[Congressional Record Volume 140, Number 25 (Wednesday, March 9, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: March 9, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                         HEALTH CARE IN AMERICA

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
February 11, 1994, the gentleman from Georgia [Mr. Kingston] is 
recognized for 30 minutes.
  Mr. KINGSTON. Mr. Speaker, I know that the gentleman from New York 
[Mr. Solomon] is here and wants to talk about the budget. If the 
gentleman is interested, I will have a few comments on health care, and 
also we can tie it into the budget, because there are a number of 
issues that I know will affect the folks of New York. If the gentleman 
would like to mention anything about health care, I would be happy to 
talk to you about it.
  I think one of the things that is significant about the budget debate 
and one of the things I appreciate the gentleman's leadership on, is 
the fact that as we look at the budget, if we look at the revenues that 
came into the coffers in 1980, I believe it was $517 billion, and in 
1990 it was about $1 trillion.
  The only problem is that during that period of time, our spending 
outpaced our collections. So instead of balancing the budget with a 
period of increased revenues, we continued at deficit levels, and, as a 
result, we have I think as of February 9 a $4.51 trillion debt.
  One of the things that I would like to do is, if we consider as one 
of the proposals possibly a freeze, particularly in certain sections of 
our budget, then we would have an opportunity to allow revenues to 
catch up with spending. We could pay off the deficit as a result of 
that, if not the first 2 or 3 years, certainly in the 4th or 5th year. 
And then, along with that, what we could do is balance the budget, and 
then pay down the debt, which right now is about 14 to 18 percent of 
the total budget that we are spending. And it is very hard for Members 
of Congress to go back and explain to people on Social Security or on 
welfare or educators who are looking out for Head Start or other 
programs that we do not have enough money, and yet 14 percent of what 
our expenditures are are going just on interest on the national debt.
  So I certainly appreciate the leadership of the people on the Budget 
Committee, people like Mr. Kasich and Mr. Shays and Mr. Solomon in that 
regard.
  I want to talk a little bit about health care, because during the 
last week there have been a number of polls that have come out about 
the Clinton health care plan and about some of the various proposals.
  I think one of the ones that was of interest is the fact that the 
Washington Post had a poll that came out I think last Tuesday that said 
8 out of 10 Americans are concerned that the quality of their health 
care would be decreased under the Clinton program. Yet they were not 
blaming that on the Clinton program per se; they were blaming that on 
the bureaucracy that would be running the program.
  One of the questions that I get at home in town meetings is, is this 
nationalized health care? When I answer that question, I always say let 
me just tell you what the National Health Care Board does, and then you 
decide.
  The National Health Care Board would be charged with a number of 
things. But among them are developing and implementing a national 
health insurance system; setting standards for doctors and health care 
providers; prohibiting health care providers from performing certain 
procedures not deemed necessary. That would be, of course, protocol 
laws. Write and develop and approve language for insurance policies; 
gather information and evaluate it; control health care costs; set 
community rates on a national basis; have an oversight power for drug 
pricing; set health care budgets in the form of insurance premium caps; 
and the list goes on and on. And I have tried to document this as much 
as possible.
  Most of the power of the National Health Care Board is in section 
1503, section 22, section 1911, section 1571, and section 1141. It 
shows what the National Health Care Board does. And in the sense that 
they would be running 14 percent of the GNP, then I think you could 
certainly make the argument that the Government would become the sole 
controller, or they would have the governing authority on almost all 
health care matters.
  The second question people ask me is how much would that bureaucracy 
cost. And generally it is going to cost about $400 billion over a 5-
year period of time. The National Health Care Board alone would be 
about $2 billion. This is all part of the program.
  The bill is, 1342 pages long, so it is not something that we can 
always predict in terms of cost. But people have asked what would the 
cost be? Even if that is the case, is the Government that far off being 
wrong now? One of the things that came out last week or the week before 
was that the nonpartisan Congressional Budget Office said that the 
Clinton health care plan would actually increase the deficit $74 
billion rather than decrease it $50 billion, which is what the 
President had said.
