WBUR interviews people who think a lot about health care, including the CEO of Boston Medical Center, on what happens now that Republicans who campaigned against Obamacare for seven years couldn't repeal it even after taking control of the federal government.
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Comments
I'm still pissed
By anon
Wed, 07/19/2017 - 8:44am
A Dem MA Gov allowed a shit federal plan to take over a function state plan implemented by a Rep.
We're ALL worse off because of Deval and it a conversation which has completely been skipped. Premiums are going to continue to climb in tandum with deductibles.
Also never forget, Deval spent $1B on a website.
Didn't we get a waiver?
By dmcboston
Wed, 07/19/2017 - 12:44pm
IIRC, some states that had a good pre-existing (not medical condition, insurance plans) setup got a waiver. Probably limited, because the state approved plans weren't up to Federal standards of covering abortions, contraceptives, addictions, etc.
The 'one size fits all' doesn't work.
I was puzzled by how the hell can you spend a billion $$ on a website. I read an article years ago that seemed to explain it. All you have to do is integrate inputs from about nineteen different govt agencies using different computers and operating systems. It was doomed.
Well, not so good.
Smart move by Republicans...by accident
By O-FISH-L
Wed, 07/19/2017 - 9:13am
Thank God for the likes of Sen. Rand Paul M.D. (R-KY) for urging a clean repeal of disastrous Obamacare and blocking any equally bad Trumpcare. The Dems own the current mess, "If you like your Doctor you can keep your Doctor" with it's massive premiums and deductibles.
Replacement
By George_Apley
Wed, 07/19/2017 - 9:27am
What policy proposals would you support to help slow down the massive premiums and deductibles? Repealing Obamacare won't do that on its own. Growth in health care spending will continue with the law in place or not. Before the ACA premiums were on the rise and millions couldn't even access the system without going deep into debt. Advocate a "clean repeal" if you must, but you must have some idea how to replace it if you've diagnosed the problems as "massive premiums and deductibles".
Have more babies
By EM Painter
Wed, 07/19/2017 - 9:38am
Cure more diseases
Transhumanize them
By EM Painter
Wed, 07/19/2017 - 11:02am
Expensive to keep the bio shell going. Who needs it? Better off without it
One View
By BostonDog
Wed, 07/19/2017 - 10:19am
There is view held by many in the GOP (and likely commenter FISH) that those without health insurance should go without healthcare, even if it leads to pain or death.
They see nothing wrong with denying care to the poor since, in their mind, one "chooses" to be poor. If they can't afford healthcare it's their own fault and society owes them nothing.
I know no one who thinks that
By Patricia-can't ...
Wed, 07/19/2017 - 11:57am
I know no one who thinks that. I have very conservative friends as well as very liberal friends.
You actually know someone that wishes people dead.
I'd find better friends. Or, I'd pipe down on the hyperbole.
Here's the problem
By dmcboston
Wed, 07/19/2017 - 12:44pm
"If they can't afford healthcare it's their own fault and society owes them nothing."
So, instead of taking the rug rat to the doctor for an appointment for that cough, you wheel him into the emergency room. You can't be denied, and you're costing the system at its most expensive point.
When I was a kid, the City of Boston had health clinics set up where we lived. Schools gave out shots and did exams. So, poor folks had some access to health care.
I don't think anyone [i]wants[/i] poor people to just go away and die, but if costs aren't controlled the system will come apart at the seams.
massive premiums and deductibles.
By anon
Wed, 07/19/2017 - 9:28am
Unless you're poor or unemployed. Obamacare was passed on the backs of the middle class during a period when the middle class was disappearing. For free shit paid for by the working class.
Ha ha, you're killin' me
By adamg
Wed, 07/19/2017 - 1:25pm
Not literally, of course, but maybe you forgot the part where the main reason for Republicans to repeal Obamacare was to end the tax on the 1% that in large part funded the subsidies for the poor and, yes, middle class.
Citation please
By dmcboston
Wed, 07/19/2017 - 2:07pm
Citation please.
You really don't know how to google
By anon
Wed, 07/19/2017 - 2:18pm
You must not read the actual news - just flashy in-group memes on Alt-Right shitposting sites.
Sad little bunny.
Nice sunglasses
By dmcboston
Wed, 07/19/2017 - 2:45pm
The conversation was going relatively well until you showed up.
