Canadian healthcare system shows how much money America could save
The Great White North has found a way to provide universal healthcare with more salubrious results and trimmed national costs. Take notes, America.
- The United States scores dramatically lower than other high-income countries in healthcare benchmarks, despite overspending them.
- A recent report published in JAMA suggests this discrepancy results from runaway administrative costs and U.S. practitioners charging more for the same medical services.
- By taking lessons from Canada's single-payer system, the U.S. may be able to reduce its healthcare costs but simultaneously improve medical access for wider range of the population.
Americans are split over Canada's single-payer healthcare system. Some see it as a model to be adopted by the United States. Others see it as an inefficient system that will hinder America's competitive edge. Proponents of either side can, of course, regale you with stories of former neighbors, distant cousins, or one-time coworkers who fled across the border to seek that elusively greener healthcare on the other side.
In truth, each system has its flaws. Canada's healthcare is universal, assuming you ignore the gaping oversight of not covering essential prescriptions; meanwhile, the U.S. has some of the best healthcare in the world, if you don't mind bankrolling a litany of unnecessary tests and treatments.
But Canada dominates its southern neighbor in one healthcare facet: cost savings. Despite publicly funding universal healthcare, Canada spent only 10.45 percent of its national GDP in 2014. The United State's expenditure was 17.4 percent of GDP. Per capita, Canada spent $4,641. The U.S.? Double that.
How does Canada do so much more with less?
Amputating administrative costs
In 2014, Canada spent 10.45 percent of its national GDP on healthcare. The United State's expenditure was 17.4 percent.
(Photo from Our World in Data)
According to a report published in the Journal of the American Medical Association, the reason the U.S. outspends Canada — and 10 other high-income countries —is not due to social spending or healthcare utilization. The culprit was price inflation across the board.
The report detailed that in the U.S. medical practitioners earn significantly more, individual services cost more, and Americans spend more on pharmaceuticals per capita.
Administrative costs were also singled out as a major price driver. According to the report, U.S. administration accounted for 8 percent of healthcare expenditures. In other high-income countries, that amount ranged from 1 to 3 percent.
"We have this discombobulated, fragmented system that leads us to have very high administrative costs, and everything is disconnected," said Dan Polsky, executive director of the University of Pennsylvania's Leonard Davis Institute of Health Economics. "You have to go from one system to another when you go from one provider to another. Some health [information] gets lost with the transfer from one provider to the next. And there's a private healthcare system that funds you when you are under 65, and when you're over 65, you get funded by Medicare."
A simplified overview of the U.S. healthcare system shows it comprises Medicaid, Medicare, Tricare, the Veteran's Health Administration, and a panoply of private health plans.
Further adding to the discombobulation, many Americans manage coverage through a patchwork of policies. A senior citizen, for example, may be on Medicare (a government-run program) but augment her coverage with a Medigap policy (insurance provided by a private company specifically to offset Medicare costs).
Meanwhile, the Great White North is currently debating whether to extend universal healthcare to encompass prescriptions. A report published in the Canadian Medical Association Journal, titled "How to pay for national insurance," found that implementing such a plan in 2020 would require $9.7 billion in new public funding.
The benefits? In addition to providing universal access to pharmaceuticals, national pharmacare would save the private sector $13.9 billion, a net savings of $4.2 billion.
The CMAJ report found that "[a]ccess to medicine is best facilitated when direct charges to patients are limited" and "[c]ost control is best achieved by single-payer systems that reduce administration costs and consolidate purchasing power."
So how much would America save if it adopted Canada's low cost, universal approach? According to a Commonwealth Fund report, the U.S. would save $1.4 trillion if it adopted Canada's healthcare approach.
Spending more, getting less
If the U.S. adopted Canada's healthcare approach, it could save as many as 101,000 lives from preventable deaths.
