Manson

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Doublethink.
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# 1984

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quote:
Originally posted by mdijon:
quote:
Originally posted by Doublethink.:
To be fair to the Pope, he made no call for outlandish provisions

I saw his statement and thought that if I was a doctor or nurse who'd just had an angst-ridden conversation explaining to the parents why we couldn't let them take their child home I could feel somewhat accused by the statement. There isn't anything in the statement to reflect what might be standing in the way of taking the child home, the implication could be that someone isn't allowing it who should allow it.
The statement I saw didn't suggest taking the child home.

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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell

Posts: 19102 | From: Erehwon | Registered: Aug 2005  |  IP: Logged
cliffdweller
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# 13338

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quote:
Originally posted by Soror Magna:
quote:
Originally posted by quetzalcoatl:
... The right wing view seems to be that Charlie is being regimented by a death panel, consisting of bureaucrats, probably something to do with Europe. In fact, all the decisions are informed by medical advice. ....

And yet they are totally ok with an insurance company, concerned only with maximizing profits, making these decisions instead. [brick wall] Somebody please tell them that if wee Charlie lived in pre-Obamacare USA, he would have blown through his lifetime cap in his first few days of life, if by some chance his parents had insurance. Even if an experimental treatment saved him, he could never get health insurance. How eager would these right-wingers be to pay for Charlie's home care so he can be with his family then? His family would be crowd-funding for the rest of their lives to keep him alive. If they have to declare bankruptcy - also not uncommon in pre-Obamacare USA - and sell everything they own, what happens to Charlie then?

And the ubiquity of crowd-funding of health care in the USA should be another sign that it isn't a free market ...

Sigh. I've been having this precise conversation with a right wing pro life friend. I pointed out the discrepancy in infant mortality rates. I pointed out the hypocrisy of caring so much about Charlie who tragically has no chance for survival, but being so willing to deny care to millions of babies that DO have a chance for survival. I was told 'that's different-- Charlie's parents aren't asking us to pay for it"

Oh. So we're pro life-- until it costs us something

That's when I got truly nasty and brought up my granddaughter whose life was saved only 4 months ago thru the Medicare program currently on the chopping block. Without the continuation of that program she and thousands of other children with such catastrophic health conditions will die

I was accused of "making it personal"

Damn straight

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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner

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mdijon
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quote:
Originally posted by Doublethink.:
The statement I saw didn't suggest taking the child home.

The quote I find it;

quote:
For this he prays that their wish to accompany and treat their child until the end isn’t neglected.
You're right, it doesn't suggest taking the child home. It does suggest though that something is neglected. Neglecting is a transitive verb and carries an accusation that someone is doing the neglecting. It seems an unhelpful wording to me. Perhaps something is lost in translation, although one would expect attention would have been given to the English wording given the location of the child.

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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon

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Golden Key
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SM--

quote:
Originally posted by Soror Magna:
quote:
Originally posted by quetzalcoatl:
Wow, just reading through some US social media, the NHS is basically murdering a child, that's what you get with socialized medicine, whereas good old US private health would bring him back from the brink, provided there's enough money. ...

To be fair, I've started to realize that Americans have never had a government that seriously wanted all its citizens to have health care. It's only natural for them to have more trust in the private market, where at least they pretend to deliver health care. Private health care which costs an arm and a leg and includes gouging, but again, it's still better than what the Republicans want to do.

Someday, Americans might figure out that a health cares system is supposed to deliver health care, not just corporate profits. In the meantime, they can pretend to care about one little kid in the UK while ignoring the fact that the USA has the highest infant mortality of any developed nation.

Have I mentioned that health care is not a free market, and that free market health care is only economically viable for the wealthy?

Frankly, most Americans have some idea of most of this. Most of us have intimate experience of at least some of it.

--We know that health insurance is hard to get and keep. And confusing as all get out.

--We know horror stories--heck, they feature on both the news and in TV medical dramas.

--We know that people face terrible choices, especially about sick kids.

--We know that, even if we're lucky enough to have insurance, we may not be able to afford the deductible and co-pays.

--We know that we may not be able to get medical care at all.

--We know that, even if we have insurance and can afford our bit, we may not have paid time off from work for appointments or sick days.

--We know, for a fact, that insurance companies will do everything they can to avoid paying--thanks to a whistle-blower who spoke before Congress, some years back.