[img]http://i.imgur.com/5qAVZbo.jpg[/img]
Since you are a fan of people
By Kinopio
Wed, 07/19/2017 - 10:23am
Since you are a fan of people losing healthcare coverage, why don't we take yours away too? If you really were a cop then taxpayers have been subsidizing you. Lets kick you off and make you pay for everything else yourself. Fair is fair right?
I have always paid into my health insurance
By O-FISH-L
Wed, 07/19/2017 - 10:48am
To whatever extent the public pays for retired police healthcare, I'm grateful. I also pay in as a retiree and paid more while active. Still, we have huge deductibles for an office visit and significant co-pays for prescriptions. Luckily, I'm in good health but the nature of the job, even more so for firefighters, offers significant health risks and many of the guys and gals die young.
If I knew a perfect solution to healthcare, I'd be in Washington but many of the questions seem easily answered. A 27 year-old healthy, single male shouldn't have to pay for gynecology. If someone is in good health and doesn't want insurance, they should have the right to refuse. I think a lot of the "Republicans stripping coverage" is from people who don't want it forced upon them. Insurance should be allowed to cross state lines with policies for the bare minimum like GEICO and State Farm on cars. Of course tort reform will never happen with all of the lawyers in Congress but before quitting at age 75, my Harvard educated PCP told me that "defensive medicine" was putting him out of business. Maybe a cap on the John Edwards ambulance chasing crowd could help control costs.
Explain
By BostonDog
Wed, 07/19/2017 - 10:52am
So if they don't buy it and get sick, who should pay? Currently if they can't afford it (or skip out on the bill) the hospital eats the tab and they pass that onto everyone in the form of higher fees.
Well, the 27 year-old is only alive because their Mother got these sorts of care. Woman pay for urology and men pay for gynecology if it makes you feel better.
I agree with needed Tort reform but most experts have said it wouldn't dramatically change the cost dynamics. And something tells me if a doctor screwed up and did something wrong to you, you wouldn't just shrug and say "Mistakes happen".
A 27 year-old healthy, single
By ZachAndTired
Wed, 07/19/2017 - 11:23am
I see a lot of lot arguments similar to this kicking around, but they run counter to the way that insurance actually works. If we had a system where people only pay for the services that they expect to use, then you end up with an a la carte system where every pool is high risk, premiums are basically equivalent to what it costs to pay for the services out of pocket without insurance, and people are not covered for unforeseen emergency situations. It doesn't work.
Don't get me wrong
By Stevil
Wed, 07/19/2017 - 11:34am
Huge proponent of universal care. We just need to make it less complex and less costly.
Hiwever, the argument about gender specific care is not valid. It's the equivalent of telling someone that doesn't drive that they need auto insurance.
You buy insurance to pool risk. If you don't face that risk, you shouldn't but insurance for it.
The only difference between health and cars
By Will LaTulippe
Wed, 07/19/2017 - 11:40am
Is that you don't (expletive) your car and maybe get it pregnant. I don't love paying for other peoples' care by fiat, but there's a benefit in spending some money to get women to the gyno, because then they can be told for the record that they don't have an STD, and then they can enter the messing around pool free and clean. That benefits my interests.
Shh
By Sock_Puppet
Wed, 07/19/2017 - 11:41am
Stevil's mommy didn't tell him about where babies come from yet.
Shhhh
By Stevil
Wed, 07/19/2017 - 12:10pm
Nobody has told Sock_puppet how insurance works yet.
That's not insurance
By Stevil
Wed, 07/19/2017 - 12:42pm
That's a tax. Kinda like everyone thinks social security is a tax. It's not. It's insurance (and the worst run insurance in the country save Medicare).
How about
By anon
Wed, 07/19/2017 - 2:20pm
NO VIAGARA FOR YOU
And NO PROSTATE EXAMS, NO SCREENING FOR YOUR PENIS. NOTHING.
Oh, but that's different?
Go fuck yourself, asshole.
One of these things...
By dmcboston
Wed, 07/19/2017 - 2:47pm
...is not like the other.
"NO VIAGARA FOR YOU
And NO PROSTATE EXAMS, NO SCREENING FOR YOUR PENIS. NOTHING."
Well?
Parthenogenesis?
By anon
Wed, 07/19/2017 - 2:19pm
It takes TWO PEOPLE to make a baby.
No sex for men again ever ... is that the world you want?
Personalized insurance
By Sock_Puppet
Wed, 07/19/2017 - 11:38am
A healthy fifty year old man with back problems shouldn't have to pay for diabetes coverage. A hyperactive child with a blazing fast metabolism shouldn't have to pay for Cushing's syndrome. An old lady with emphysema shouldn't have to pay for erectile disfunction treatment.