(Image from the Commonwealth Fund)
The United States' unprecedented spending would be worthwhile if it could produce results above and beyond those of Canada and other high-income countries. Sadly, the data suggests the opposite is true.
As noted in the JAMA report, the U.S. system covers less of its population — 90 percent compared to the 99–100 percent range of its peers. Americans go to the doctor less often and spend fewer recover days in the hospital.
The consequences of these differences are stark. Canadian citizens sport a higher life expectancy (82.21 years compared with 79.24 in the U.S.). The country's maternal mortality rate is also significantly lower. Only 27 pregnant women died in Canada in 2015, compared with 550 in the U.S. In fact, the United States' maternal mortality rate is the worst in the developed world.
As for those infamous Canadian wait times, they do exist but their effect on the Canadian healthcare system has been greatly exaggerated. They are mostly applied to elective procedures as a means of reducing cost.
As such, adopting Canada's healthcare approach would save the U.S. more than money. The aforementioned Commonwealth Fund report noted that the U.S. would avoid 101,000 fewer preventable deaths, 4,800 fewer infant deaths, and 42 million fewer American adults neglecting care because of costs.
Saving more than money
How is it that the U.S. system outspends so many other high-income countries, yet produces far less salubrious outcomes? The answer is an unequal distribution of healthcare, with spending being concentrated at the socio-economic top.
In the United States, the top 1 percent of spenders account for more than 20 percent of total healthcare expenditures. The spending of the top 5 percent accounts for almost half.
According to Esteban Oritz-Ospina and Max Roser, inequality in healthcare spending is to be expected — the elderly and individuals with complicated health conditions will always require larger expenditures. However, the discrepancy of spending in the data suggests to them that the United States suffers from an "inequality of access over and above inequality in need."
In contrast, Canada uses cost control to curb administration costs, allowing the country to cast a wider healthcare safety net that extends from the top to the bottom.
In sum, Canada's healthcare system isn't without its flaws, but we shouldn't make the best the enemy of the good. If the United States would learn from Canada's example, it could do a lot of good — and save some money in the process.
Join Radiolab's Latif Nasser at 1pm ET on Monday as he chats with Malcolm Gladwell live on Big Think.
Astronomers find these five chapters to be a handy way of conceiving the universe's incredibly long lifespan.
- We're in the middle, or thereabouts, of the universe's Stelliferous era.
- If you think there's a lot going on out there now, the first era's drama makes things these days look pretty calm.
- Scientists attempt to understand the past and present by bringing together the last couple of centuries' major schools of thought.
The 5 eras of the universe<p>There are many ways to consider and discuss the past, present, and future of the universe, but one in particular has caught the fancy of many astronomers. First published in 1999 in their book <a href="https://amzn.to/2wFQLiL" target="_blank"><em>The Five Ages of the Universe: Inside the Physics of Eternity</em></a>, <a href="https://en.wikipedia.org/wiki/Fred_Adams" target="_blank">Fred Adams</a> and <a href="https://en.wikipedia.org/wiki/Gregory_P._Laughlin" target="_blank">Gregory Laughlin</a> divided the universe's life story into five eras:</p><ul><li>Primordial era</li><li>Stellferous era</li><li>Degenerate era</li><li>Black Hole Era</li><li>Dark era</li></ul><p>The book was last updated according to current scientific understandings in 2013.</p><p>It's worth noting that not everyone is a subscriber to the book's structure. Popular astrophysics writer <a href="https://www.forbes.com/sites/ethansiegel/#30921c93683e" target="_blank">Ethan C. Siegel</a>, for example, published an article on <a href="https://www.forbes.com/sites/startswithabang/2019/07/26/we-have-already-entered-the-sixth-and-final-era-of-our-universe/#7072d52d4e5d" target="_blank"><em>Medium</em></a> last June called "We Have Already Entered The Sixth And Final Era Of Our Universe." Nonetheless, many astronomers find the quintet a useful way of discuss such an extraordinarily vast amount of time.</p>