  But look at the Government track record when it comes to evaluating 
the cost of programs. If we go back to the 1960's, we find that in its 
early days, Medicare actually ran 70 percent above the projected budget 
for the first 5 years that it was in operation. And in countries such 
as Canada and France and Germany, where you have socialized medicine 
plans, there are constant budget crises. Canada, I believe in December, 
came out in the Province of Ontario and said the hospitals had to cut 
about $200 million from their budget and there they required hospital 
staff to take 12 days of unpaid leave and closed down about 250 
hospital beds since last year. That is just a small example.
  Now, one of the things that also has come up in the last week was 
this situation where the DNC has got a quote in an ad that Governor 
Carroll Campbell is saying there is not a health care crisis, which is 
too bad, because he never made that statement. He was saying there 
certainly is a crisis. The crisis is more pronounced in some areas of 
the economy and for some people than it is for others.
  It is a complete misrepresentation of his words. But if we do dare to 
examine who is the 37 million who are uninsured, we find that 70 
percent of these 37 million are transient uninsured, and that they are 
going in and out of the system as they are finding a new job or they 
are temporarily out of work, and so forth.
  Many of them are on COBRA. But that leaves about 11 million hardcore 
uninsured. And those are the folks who are the working poor, the folks 
with the high risk health problems like multiple sclerosis and cerebral 
palsy and so forth, and these are the men and women we need to target 
the first level of reforms at.

                              {time}  1950

  I believe the Michel plan does that. The Michel plan, of which I am a 
cosponsor, allows small businesses to form purchasing pools so that 
they could have the economies of scale that large businesses have. It 
allows greater tax deduction for unincorporated businesses. Currently 
unincorporated businesses can only have a tax deduction of 25 percent 
as opposed to incorporated businesses who have to have 100 percent. It 
allows some of the malpractice reforms which would allow hospitals to 
exchange lifesaving and premium dollar saving information back and 
forth without being sued for antitrust.
  It has malpractice reform. It has MediSave accounts and so forth.
  I want to say that unfortunately this MediSave account is getting a 
lot of undue criticism. I do not think anybody is saying the MediSave 
account will completely reform medicine by itself, but the idea that 
consumers drop off a cliff when it comes to health care, no one can 
tell you if they break their arm, if it is going to cost $150, $400, 
$600 and so forth. Yet would these same American consumers go to a 
store, a retail store that did not have price tags on its goods? Never. 
But when it comes to medicine, we do not seem to know what the costs of 
goods and services are.
  I believe if we had some disclosure of physician fees, along with 
hospital fees for various services, and MediSave accounts that would 
empower consumers rather empower the Government, we would have the 
placement of a competitive market in the medical system which is 
absolutely void of it right now.
  The gentleman from California has joined us. I yield to him.
  Mr. HUNTER. I want to thank my friend for yielding.
  On the subject of the MediSave account, I think you have accurately 
stated that it would be beneficial. We had a chance to have one 
company, their name escapes me now, this has been several weeks ago, 
but in fact several companies from the private sector came in and 
testified to the Republican Task Force on Health Care and talked about 
how their employees reacted to their MediSave accounts, where they gave 
the employees catastrophic coverage at the top end, then they gave them 
so much money. And if they did not spend the money on medical 
procedures, they got to keep it.
  They talked about the way the employees reacted to that, how that 
trained them and disciplined them to be careful spenders of health care 
dollars. And ultimately, the employees ended up saving money, enjoying 
this choice.
  This freedom that you have when you have a MediSave account, I think 
that goes back to the basic bill.
  The facts are that what we offer, as Republicans, I think puts more 
trust in the American people than the package that is offered by the 
Democrats.
  Mr. KINGSTON. I want to throw something in. I was an economics major 
in college. I did my senior year term paper on the Russian agriculture 
system. I wish I could remember all the statistics, but the Government 
collective farms, which basically the farmers of Russia had to give all 
their food to the Government, they allowed the individual farmers to 
keep or, excuse me, to use 25 percent of their land for their own food 
production.
  It turned out, on that 25 percent of the land that the farmers would 
keep all their production on, that produced more crops than the entire 
75 percent in the system that went to the Government. The point is that 
if people are using their own money, they have a motive to keep 
whatever is leftover for a college education, long-term health care, 
they will be a lot more careful than what is happening right now, where 
insurance companies are going in there and you have bureaucrats 
spending their money.
  American consumers know how to spend their money a heck of a lot 
better than we do in Washington.