This should be a board game.
No one pays this way
By BostonDog
Wed, 07/19/2017 - 12:06pm
Insurance isn't ordering off a menu. Men don't pay specifically for OBGYN coverage and even if it's listed as a covered option. Insurance companies know men won't be needing pregnancy services and most woman won't be needing prostate exams. It all evens out.
There are low risk and high risk people but that's mostly a factor of uncontrollable factors such as age and genetics. For "lifestyle" decisions such as smoking they are allowed to charge different policy amounts.
Well...
By dmcboston
Wed, 07/19/2017 - 1:08pm
...don't let them get their hands on your genetic profile.
Whoops, too late!
Translation
By Bob Leponge
Wed, 07/19/2017 - 12:48pm
Translation: Instead of standard coverage with underwriting based on only 4 questions (age, sex, occupation, zip code) we go back to the old 30 page application, leading to that libertarian paradise of "coverage customized just for you." And then the insurance company gets to deny your claim for leukemia treatment, because you neglected to mention on the 30 page application form that you had acne when you were 15. ("Lied on the form? Claim denied!")
The whole point of insurance is to spread the risk. That means people who are lucky enough not to have a kid with cerebral palsy pay a little extra, so that the people with the bad luck to have a kid with cerebral palsy can catch a break.
Pools are the problem and the solution, maybe?
By dmcboston
Wed, 07/19/2017 - 1:06pm
"This should be a board game."
Maybe you're right.
"Huge proponent of universal care. We just need to make it less complex and less costly."
I've dealt with high risk pools in the past in real estate. 'Red-lining' was a system of denying property in certain areas coverage. Usual solution was some type of state run insurance pool to spread the risk using reinsurance. Did it work? Well, poor areas had the highest insurance rates. Not the ideal solution.
Maybe it should be a board game...pools of different scaled risks are insured at different rates.
25 year old non smoker...pretty good risk, coverage for most stuff, probably doesn't want gyno, or dental, but, hey it's your choice. Lower the premium even more with a high deductible.
High risk person that totally can't afford shit for coverage (We won't cover heart problems, Mr. AGGGGGHHHH) get help from a high risk pool.
Pools. Saunas. Get what you need or can afford. You want Cadillac? Pay for Cadillac. Or BCBS. You want minimum? Get it.
An internet troll
By Sock_Puppet
Wed, 07/19/2017 - 1:10pm
With a functioning sarcasm detector shouldn't have to pay to cover humor disfunction.
Okaaayyy
By Katie
Wed, 07/19/2017 - 12:13pm
Fine. A healthy 27-year old woman shouldn't have to pay for erectile dysfunction.
This is not how insurance works.
That's a correct statement
By Stevil
Wed, 07/19/2017 - 12:46pm
If you are pooling risk, that's insurance.
If you are forced to pay for pooling someone else's risk by the government, that's a tax.
But Healthy People
By Meg
Wed, 07/19/2017 - 1:05pm
Drive the cost down because they're creating less claims to the company than the sicker people, who drive those numbers up.
Also, if you have an issue on what your insurance covers, talk to your employer. They're the ones that create the coverage. Not the insurance companies. That and the DOI makes everything specific, so go ahead and fight with them too.
I work for insurance. Don't mess with me, bro.
That's lovely
By Stevil
Wed, 07/19/2017 - 5:50pm
Absolutely nothing to do with my comment.
But lovely
I would never belong to a pool
By Sock_Puppet
Wed, 07/19/2017 - 1:11pm
That would have me as a member.
Depends on the size of the pool
By dmcboston
Wed, 07/19/2017 - 1:23pm
Obamacare seemed to make it just one big pool, possibly leading up to single payer when it crashes.
Probably a better way of doing it is to let the companies set tiered risk pools, with the most expensive ones, the hopelessly expensive ones, with significant subsidies.
There's a reason the Shriners Hospital in Boston doesn't have a billing department.
Forget "risk"
By tachometer
Wed, 07/19/2017 - 1:33pm
You keep talking about "risk" but that is such an unknown factor that it is nearly meaningless and the argument should be framed around pooling coverage.