But, given that various powers that be (PTB)--insurance industry, medical industry, big pharma, and everyone in their pockets--fight tooth and nail to keep us from having affordable health care, let alone *universal*; insist on demolishing Obama's imperfect attempt; and want to pretty much demolish Medicare and Medicaid...what do you expect us to do differently, that might actually work, become law, and *stay* law?

Some people who can't afford care are lucky enough to get occasional treatment at traveling Remote Area Medical clinics.

Two relevant articles:

1) "When Sleeping In The Car Is The Price Of A Doctor Visit" (NPR; article, transcript, and audio).

2) "Free RAM Medical Clinic this weekend in Cleveland" (WRCB).

If you think that sounds like charity clinics in 3rd world countries, you're right.

And yes, many of us do spare some care for Charlie. FYI: those decisions by not-the-parents comprise a good chunk of the fear of socialized medicine.

Yes, I am a bit [Mad] , pointed in a variety of directions--at responsible parties; at experiences I've had; and at some posts on this thread. It's one thing to think "Wow, the Yanks desperately need a health care system that works", and another to think "...and they're too stupid to know that, and too lethargic to do anything about it".

[ 04. July 2017, 09:28: Message edited by: Golden Key ]

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Blessed Gator, pray for us!
--"Oh bat bladders, do you have to bring common sense into this?"--Dragon, "Jane & the Dragon"
--"I'm not giving up--and neither should you." --SNL

Posts: 17262 | From: Chilling out in an undisclosed, sincere pumpkin patch. | Registered: Oct 2001  |  IP: Logged
Boogie

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Stupid and lethargic are totally the wrong descriptions.

But why such fear of socialised medicine that they would rather have big business in control?

There are only two market forces - fear and greed - applying them to medicine and social care is plain wrong.

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Garden. Room. Walk

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la vie en rouge
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quote:
Originally posted by Golden Key:
And yes, many of us do spare some care for Charlie. FYI: those decisions by not-the-parents comprise a good chunk of the fear of socialized medicine.

I think this is a big part of the transatlantic difference in attitude. ISTM this is not just a question about entitlement to medical treatment per se. It is also about attitudes to parents’ rights in relation to their children. AFAICT in the US it is more common to consider that children in some sense “belong” to their parents and that they should get the final say about what happens to them. This shows up in question to things like (home-)schooling and corporal punishment. In Europe the line is drawn in a different place, regarding the point at which the State can step in and say that parents are not acting in their child’s best interest. I can well believe that treatment might have continued in the US, if the money had been there for it. But again, the judge didn’t rule against treatment because of cost, but because continuing treatment was considered to be against the child’s best interest.

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Rent my holiday home in the South of France

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L'organist
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Surely a lot of the discussion about the Charlie Gard case comes down to a modern-day reluctance to accept two things: First, that there are instances where people, especially children, can't be "fixed" which underlines the ultimately limited abilities of our doctors and hospitals to preserve the life of those we hold dear.

Second, that there are - probably always will be - some conditions which we cannot screen for and for which there is, at least at the moment, no possible cure. Mitochondrial DNA Depletion Syndrome (MDDS) is one of these and although some patients with one of the variants - there are broadly three: myopathic, hepatopathic and encephalomyopathic - can be given limited treatment to extend life, there is no 'cure' as such.

In an instance such as this tragic case it has nothing to do with money because there is nothing available that would effect a cure for this child.

As for the question of who takes decisions on the future of this little boy, it all boils down to whether or not one considers that parents have an inalienable right to insist on whatever palliative care is available, regardless of whether or not it is actually working. The doctors in the Gard case say that not only are they unable to offer any condition improving treatment, they also can no longer offer effective palliative analgesia - in other words the little chap is probably in pain which cannot be properly alleviated or managed. They have no way of knowing for sure because Charlie is deaf, blind, immobile and unable to make a noise - all evidence of the catastrophic brain damage which the disease has brought about.

It is understandable that the parents don't want to take the decision to tell doctors to switch off the machines that are keeping their son alive; understandable too that they would grab at anything offered which claimed to be able to help their son. But in this instance the medical experts on both sides of the atlantic say the same thing: that there is no hope of either cure or enhanced short life; that the offer of "treatment" that has been made can have no chance of success; and that there is in any case no way of getting the patient to the USA without causing further pain.