  Mr. HUNTER. The gentleman is right on that accountability aspect.
  I had a constituent of mine, a senior citizen come in to my office 
months ago. She said, ``Congressman, I was told not to complain about 
this because insurance is paying for it, but I just feel like it is my 
duty to show you what is going on.''
  She held up a little wrist brace, a little piece of plastic. She had 
had a sprained wrist. She was given a wrist brace to immobilize that 
wrist. It had two little elastic bands on it.
  The bill to the insurance company was $550. She said, ``That is not 
the kicker. Here is the kicker.''
  She held up a little cheesecloth mitten that could not have cost more 
than 5 cents or 6 cents to make. She showed me the bill. The bill on 
that cheesecloth mitten was $120. She was told, do not worry about it. 
The insurance is going to pay for it.
  I am sure that even the insurance company is going to try to whittle 
that bill down. They will not accept something that outrageous.
  I felt, as the guy who used to have to defend the $600 hammer, as a 
prodefense person, remember that in the mid-1980's, and the $300 
military ashtray, that here we had the equivalent of a $600 hammer. But 
it was the $600 medical hammer. The reason we had it was the same 
reason that we had the $300 ashtray and the $600 hammer with respect to 
the military establishment. That is, because there was no individual 
directly responsible for paying that money.
  This constituent of mine had enough of an ethic and a sense of 
responsibility to come and complain about this and to fight it. But I 
think the fact that you do not have accountability on many of the 
things that are purchased in health care means that you have a lot of 
overcharging going on. And you do reduce that in the MediSave accounts 
when these families have a chance to save money, if they do not spend 
it. I think it would be safe to say that if a family had a thousand 
dollars in their MediSave account and they knew they were going to get 
that at the end of the year, if they did not spend it, and one of their 
kids got a wrist sprain in a football game that they would, and the 
doctor put a little wrist brace on it and said, ``I'm going to charge 
you $550 for it,'' I think you would hear the roof come off of that 
doctor's office. Because it was their money, and they would not allow 
that.
  Mr. KINGSTON. They would know exactly how much that wrist brace was 
going to cost them, also, because they would have information available 
to them. And they would find out. They would have the motivation.
  The beauty of the MediSave account is that it cuts out the middle 
man, the big insurance companies and all the bureaucracies are out of 
it. You go directly to the source. You make your purchase at the point 
of purchase, and you pay for it. But I think it empowers consumers and 
not the Government.
  And finally, most important, it puts that free market mechanism to 
work in medicine, which it is not allowed to do right now.
  If the gentleman will allow us to move on, one of the things I wanted 
to talk about also was the reform.
  And so often in Washington we seem to be debating, do we want 
McDermott, do we want Clinton, do we want Michel, do we want Armey, do 
we want Cooper, Wellstone, Clinton.
  We are looking at all these things. What about the local reforms that 
are already going on? They are going on all over your great State of 
California. I know they are going on all over Georgia.
  I was at a retreat that a hospital had this weekend, and I went and 
listened to some of the reforms they are doing. It is textbook example 
of what can be done in medicine, if government stays out of it.
  There are things that are making it more competitive, bringing down 
the prices, and assuring the quality is still there, increasing 
quality. And these reforms are going on now without Washington and 
without the State legislature. And it makes me think that we need to 
end this debate, include the efforts of local people and what they are 
already doing before we go off and nothing happens to it in Washington 
in this great body called the United States Congress.
  Mr. HUNTER. I think the gentleman is right. I think in a way we are 
making the same mistakes that a lot of very intelligent people made in 
Moscow for many years. That was when a 5-year plan failed, and we know 
it failed because a government does not make anything efficiently, and 
government cannot direct costs to go down, and government cannot 
mandate prosperity. But when a 5-year plan failed, the Kremlin would 
stick another batch of bureaucrats into it. They would say, there are 
not enough bureaucrats.
  There is not enough control. There is not enough government 
intervention in this particular enterprise.
  And they would overload it even more, and it would fail quicker than 
it had before. Any they never broke the code until we taught them that 
socialism does not work.
  I just hope that we remember that lesson that we taught the entire 
world.