The Primordial era<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMjkwMTEyMi9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyNjEzMjY1OX0.PRpvAoa99qwsDNprDme9tBWDim6mS7Mjx6IwF60fSN8/img.jpg?width=980" id="db4eb" class="rm-shortcode" data-rm-shortcode-id="0e568b0cc12ed624bb8d7e5ff45882bd" data-rm-shortcode-name="rebelmouse-image" />
Image source: Sagittarius Production/Shutterstock<p> This is where the universe begins, though what came before it and where it came from are certainly still up for discussion. It begins at the Big Bang about 13.8 billion years ago. </p><p> For the first little, and we mean <em>very</em> little, bit of time, spacetime and the laws of physics are thought not yet to have existed. That weird, unknowable interval is the <a href="https://www.universeadventure.org/eras/era1-plankepoch.htm" target="_blank">Planck Epoch</a> that lasted for 10<sup>-44</sup> seconds, or 10 million of a trillion of a trillion of a trillionth of a second. Much of what we currently believe about the Planck Epoch eras is theoretical, based largely on a hybrid of general-relativity and quantum theories called quantum gravity. And it's all subject to revision. </p><p> That having been said, within a second after the Big Bang finished Big Banging, inflation began, a sudden ballooning of the universe into 100 trillion trillion times its original size. </p><p> Within minutes, the plasma began cooling, and subatomic particles began to form and stick together. In the 20 minutes after the Big Bang, atoms started forming in the super-hot, fusion-fired universe. Cooling proceeded apace, leaving us with a universe containing mostly 75% hydrogen and 25% helium, similar to that we see in the Sun today. Electrons gobbled up photons, leaving the universe opaque. </p><p> About 380,000 years after the Big Bang, the universe had cooled enough that the first stable atoms capable of surviving began forming. With electrons thus occupied in atoms, photons were released as the background glow that astronomers detect today as cosmic background radiation. </p><p> Inflation is believed to have happened due to the remarkable overall consistency astronomers measure in cosmic background radiation. Astronomer <a href="https://www.youtube.com/watch?v=IGCVTSQw7WU" target="_blank">Phil Plait</a> suggests that inflation was like pulling on a bedsheet, suddenly pulling the universe's energy smooth. The smaller irregularities that survived eventually enlarged, pooling in denser areas of energy that served as seeds for star formation—their gravity pulled in dark matter and matter that eventually coalesced into the first stars. </p>
The Stelliferous era<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMjkwMTEzNy9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxMjA0OTcwMn0.GVCCFbBSsPdA1kciHivFfWlegOfKfXUfEtFKEF3otQg/img.jpg?width=980" id="bc650" class="rm-shortcode" data-rm-shortcode-id="c8f86bf160ecdea6b330f818447393cd" data-rm-shortcode-name="rebelmouse-image" />
Image source: Casey Horner/unsplash<p>The era we know, the age of stars, in which most matter existing in the universe takes the form of stars and galaxies during this active period. </p><p>A star is formed when a gas pocket becomes denser and denser until it, and matter nearby, collapse in on itself, producing enough heat to trigger nuclear fusion in its core, the source of most of the universe's energy now. The first stars were immense, eventually exploding as supernovas, forming many more, smaller stars. These coalesced, thanks to gravity, into galaxies.</p><p>One axiom of the Stelliferous era is that the bigger the star, the more quickly it burns through its energy, and then dies, typically in just a couple of million years. Smaller stars that consume energy more slowly stay active longer. In any event, stars — and galaxies — are coming and going all the time in this era, burning out and colliding.</p><p>Scientists predict that our Milky Way galaxy, for example, will crash into and combine with the neighboring Andromeda galaxy in about 4 billion years to form a new one astronomers are calling the Milkomeda galaxy.</p><p>Our solar system may actually survive that merger, amazingly, but don't get too complacent. About a billion years later, the Sun will start running out of hydrogen and begin enlarging into its red giant phase, eventually subsuming Earth and its companions, before shrining down to a white dwarf star.</p>