I can't begin to imagine how the Gard parents are feeling but in this instance no amount of money or goodwill can help.

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Rara temporum felicitate ubi sentire quae velis et quae sentias dicere licet

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Matt Black

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quote:
Originally posted by la vie en rouge:
quote:
Originally posted by Golden Key:
And yes, many of us do spare some care for Charlie. FYI: those decisions by not-the-parents comprise a good chunk of the fear of socialized medicine.

I think this is a big part of the transatlantic difference in attitude. ISTM this is not just a question about entitlement to medical treatment per se. It is also about attitudes to parents’ rights in relation to their children. AFAICT in the US it is more common to consider that children in some sense “belong” to their parents and that they should get the final say about what happens to them. This shows up in question to things like (home-)schooling and corporal punishment. In Europe the line is drawn in a different place, regarding the point at which the State can step in and say that parents are not acting in their child’s best interest. I can well believe that treatment might have continued in the US, if the money had been there for it. But again, the judge didn’t rule against treatment because of cost, but because continuing treatment was considered to be against the child’s best interest.
It's not so much 'state rights - v- parents' rights' as 'children's rights -v - parents' rights'.

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"Protestant and Reformed, according to the Tradition of the ancient Catholic Church" - + John Cosin (1594-1672)

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Jane R
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Yes, as I said earlier, in the UK children are not considered to be the property of their parents and British law recognises that parents are not always the best guardians of their children's well-being.

[ 04. July 2017, 17:52: Message edited by: Jane R ]

Posts: 3733 | From: Jorvik | Registered: May 2001  |  IP: Logged
Doublethink.
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Well yes, but child marriage¹ is still legal in the USA with parental approval. We'd jail the parents and take the children into care - it's a very different culture.

---

¹ Washington Post

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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell

Posts: 19102 | From: Erehwon | Registered: Aug 2005  |  IP: Logged
Patdys
Iron Wannabe
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quote:
Originally posted by Lyda*Rose:
quote:
Originally posted by Nicolemr:
I'm not sure but I think the hospital is allowing time for extended family and friends to gather to be there and say good-bye before they turn off life support.

Yes, but they really want him to go home. Would that be too much to ask considering their trauma?
Short answer. No.
Long Answer. No, but it depends. When I send (In my health system) someone home to die, they understand they may die enroute. There needs to be family with capacity to provide nursing care and administer simple labelled medications for symptoms. It comes down to the capacity of the family.
And then there is the whole question of the ventilator for transport etc.
It can work brilliantly. And it can go pearshaped.

quote:
Originally posted by Karl: Liberal Backslider:
quote:
Originally posted by Bishops Finger:
Notwithstanding all the medical arguments for and against, there is still the basic (IMHO) Christian belief that death is the ultimate form of healing.

I thought it was the last enemy to be conquered. It never seems to be referenced positively in Scripture, and that concurs with how most people see things.

The ultimate healing is resurrection, the opposite of death; its undoing.

Were death healing, it would be logical for Christian tradition to be in favour of euthenasia - "medicine can't cure you, so we're prescribing the ultimate healing for you" - and it generally isn't.

I would argue that you can experience healing in the face of death.
There is a difference between Hippocratic fixing and Asklepian healing.
We all die. There is no say in that. There can be substantial say in how well we die.
And that underpins the joy and challenge of palliative care.

quote:
Originally posted by L'organist:
Surely a lot of the discussion about the Charlie Gard case comes down to a modern-day reluctance to accept two things: First, that there are instances where people, especially children, can't be "fixed" which underlines the ultimately limited abilities of our doctors and hospitals to preserve the life of those we hold dear.

Indeed, modern medicine is very concerned with fixing disease and the medical profession does struggle when the fix is not possible. A focus on the person from the outset, and this culture is changing (YMMV) seems more valuable and integrated.

quote:
Originally posted by L'organist:
In an instance such as this tragic case it has nothing to do with money because there is nothing available that would effect a cure for this child.