  Mr. KINGSTON. I think that is a good point, because although people 
are rejecting Washington driven alliances on a local basis, I am 
finding that if it is a voluntary alliance and it is one that is 
controlled locally by the private sector, then they are willing to take 
a look at it. But they do not want us in Washington mandating a series 
of licenses saying that this is the cooperative that you have to get 
your health care from, you have to give up what you have now, and we 
are going to set the price. We are going to take all the negotiation 
out of it from you locally.
  The Michel plan would allow this, because there is another difference 
between it and the Clinton plan. It does not repeal the McCarran-
Ferguson Act. The Clinton plan repeals McCarran-Ferguson and says 
basically that States can no longer regulate health care, that it will 
be the domain of the U.S. Congress and the Federal Government. And in 
doing so, it usurps the power of 50 States, but it takes away all this 
local initiative, which is to me one of the biggest tragedies and one 
of the things I have found, as a new Member of Congress, is that the 
franchise or the franchises on brilliance are not issued in Washington, 
DC. There are a lot of brains back home, a lot of thinking people who 
can handle their problems just fine without us.
  Mr. HUNTER. The gentleman is absolutely right. We have 435 Members of 
the House and 100 Members of the other body.

                              {time}  2000

  We cannot possibly be experts on everything, and there is no way that 
Members of Congress can respond in a meaningful and thoughtful way to 
the complaints and the ideas and the initiatives of all of these 
constituents across this country, and the health care professionals, 
and the patients, and the folks who are affected by health care if they 
all come to Washington, DC., instead of going to their local bodies to 
try to steer the right course. There is no way we can handle them. We 
do not have a staff big enough to handle them.
  So what it means is there is going to be a lot of hastily conceived 
ideas that do not work in practice where we have not looked at the 
great laboratories, which the States are in terms of making policy. And 
we are going to make a lot of mistakes. Washington cannot solve this 
problem.
  Mr. KINGSTON. Another thing that is interesting about this health 
care debate is last week I made a list of the various plans and the 
numbers of cosponsors per plan. And it was amazing to me, I think the 
two plans with the most cosponsors were the Clinton plan, I think with 
101, and I do not want to say exactly, but I believe that was it, and 
the Michel plan with 161. The other plans, some of them had 40, some of 
them had 20, and some of them that get a lot of publicity do not have 
very many cosponsors.
  But last night, as you and I know, there was a tribute to 
Representative Bob Michel, and over and over again we heard great words 
about Bob Michel. And there was one thing that was just absolutely in 
every sentence, and that was ``nonpartisan leader,'' a ``nonpartisan 
guy,'' ``nonpartisan Republican,'' ``a bipartisan thinker,'' ``a 
consensus builder.'' And so here is this guy who really does epitomize 
the best of both parties in terms of bipartisan cooperation, and his 
plan is not a Republican plan, it is a bipartisan plan. And we have 
offered the bill to our Democrat colleagues and said please sign this 
bill. It is a good bipartisan bill and we welcome your support, because 
we want to target our reforms on the 10, 12 million uninsured, the core 
uninsured right now. We want to give States flexibility, and we want to 
empower consumers and not government, and we need your help.
  Mr. HUNTER. The gentleman is exactly right. I was not at the tribute 
to Bob Michel last night, but when the gentleman said nonpartisan, 
bipartisan, he described Bob Michel, a guy whose first question is, 
``How will this help America and how will it help Americans?''

  I think it is interesting that he has more cosponsors on his plan 
than the President of the United States has on his plan.
  Mr. KINGSTON. I know the gentleman from New York wants to talk about 
the budget, and we are going to yield the floor in a minute. But we 
need to pound that nail very deep into the wood of thinking here, 
because when we talk about it, here is a quote from Tip O'Neill who 
called Bob Michel ``the finest Republican that ever walked the floors 
of the House.'' There was a quote in the program from Speaker Foley, 
saying that he had always worked with him in a bipartisan fashion, that 
he was one of the finest Members of the House and they were very close 
personal friends. We are not talking about a partisan guy. We are not 
talking about a guy who is an in-your-face Republican in any way. We 
are talking about a guy whose first concern, his first thought in 
building a consensus, as the gentleman pointed out, is for what is best 
for the United States of America. And if it was not best, then you can 
be sure that Bob Michel would not lend his name to it.