The Degenerate era<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMjkwMTE1MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxNTk3NDQyN30.gy4__ALBQrdbdm-byW5gQoaGNvFTuxP5KLYxEMBImNc/img.jpg?width=980" id="77f72" class="rm-shortcode" data-rm-shortcode-id="08bb56ea9fde2cee02d63ed472d79ca3" data-rm-shortcode-name="rebelmouse-image" />
Image source: Diego Barucco/Shutterstock/Big Think<p>Next up is the Degenerate era, which will begin about 1 quintillion years after the Big Bang, and last until 1 duodecillion after it. This is the period during which the remains of stars we see today will dominate the universe. Were we to look up — we'll assuredly be outta here long before then — we'd see a much darker sky with just a handful of dim pinpoints of light remaining: <a href="https://earthsky.org/space/evaporating-giant-exoplanet-white-dwarf-star" target="_blank">white dwarfs</a>, <a href="https://earthsky.org/space/new-observations-where-stars-end-and-brown-dwarfs-begin" target="_blank">brown dwarfs</a>, and <a href="https://earthsky.org/astronomy-essentials/definition-what-is-a-neutron-star" target="_blank">neutron stars</a>. These"degenerate stars" are much cooler and less light-emitting than what we see up there now. Occasionally, star corpses will pair off into orbital death spirals that result in a brief flash of energy as they collide, and their combined mass may become low-wattage stars that will last for a little while in cosmic-timescale terms. But mostly the skies will be be bereft of light in the visible spectrum.</p><p>During this era, small brown dwarfs will wind up holding most of the available hydrogen, and black holes will grow and grow and grow, fed on stellar remains. With so little hydrogen around for the formation of new stars, the universe will grow duller and duller, colder and colder.</p><p>And then the protons, having been around since the beginning of the universe will start dying off, dissolving matter, leaving behind a universe of subatomic particles, unclaimed radiation…and black holes.</p>
The Black Hole era<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMjkwMTE2MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYzMjE0OTQ2MX0.ifwOQJgU0uItiSRg9z8IxFD9jmfXlfrw6Jc1y-22FuQ/img.jpg?width=980" id="103ea" class="rm-shortcode" data-rm-shortcode-id="f0e6a71dacf95ee780dd7a1eadde288d" data-rm-shortcode-name="rebelmouse-image" />
Image source: Vadim Sadovski/Shutterstock/Big Think<p> For a considerable length of time, black holes will dominate the universe, pulling in what mass and energy still remain. </p><p> Eventually, though, black holes evaporate, albeit super-slowly, leaking small bits of their contents as they do. Plait estimates that a small black hole 50 times the mass of the sun would take about 10<sup>68</sup> years to dissipate. A massive one? A 1 followed by 92 zeros. </p><p> When a black hole finally drips to its last drop, a small pop of light occurs letting out some of the only remaining energy in the universe. At that point, at 10<sup>92</sup>, the universe will be pretty much history, containing only low-energy, very weak subatomic particles and photons. </p>
The Dark Era<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMjkwMTE5NC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0Mzg5OTEyMH0.AwiPRGJlGIcQjjSoRLi6V3g5klRYtxQJIpHFgZdZkuo/img.jpg?width=980" id="60c77" class="rm-shortcode" data-rm-shortcode-id="7a857fb7f0d85cf4a248dbb3350a6e1c" data-rm-shortcode-name="rebelmouse-image" />
Image source: Big Think<p>We can sum this up pretty easily. Lights out. Forever.</p>
Innovators don't ignore risk; they are just better able to analyze it in uncertain situations.
Remarkable 'fan art' commemorates 50th anniversary of legendary guitar player's passing.
- Legendary rock guitarist Jimi Hendrix died exactly 50 years ago today.
- From September 1966 to his death, he performed over 450 times.