Unfortunately, justice and limited community resources means money does come into it.
The community pays for health care, no matter the funding system. Life support is expensive and the cost is transferred into waiting lists for elective surgery for example. This is a community decision. What does the community value? Not for individual cases, but for the political policy driving health care funding.

quote:
Originally posted by L'organist:
As for the question of who takes decisions on the future of this little boy, it all boils down to whether or not one considers that parents have an inalienable right to insist on whatever palliative care is available, regardless of whether or not it is actually working. The doctors in the Gard case say that not only are they unable to offer any condition improving treatment, they also can no longer offer effective palliative analgesia - in other words the little chap is probably in pain which cannot be properly alleviated or managed. They have no way of knowing for sure because Charlie is deaf, blind, immobile and unable to make a noise - all evidence of the catastrophic brain damage which the disease has brought about.

I am not sure we mean the same thing by palliative care.
I would use the WHO definition.

Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

I have not been able to find where the doctors have said they cannot provide symptom relief. That would surprise me and I would be interested to see the links.

quote:
Originally posted by L'organist:
It is understandable that the parents don't want to take the decision to tell doctors to switch off the machines that are keeping their son alive; understandable too that they would grab at anything offered which claimed to be able to help their son. But in this instance the medical experts on both sides of the atlantic say the same thing: that there is no hope of either cure or enhanced short life; that the offer of "treatment" that has been made can have no chance of success; and that there is in any case no way of getting the patient to the USA without causing further pain.

I can't begin to imagine how the Gard parents are feeling but in this instance no amount of money or goodwill can help.

Absolutely. This is truly horrible. I would argue that the parents shouldn’t be the ones to make the decision. I appreciate autonomy carries different weight in different countries.

I think it is important to note that all suffer here. The patient, family and health team.
This is not good and bad people. This is all the involved people all suffering and struggling with what the best way forward looks like.

One of the things I teach is
Don't do something, just stand there.
Being there for others.

This is one of those diabolical situations where the choice is of the least bad outcome. And they are all bad. And my understanding of theology is that the tears and struggles are shared by and with the Trinity.

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Soror Magna
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quote:
Originally posted by Golden Key:
...--We know that health insurance is hard to get and keep. And confusing as all get out.

--We know horror stories--heck, they feature on both the news and in TV medical dramas.

--We know that people face terrible choices, especially about sick kids.

--We know that, even if we're lucky enough to have insurance, we may not be able to afford the deductible and co-pays.

--We know that we may not be able to get medical care at all.

--We know that, even if we have insurance and can afford our bit, we may not have paid time off from work for appointments or sick days.

--We know, for a fact, that insurance companies will do everything they can to avoid paying--thanks to a whistle-blower who spoke before Congress, some years back. ...

It's one thing to think "Wow, the Yanks desperately need a health care system that works", and another to think "...and they're too stupid to know that, and too lethargic to do anything about it".

Yep, private health insurance really sucks, doesn't it? So why stick with it? Millions of ordinary folks in the USA are already getting care through government and non-profit insurance programs. (They're the ones holding the signs that say, 'Keep government out of Medicare'.) Why not everybody? If it isn't lethargy or stupidity, it's whatever the word is for "I would rather be fucked over by a corporation than be served by my government because FREEDOM!"

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Ohher
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quote:
Originally posted by Soror Magna:
"I would rather be fucked over by a corporation than be served by my government because FREEDOM!"

[Overused]

This. It's almost as though people thought the Declaration of Independence (hey, it's still July 4 where I am) spoke of the unalienable rights to liberty, life, and the pursuit of happiness. You know, because the order matters. That's why Adam got to call the shots, right? He was created first?

Yay. We're free to die.

[ 05. July 2017, 02:50: Message edited by: Ohher ]

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Boogie

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Private health insurance works very well in Germany. Everyone gets it through work, you choose the 'extras' but the basics are for all. Anyone who doesn't work gets health insurance through state benefit.

All hospitals are private.

It works. We are too precious here in the UK about the NHS and they are too silly in the US about giving benefits to all who need it.

I say to both - look at the German model and learn.

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Garden. Room. Walk

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mdijon
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I think you misrepresent German healthcare.
quote:
Germany has a universal multi-payer health care system with two main types of health insurance: "Statutory Health Insurance" (Gesetzliche Krankenversicherung) known as sickness funds (Krankenkassen) and "Private Health Insurance" (Private Krankenversicherung).... According to the World Health Organization, Germany's health care system was 77% government-funded and 23% privately funded as of 2004.