  Mr. HUNTER. The gentleman is absolutely right. From Bob Michel 
carrying that BAR in World War II and just being concerned about those 
five or six guys in his squad, to becoming a representative from 
Peoria, IL, Bob Michel has always been concerned about his fellow 
Americans. And he does not distinguish Democrat-Republican. I think the 
fact that he has more people on his bill that the President indicates 
also that Bob Michel has been listening to the American people, as have 
the members of the Republican task force on health care who have done a 
great job, the leadership task force, and I think there is a little 
more of the American people's input into Bob Michael's bill and into 
this process than there is in the other bill, in President Clinton's 
bill.
  Mr. SOLOMON. Mr. Speaker, will the gentleman yield?
  Mr. KINGSTON. Absolutely, I yield to the gentleman from New York.
  Mr. SOLOMON. Mr. Speaker, I am just so impressed with the special 
order that is going on here because I represent an area in northern New 
York, and we have snow up there, we are at 7 feet it seems like now.
  I have a chain link fence around my property that is 7-feet tall, and 
I have Siberian husky dogs out there that are looking over the fence, 
the snow is so deep.
  But the point is that it borders on Canada, and there was a wire 
service story yesterday which indicated that their socialized medicine 
program that they have in Canada is now bankrupt. It is bankrupt, yet 
people cannot even get medical services there. And they flow across the 
Canadian border in my district, and all across New York on the border, 
and all across the rest of the country where they have to wait weeks 
and months for very, very minor but serious operations.
  The thing about Bob Michel's bill is, and you know his bill is 
subject to change like all of the rest, but his bill does not fix what 
is not broke. And the people in my area, senior citizens in particular 
are scared to death. They are scared to death when they hear about this 
single payer plan which is going to wipe out all of the other plans, 
wipe out Medicare and Medicaid and all of the large corporate health 
programs, all of the small business health programs, and they are just 
scared to death. Bob Michel's bill does not touch Medicare. It deals 
with those problems where for small businesses, under this plan small 
businesses would be able to, without a mandate, have small group 
insurance policies available to them. Do Members know how much of a 
savings that is? In other words, if you have a policy that is worth 
$5,000, costs you or your employee $5,000, just making a group 
insurance policy available reduces that cost about 20 percent, and 20 
percent off $5,000 is a lot of money. It is $1,000. Now you are down to 
a cost of $4,000, and do you know, and you two probably do your own 
income taxes like I know I do, but it is so frustrating to have to keep 
track of all of your medical bills, and your insurance costs. And then 
when you figure out the formula, and you go to take your deduction, you 
do not save a doggone thing. If you could write off the total cost of 
your insurance premium out of your pocket, and your deductible or your 
out-of-pocket medical costs, and if you had a cost of $1,000, and you 
were in a 25-percent tax  bracket or a 30-percent tax bracket, you have 
already reduced the cost of that premium by another $300 or $400.

  Then if we could ever get through medical malpractice in this 
Congress, think what that would do to lower the cost of insurance to 
individuals.
  You know, these are the things we ought to be doing. That is really 
what Bob Michel's bill does, and that is why I admire the gentleman for 
coming over here and talking about it.
  Mr. KINGSTON. If the gentleman will yield, first of all let me say 
No. 1, I am surprised that the gentleman has the ability, though I 
should not be surprised because he is certainly one of the brightest 
Members of Congress, to do your own taxes. But I think it is 
interesting to point out that the tax simplification bill of 1986 was 
491 pages long. This bill is 1,392 pages long, and I do not know too 
many people who do their own taxes. We have tax simplification, and yet 
many of the smartest business people I know right now have to go to an 
accountant, and so do the slower ones, such as me.
  So I certainly sympathize with all of them.
  Mr. HUNTER. I just want to thank the gentleman for having this 
special order and talking in a commonsense way about what we need in 
health care. I think the American people have, and I think my friend 
from New York knows this better than almost anybody because he has 
talked about it a lot, the thing I think that makes Americans a little 
different from Canadians, and Brits and Frenchmen, and Germans, and 
people in other countries that have adopted one form or another of 
socialized medicine, is that Americans have a little streak of 
independence in them, and they have a wariness of government, of big 
government. And I just hope that that commonsense instinct not to let 
big government say, ``We are from the government and we are here to 
help, and we are going to take over health care, we are going to make 
it cheaper, we are going to command it to be more efficient,'' I think 
the American people are a little more sophisticated than that, and a 
little more independent. And a lot of the so-called policy wonks in 
Washington, DC, these academics and others who have decided that the 
American people are not smart enough to be trusted with their health 
care, they have to have that handled for them, I think the American 
people are going to surprise the Clinton administration with their 
position on this bill.