- This spectacular 'gigograph' shows the geographic dimension of his short but busy career.
Last night at the Samarkand<video controls id="3f8a7" width="100%" class="rm-shortcode" data-rm-shortcode-id="5cd31bc25fbed5fd4fbc5905d44527e8" expand="1" feedbacks="true" mime_type="video/mp4" shortcode_id="1600450310811" url="https://roar-assets-auto.rbl.ms/runner%2F19636-JimiHendrix_LivePerformances.mp4" videoControls="true"> <source src="https://roar-assets-auto.rbl.ms/runner%2F19636-JimiHendrix_LivePerformances.mp4" type="video/mp4"> Your browser does not support the video tag. </video><p>On September 17, 1970, Jimi Hendrix awoke at the Samarkand Hotel in Notting Hill, London, in the basement flat where his German girlfriend Monika Dannemann was staying. At around 2 p.m., they had tea in the hotel's garden and Monika took some snaps of Jimi with 'Black Beauty,' his favorite Fender Stratocaster guitar. Those were the last pictures ever taken of him. </p><p><span></span>Later in the afternoon, the couple went out – visiting local hipness hotspot <a href="https://en.wikipedia.org/wiki/Kensington_Market,_London" target="_blank">Kensington Market</a>, an antiques market in Chelsea and Jimi's suite at the Cumberland Hotel, near Marble Arch. They had tea and wine at a friend's flat, argued and made up, and went back to the Samarkand Hotel, where they had a late meal, drank a bottle of wine and Jimi wrote a poem titled 'The Story of Life.'</p><p>Well after midnight, Hendrix went to a party, where he took some amphetamine. Dannemann showed up at the party, and around 3 a.m. the couple returned to the Samarkand. Unable to sleep, Jimi took nine of Monika's sleeping pills (the recommended dose was half a pill). When she awoke that morning, she found him unresponsive and covered in vomit. Around noon of the 18th of September – exactly 50 years ago today – Jimi Hendrix was pronounced dead.</p><p>The last stanza of the poem he wrote the night before reads:</p><p style="margin-left: 20px;"><em>The story of life is quicker than the wink of an eye.</em></p><p style="margin-left: 20px;"><em>The story of love is hello and goodbye.</em></p><p style="margin-left: 20px;"><em>Until we meet again.</em></p><p>Amid the initial confusion surrounding his death, the poem was mistaken by some for a suicide note. Several subsequent investigations have provided nothing but indications of an accidental death. <br></p>
Immortalised in the '27 Club'<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDQyNDQ3NC9vcmlnaW4ucG5nIiwiZXhwaXJlc19hdCI6MTYxMDU1NjcxNX0.27c7ESrA2OnXExGCsigfs5jOVoAAAR-M9pn3sIFRZdA/img.png?width=980" id="b5894" class="rm-shortcode" data-rm-shortcode-id="6979d0862296c37bddbf9ea081cd3171" data-rm-shortcode-name="rebelmouse-image" alt="\u200bJimi Hendrix performing for the Dutch TV show 'Hoepla' on 11 June 1967." />
Jimi Hendrix performing for the Dutch TV show 'Hoepla' on 11 June 1967.