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Boogie

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quote:
Originally posted by mdijon:
I think you misrepresent German healthcare.
quote:
Germany has a universal multi-payer health care system with two main types of health insurance: "Statutory Health Insurance" (Gesetzliche Krankenversicherung) known as sickness funds (Krankenkassen) and "Private Health Insurance" (Private Krankenversicherung).... According to the World Health Organization, Germany's health care system was 77% government-funded and 23% privately funded as of 2004.

Yes - I should have used the words 'public health insurance' instead of private.

My point is that everyone pays in and it works. It's not taken out of tax or treated like a political football like ours or a complete hotch potch like the USA.

My son, who lives in Heidelberg, had knee trouble. He went to the GP, no waiting. Was sent straight for scans and x-rays then to the consultant and for injections - all in his lunch hour!

He works as a nurse. No overcrowding, no bed shortages and no stressful job. He loves it.

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Patdys
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Health Systems

Cheap Cost
Short Waiting Times
Minimal Limitations on what is provided

Pick any two.
It's the best you can do.

Germany is reported as having one of the best health systems in the world. And it is failing on cost from what I am reading.

Australia is a bit between the UK and US systems.
We are blowing out on cost and waiting times.
And there are limitations on what is provided.

But I am proud that all people can access the service.

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Jane R
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Yes, the German system is a lot more expensive than the NHS. The NHS could be as good if the government threw a lot more money at it, but they can't even bring themselves to lift the pay cap for the staff they've got now...
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mdijon
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quote:
Originally posted by Boogie:
He works as a nurse. No overcrowding, no bed shortages and no stressful job. He loves it.

At 11.3% of GDP vs 9.1% of GDP for the UK. Percentages out of GDPs of $3.2T vs $2.3T.

So if the NHS had 60% more funding it would be a good comparison. And that is where the political differences are. Presumably in Germany there is a political consensus to fund health to that level, therefore it isn't a political football. In the UK there are opposing views on the right level of funding.

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quetzalcoatl
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Yes, boogie said something about people being 'precious' about the NHS, which I don't get. It works fine with enough money. The Tories will starve it of money, then the right-wing press will say that the NHS isn't working, then some right-wing dork will suggest private insurance.

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no path

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Boogie

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quote:
Originally posted by quetzalcoatl:
Yes, boogie said something about people being 'precious' about the NHS, which I don't get. It works fine with enough money. The Tories will starve it of money, then the right-wing press will say that the NHS isn't working, then some right-wing dork will suggest private insurance.

I think, if we are keeping the NHS, we should pay a proper tax which is completely ring fenced for the NHS, no political interference.

I would much prefer to move over to the German system, even if it costs a lot - it works. But saying this causes people to think I want to go the American way. Far from it, I think they have the worst of all health provision.

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Boogie

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quote:
Originally posted by mdijon:
quote:
Originally posted by Boogie:
He works as a nurse. No overcrowding, no bed shortages and no stressful job. He loves it.

At 11.3% of GDP vs 9.1% of GDP for the UK. Percentages out of GDPs of $3.2T vs $2.3T.

So if the NHS had 60% more funding it would be a good comparison. And that is where the political differences are. Presumably in Germany there is a political consensus to fund health to that level, therefore it isn't a political football. In the UK there are opposing views on the right level of funding.

Exactly.

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quetzalcoatl
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quote:
Originally posted by Boogie:
quote:
Originally posted by quetzalcoatl:
Yes, boogie said something about people being 'precious' about the NHS, which I don't get. It works fine with enough money. The Tories will starve it of money, then the right-wing press will say that the NHS isn't working, then some right-wing dork will suggest private insurance.

I think, if we are keeping the NHS, we should pay a proper tax which is completely ring fenced for the NHS, no political interference.

I would much prefer to move over to the German system, even if it costs a lot - it works. But saying this causes people to think I want to go the American way. Far from it, I think they have the worst of all health provision.

I can't follow that. If more money will make the NHS work fine, why move to a different system? And after Blair pumped money in, it did seem to work fine, as far as my experience went. The right wing tend to dislike the NHS, therefore starve it of money.

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no path

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Leorning Cniht
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quote:
Originally posted by quetzalcoatl:
I can't follow that. If more money will make the NHS work fine, why move to a different system? And after Blair pumped money in, it did seem to work fine, as far as my experience went. The right wing tend to dislike the NHS, therefore starve it of money.