It doesn't matter what the specific treatment is for, it's about actuarial tables and how there are segments of the population that have high medical costs and segments of the population that have low medical costs (an an accident can put that healthy 27 year old into the high medical cost without warning). So with a very large pool, preferably the entire population, if you're in the latter you pay a little bit more to cover the former so that if/when you end up in the former you don't go bankrupt and get the coverage you need thanks to the folks who are at that time in the latter pool.
So unfair
By Sock_Puppet
Wed, 07/19/2017 - 7:09pm
Nobody should ever have to be in an insurance pool with people sicker than him.
You should call Ryan with this insight!
Meaning, back to the argument
By Katie
Wed, 07/19/2017 - 1:41pm
Meaning, back to the argument in which a healthy 27-year old man shouldn't have to pay for gynecology is equal to a healthy 27-year old woman shouldn't have to pay for erectile dysfunction.
Healthy persons offset ill persons. You may be healthy now, but eventually you will get sick.
Translation
By Bob Leponge
Wed, 07/19/2017 - 12:51pm
Translation: If the citizens of a state want to provide some level of consumer protection by regulating insurance, the insurance companies can circumvent that by operating out of some other state and selling the policy across state lines.
Casting the gutting of consumer protection as "freedom" is one of the major triumphs of the corporate lackeys in Congress.
An example
By dmcboston
Wed, 07/19/2017 - 1:34pm
Hypothetically, of course...say the Commonwealth decides that all policies have to cover gender reassignment surgery. Say that I think I'm at low risk for that cost to the insurance company. I decide to forgo that coverage.
Hello, out of state coverage.
Sounds crazy? Well, a while back a doctor was jailed for killing his wife. He wanted a gender reassignment surgery. Commonwealth said "FU". He went to court...
So?
By adamg
Wed, 07/19/2017 - 1:43pm
I will go out on a limb and posit that you will never have any need of pregnancy, abortion or endometriosis care. If you're a good 1%-loving Republican, then you want a policy where you don't have to sully your premium fees with those. That, in fact, is what the Republicans were proposing. Strangely, nobody ever proposed making prostate cancer a "preexisting condition."
But that is not how insurance works - any more than the idea that you should get a tax rebate for the cost of fire protection because your house didn't burn down last year.
Tax rebate for no fire...
By dmcboston
Wed, 07/19/2017 - 2:33pm
Please, knock it off with the 1% bullshit. This is Massachusetts. The one percent here is probably more left than right. Anyway, as far as my premiums go...
Ever hear of 'family' plans? That's when I pay to insure my family.
So, years ago, my wife, a NICU nurse at Tufts (HI to all Tufts nurses!) decides at thirty two weeks babby was being formed (obscure). It might have been my son's fault, who knows. Long time in the BW and kid spent a month in the NICU there. Oh, by the way, she had an endometriosis thing before that, too.
There was no friggin way I was paying the freight on that one. Of course, my insurance covered most of it.
I understand how insurance works. See other posts about 'pools' and all.
Re: tax rebate no fire
By O-FISH-L
Fri, 07/21/2017 - 6:21pm
Actually Adam, I get a generous discount on homeowners and auto for a "claim free" history. You should look into it if you're not getting it. Also a discount for combining homeowners and auto with same company.
I go to the doctor once a year for a physical. Between age 12 and 45 I never went but either my family or I dutifully paid into our HMO. I have friends that go to the ER at the first sniffle or sneeze. We had a regular 911 caller who would take the ambulance to the hospital to visit the store next door for cigarettes. No ailment but you couldn't refuse her and of course the ambulance billed for stethoscope, blood pressure, oxygen, gloves, hand sanitizer, the whole bit. This went on several times a week. In the USA, we should be able to pick and choose the private coverage we want or no coverage at all, not forced to subsidize others who take advantage. I would be open to a pool for pre-existing conditions but disagree that folks should be forced to buy unwanted, unneeded coverage.
For instance, I don't take "towing" on my car insurance because I know all of the tow operators where I live. If I travel out of state, that's the risk I take.
That wouldn't happen!
By tachometer
Wed, 07/19/2017 - 1:34pm
And it's merely a coincidence that every credit card is based in North Dakota or Delaware.
/s
We need to level the field for all taxpayers and eliminate
By bulgingbuick
Wed, 07/19/2017 - 1:43pm
pensions and health insurance for police and firefighters. I have no issue with providing these benefits to other public employees. Every cop and fireman I know vote republican and proceed to expect a free pass when it comes to their benefits. So lets treat them as they wish to treat others. As republicans shouldn't these public servants want to privatize their jobs?