  You know, it is interesting. The polls I have seen show that as 
people read the bill, and they are asked the basic question, ``Do you 
like it more or do you like it less now that you know more about it?'' 
Most Americans polled say, ``We like it less,'' after they have read 
it.
  That indicates to me that this is not going to be quite as easy a 
snow job as I think a lot of the folks thought it would be.
  Mr. KINGSTON. Let me ask both gentlemen a question. And I am serious 
about yielding the floor before the sunrises. The gentleman is from 
California, and this gentleman from New York and I am from Georgia, 
three different parts of the country. Ours incidentally has 80 degrees 
this week, so leave your huskies up there, but you may come down. The 
question that people are asking me is will I have to give up my current 
policy which I am happy with under the Clinton plan? And I tell them 
yes, and they are upset about that. How do the folks in California 
react, and I want to ask about the folks in New York, how do they feel?

                              {time}  2010

  Mr. HUNTER. Well, let me tell you, from the radio talk shows that I 
have been on, once they learn that, and I have debated this with 
Members of the other side of the aisle, and I cheated in the last 
debate, I actually brought the Clinton bill to the debate with me and 
read from it, and first, my opponent in the debate thought that that 
could not possibly really be the Clinton bill, but I assured him that, 
yes, it was.
  When people realize this is mandatory, you give up some freedoms to 
get this great security that the President talks about; the first 
freedom is the freedom not to be in the plan. It says every American 
shall be in the plan, and it also says every American shall contribute. 
Now, as I recall, if you do not contribute, you get fined substantially 
for not contributing.
  So the first thing you give up is your right not to be in it, and, 
you know, you mentioned, you were talking about the 37 million so-
called uninsured Americans and who they really are. A lot of those are 
folks that make over $50,000 a year and just say, ``Thank you very 
much, I will pay for my health care. I do not want to pay a middleman 
in an insurance company to have health care.'' I think Americans ought 
to have that right.
  So there are a lot of freedoms that are given away, and I think 
Americans are pretty wary right now of giving up freedoms.
  Mr. KINGSTON. I would ask the gentleman from New York [Mr. Solomon], 
is that how folks in New York feel?
  Mr. SOLOMON. Listen, you would think the gentleman from California 
[Mr. Hunter] represents my people up in northern New York up there.
  Mr. HUNTER. I will in the springtime. Not the winter.
  Mr. SOLOMON. He sounds just like Gerry Solomon.
  I will tell you what people up there are alarmed about. They are 
alarmed that some bureaucrat is going to be dictating to them who is 
going to deliver the medical delivery care system to them. They are 
terribly concerned about it. They are concerned that they are going to 
have to pay more for less medical services, that we just cannot allow 
to happen.
  Mr. HUNTER. Let me just add one thing.
  Incidentally, let me thank the gentleman from Georgia for making this 
special order happen. His deliberate analysis of this health care bill 
is real important.
  One thing I would offer folks to think about in a commonsense way is 
that we are going to have 300,000 new Government bureaucrats injected 
into this, hired to manage health care. If we have a finite amount of 
money available for health care in this country and we want to have as 
much of it as possible being used to actually be used for treatment, 
that interaction between doctors and patients, well, that means that 
not only are we going to be continuing to pay the middlemen you talked 
about, the insurance guy that used to have those guys in the middle, 
you are going to be paying the lawyer cause the trial lawyers who own 
the Clinton administration are going to be getting their cut of the 
action, but now you are going to be paying 300,000 fine Federal 
workers, and you are going to be using the same finite dollars, that 
is, dollars that the American people earn to pay that.
  The SPEAKER pro tempore (Mr. Strickland). Pursuant to the Speaker's 
announced policy of February 11, 1994, the gentleman from New York [Mr. 
Solomon] is recognized for 30 minutes as the minority leader's 
designee.

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