The interesting question, of course, is not "can we make the NHS better with more money?" but "what way of spending our money produces the best results?".

It's completely clear that the American answer is the wrong one, but Boogie points out that Germany has a system that works OK, and there are several other countries with healthcare systems that seem to work OK.

So it's possible that the best answer is just "increase the NHS budget", but if there are things that we could copy from other systems that would make the NHS more efficient, why wouldn't we look at that?

Maybe you look at other systems, and decide that they don't have anything useful to offer.

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quetzalcoatl
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quote:
Originally posted by Leorning Cniht:
quote:
Originally posted by quetzalcoatl:
I can't follow that. If more money will make the NHS work fine, why move to a different system? And after Blair pumped money in, it did seem to work fine, as far as my experience went. The right wing tend to dislike the NHS, therefore starve it of money.

The interesting question, of course, is not "can we make the NHS better with more money?" but "what way of spending our money produces the best results?".

It's completely clear that the American answer is the wrong one, but Boogie points out that Germany has a system that works OK, and there are several other countries with healthcare systems that seem to work OK.

So it's possible that the best answer is just "increase the NHS budget", but if there are things that we could copy from other systems that would make the NHS more efficient, why wouldn't we look at that?

Maybe you look at other systems, and decide that they don't have anything useful to offer.

It gets complicated when other systems spend more on health. So first, you have to strip that out, and then compare various aspects of health. I don't think that efficiency is the only factor, by the way. It would be efficient to let certain people just die, wouldn't it, and not bother with care for them?

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no path

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mdijon
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quote:
Originally posted by Leorning Cniht:
but Boogie points out that Germany has a system that works OK

It works OK with 60% more money. So difficult to say that the system makes it better. I've no doubt that efficiency can be improved in the NHS, but the German system wholesale isn't necessarily going to do that. It is just as likely that Germany is worse in terms of system, but funded enough to get over that.

Also when a system is struggling just to stay alive it is harder for people to be reflective and work out what to do better.

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Jane R
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It's not just a question of throwing more money at the problem; it's also important to spend it wisely. Scotland, for example, has reorganised the way healthcare is delivered (by getting agencies to work together more effectively). They won't be able to go on doing it if they're starved of funds, though.

And there is no slack in our system at all. I expect that's why Boogie's son was able to get his bad knee sorted out so quickly; the German system presumably has extra capacity built-in. They don't have to leave patients on trolleys in the corridor every time there's a slight uptick in the number of people coming into A&E. Meanwhile, in the NHS, staff are being run off their feet because they're all trying to do at least one and a half jobs.

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mdijon
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quote:
Originally posted by Jane R:
And there is no slack in our system at all. I expect that's why Boogie's son was able to get his bad knee sorted out so quickly; the German system presumably has extra capacity built-in.

Germany has 9 acute beds per 1000 population. The UK has 3.

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Jane R
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Well, there you go then.
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Ricardus
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ISTM that after a certain point, any organisation that is financially well run will give less value for money if more money is given to it and that is proof that it is well run.

In crude terms, say you are the finance manager of a hospital and you are presented with three proposals. All of them cost 1 million ducats but the first will save a hundred thousand lives, the second fifty thousand lives, and the third ten thousand lives. If you are financially prudent you will purchase the first option. If more money becomes available then you may decide to purchase the second one as well. As soon as you do so, you have caused the amount the hospital spends per life saved to increase - but you have also acted with financial prudence.

IOW, all these right-wing journalists who say Mr Blair's health spending increases didn't give good value for money, even if they are correct, are very likely to be missing the point.

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Then the dog ran before, and coming as if he had brought the news, shewed his joy by his fawning and wagging his tail. -- Tobit 11:9 (Douai-Rheims)

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quetzalcoatl
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It's said that the British, or maybe I mean the English, are inordinately fond of low taxes, and are therefore prepared to put up with poor services, including poor health care.

I don't know whether this is true or not, but the austerity agenda presumably relied on it. And the recent election is being interpreted as showing an increasing exasperation about it. But this also involves low wages as well. I suppose Labour trade partly on the idea of better services and higher taxes and higher pay.

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no path

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Golden Key
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Soror Magna--

quote:
Originally posted by Soror Magna:
quote:
Originally posted by Golden Key:
...--We know that health insurance is hard to get and keep. And confusing as all get out.