Credit: A. Vente, CC BY-SA 3.0<p>Arguably the<a href="https://www.youtube.com/watch?v=cJunCsrhJjg&ab_cha..." target="_blank"> greatest guitarist in rock history</a>, Hendrix was one of the first modern members of the '27 Club' – musicians immortalised mid-fame, dead at the still-tender age of 27. Earlier members include Robert Johnson (d. 1938) and Brian Jones (d. 1969), later ones Janis Joplin (who died two weeks after Hendrix), Jim Morrison (d. 1971), Kurt Cobain (d. 1994) and Amy Winehouse (d. 2011).</p><p>In the States, Hendrix had made a name for himself as a band guitarist, playing for both Little Richard and Ike Turner. Not an undividedly positive name: he got fired from both of those bands. His own career – as a solo artist, and as the leader of the Jimi Hendrix Experience – only took off when he moved to London. <br></p><p>The graph above connects over 450 dots, one for each gig he played. It shows the amount of hard work Hendrix put into his career, and how it paid off – after criss-crossing Northwestern Europe, but mainly England, his fame hops back across the Atlantic and becomes transcontinental. A few samples from his <a href="https://concerts.fandom.com/wiki/Jimi_Hendrix" target="_blank">gig database</a>:</p>
London first, London last<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDQyNDQ4My9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYzMDQ4MTg5Nn0.ST2r7qyiI9CELqKP0-CpoV7YIWioAEQBXscq9mJVESM/img.jpg?width=980" id="86886" class="rm-shortcode" data-rm-shortcode-id="0d79abc719416b4068456e6938fcd776" data-rm-shortcode-name="rebelmouse-image" alt="The Jimi Hendrix Experience in 1968, with Jimi, bass player Noel Redding (right) and drummer Mitch Mitchell (on the floor)." />
The Jimi Hendrix Experience in 1968, with Jimi, bass player Noel Redding (right) and drummer Mitch Mitchell (on the floor).
Credit: public domain<ul><li>24 September 1966: first solo performance in London, at Scotch of St James.</li><li>13 October 1966: first concert of the Jimi Hendrix Experience, supporting Johnny Halliday in Évreux, France.</li><li>18 January 1967: performing 'Hey Joe' on 'Top of the Pops', at the BBC TV's Lime Grove Studios in London.</li><li>18 June 1967: first stateside gig, at the <a href="https://www.youtube.com/watch?v=fe82eYRjiBU&ab_cha..." target="_blank">Monterey International Pop Festival</a> in California.</li><li>3 July 1967: first East Coast show, at the Scene Club in NYC.</li><li>9 October 1967: L'Olympia, Paris.</li><li>14 November 1967: at the Royal Albert Hall in London; first gig of package tour with Pink Floyd, The Nice and others.</li><li>31 December 1967: at the Speakeasy in London. Jimi plays a 30-minute rendition of <em>Auld Lang Syne</em>.</li><li>12 March 1968: jam session with Jim Morrison, Buddy Miles and others at The Scene in NYC.</li><li>22 June 1968: at The Scene in NYC, Jimi jams with the original lineup of the Jeff Beck Group, which also includes Rod Stewart and Ron Wood.</li><li>14 September 1968: Hollywood Bowl, Los Angeles.</li><li>23 January 1969: two shows at the <em>Sportpalast</em> in Berlin, Germany.</li><li>18 May 1969: Madison Square Garden, NYC.</li><li>29 June 1969: Mile High Stadium, Denver – the last performance of the Jimi Hendrix Experience.</li><li>17 August 1969: <a href="https://www.youtube.com/watch?v=MwIymq0iTsw&t=14s&..." target="_blank">Woodstock</a>, New York.</li><li>30 August 1970: Isle of Wight Festival, England.</li><li>16 September 1970: jam with Eric Burdon's new band War at Ronnie Scott's in Soho, London. Jimi's last public performance.</li></ul><p>This bit of 'fan art' was created by Owen Powell, who points out that "it's not an academic study of Jimi Hendrix's movements, more a visualisation of the data mapped in sequential order." So if he flew home between gigs, that's not recorded here. <br></p><p><em>The Jimi Hendrix 'gigograph' reproduced with kind permission from Mr Powell. Check out his <a href="https://twitter.com/owenjpowell" target="_blank">twitter</a> and his <a href="https://owenpowell.wordpress.com/" target="_blank">website</a>.</em></p><p><strong>Strange Maps #1048</strong></p><p><strong></strong><em>Got a strange map? Let me know at </em><a href="mailto:email@example.com" style="">firstname.lastname@example.org</a>.<br></p>
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