--We know horror stories--heck, they feature on both the news and in TV medical dramas.

--We know that people face terrible choices, especially about sick kids.

--We know that, even if we're lucky enough to have insurance, we may not be able to afford the deductible and co-pays.

--We know that we may not be able to get medical care at all.

--We know that, even if we have insurance and can afford our bit, we may not have paid time off from work for appointments or sick days.

--We know, for a fact, that insurance companies will do everything they can to avoid paying--thanks to a whistle-blower who spoke before Congress, some years back. ...

It's one thing to think "Wow, the Yanks desperately need a health care system that works", and another to think "...and they're too stupid to know that, and too lethargic to do anything about it".

Yep, private health insurance really sucks, doesn't it? So why stick with it? Millions of ordinary folks in the USA are already getting care through government and non-profit insurance programs. (They're the ones holding the signs that say, 'Keep government out of Medicare'.) Why not everybody? If it isn't lethargy or stupidity, it's whatever the word is for "I would rather be fucked over by a corporation than be served by my government because FREEDOM!"
Um, did you miss the bit you snipped out?

quote:
But, given that various powers that be (PTB)--insurance industry, medical industry, big pharma, and everyone in their pockets--fight tooth and nail to keep us from having affordable health care, let alone *universal*; insist on demolishing Obama's imperfect attempt; and want to pretty much demolish Medicare and Medicaid...what do you expect us to do differently, that might actually work, become law, and *stay* law?
We've been trying to get health care since at least the mid 1800s, per "History of health care reform in the United States" (Wikipedia).

I happen to be on both Medicare and Medicaid (Medi-Cal, in California). I'm extremely grateful to have them. FYI, Medi-Cal pays very little to vendors (docs, etc.), and it's hard to get them to do it. Many docs won't take Medi-Cal patients. Some, like at least one of mine, will only take a Medi-Cal patient if the person also has Medicare. And we periodically lose certain Medi-Cal benefits. (E.g., most dental coverage may be cut, then restored a few years later.)

I'd be happy if everyone were put on Medicare. (Or on the Congressional health plan, as has occasionally been suggested in the media and to Congress.) Medicare doesn't cover everything, though, and doesn't pay the full, agreed-upon cost for what it does cover. So there are co-pays, which means members paying out of their own pockets, or getting Medicare Advantage plans to cover the difference, or getting Medicaid.

Both corporations and all levels of gov't (pardon my language) screw us over. To paraphrase G.K. Chesterton, it's not that universal health care in America has been tried and found wanting, or that nobody bothered; it's that we've tried and we've fought for it, and the powers that be keep taking it away.

Please don't assume that you understand the situation.

Oh, and per that Wikipedia article, it was the American Medical Association (AMA) that termed it "socialized medicine", in the early 1900s--and fought against it. (See also "Socialized Medicine" (Wikipedia), which is about the American usage of the term.)

[ 06. July 2017, 07:37: Message edited by: Golden Key ]

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mdijon
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quote:
Originally posted by Golden Key:
Oh, and per that Wikipedia article, it was the American Medical Association (AMA) that termed it "socialized medicine", in the early 1900s--and fought against it.

And in the UK the British Medical Association at one point voted against joining the newly-proposed NHS, although they did eventually get on board.

quote:
If medicine were taken over by the state, it would be as disastrous as was the domination by the Church in the Middle Ages; a greater disaster, because the Church was cultured."
quote:
the work of a complete and uncontrolled dictator, with quisling doctors to help him
quote:
a nationalised health service is the first step, and a big one, towards national socialism with the government as medical Führer

Sounds familiar? These were British doctors talking about the creation of the NHS.

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Jane R
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There was a lot of opposition to the NHS too when it was founded. The richer GPs and Harley Street specialists were worried about their income and used their clout to get extremely favourable terms for doing NHS work. That's why GPs all earn shedloads of money (compared to nurses) and senior consultants only work part-time for the NHS and can see private patients all the rest of the week.

And we still have a private health service, it's just that the average person never uses it because it's not worth paying all that extra money if the NHS can do the job instead. The super-rich can still get their private hospital rooms and personal physicians.

[x-posted with mdijon]

[ 06. July 2017, 07:56: Message edited by: Jane R ]

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