In an equally amusing exercise, I love reading how insurance functions through the words of the uninformed. An insurance pool only works with multiple lives across all ages and demographics. No men don't have a uterus and women don't have prostate. Segregating people and condition by sex or illness is not insurance. It's dumb, but dumb got the Russian agent elected.
Hmmmnnn...
By dmcboston
Wed, 07/19/2017 - 2:40pm
"An insurance pool only works with multiple lives across all ages and demographics"
So insurance was a total fail until Obamacare?
What you just described is single payer. Do an online search for "that kid in England whose parents raised enough money to fly him to the US but the govt won't let him go".
Russian agent...please...
"Data" is not the plural of "Anecdote"
By Bob Leponge
Wed, 07/19/2017 - 3:35pm
Are we going to reason from actual aggregate data or from cherry-picked gut-wrenching individual stories?
Outcomes are way better under Canadian (and even grossly underfunded British) healthcare than under American. Look at the statistics for stuff that actually might affect you: rates of morbidity and mortality from preventable, treatable causes. There's big money being spent to make sure you've heard of that kid in England. Unfortunately, there's nobody bankrolling an equivalent PR campaign to make sure you've heard of the retired steelworker dying of cancer whose insurance company keeps denying his claims.
Don't conflate single payer with the principal of insurance.
By bulgingbuick
Wed, 07/19/2017 - 4:56pm
Wrong argument.
Lol. If Trump is a Russian
By CCD
Wed, 07/19/2017 - 3:21pm
Lol. If Trump is a Russian agent, so is Hilary Clinton.
Why are Trump supporters so
By ZachAndTired
Wed, 07/19/2017 - 3:54pm
Why are Trump supporters so obsessed with Hillary Clinton? The election has been over for 8 months, guys. Time to move on.
P.S. Your comment doesn't make any sense anyway.
Its an evidence thing
By SwirlyGrrl
Wed, 07/19/2017 - 3:57pm
Many of them don't seem to understand what reality is even when it smacks them upside the head. They certainly aren't able to cope with terms like "preponderance of evidence" or "how to google".
Note the Drumpf supporters who insist that they won't lose their healthcare.
Google "reality".
By bulgingbuick
Fri, 07/21/2017 - 9:06am
You support a traitor.
Who pays for your healthcare?
By Dave-from-Boston
Thu, 07/20/2017 - 10:19am
Seems to me for a guy who claims to be a retired cop you have a lot of gall to be commenting on what other Americans may want or need for healthcare coverage.
Presumably your coverage is paid for by the taxpayers. Given that, and I want to be respectfully, why don't you go back in the corner, stick you fat thumb back into your Trump trap hole and shut the f up. Adults are talking right now.
You
By bulgingbuick
Fri, 07/21/2017 - 9:06am
do.
Millions would not be forced to buy health insurance
By EM Painter
Wed, 07/19/2017 - 9:36am
Horrors
Interesting how you ignore
By Kinopio
Wed, 07/19/2017 - 10:12am
Interesting how you ignore the millions who Trump wants to take away healthcare coverage from. I guess Trump had such a good experience declaring bankruptcy over and over after his countless failed businesses went under that he wants millions of Americans to have to declare bankruptcy too the first time they get sick without coverage.
Is is "taking away"
By CCD
Wed, 07/19/2017 - 11:12am
Is it "taking away" healthcare or just not requiring/forcing folks to purchase insurance? You're conflating issues here.
How about
By bgl
Wed, 07/19/2017 - 12:11pm
Taking away the ability to purchase health care at any reasonable rate, or, better yet - actually taking away health care, at least in the case of Mass Health here.
Are you talking about
By CCD
Wed, 07/19/2017 - 3:26pm
Are you talking about purchasing Insurance or purchasing healthcare? Those are two different things, albeit related. Anyone can walk into the ER and access healthcare therefore nothing is being "taken away." Sure you're gonna have to pay for said trip to the ER but the option to go there is still available...
No, YOU'RE going to pay for
By Nonanon
Wed, 07/19/2017 - 4:15pm
No, YOU'RE going to pay for that person's trip to the ER if that person doesn't have insurance.
It's really not difficult to understand. If you don't have insurance, you can't afford healthcare except maybe for the most basic services. God forbid you have a serious injury, develop diabetes, cancer, etc. Without insurance you're not going to the ER and getting regular treatment for those. It's a death sentence.
"If you don't have insurance, you can't afford healthcare"
By Will LaTulippe
Wed, 07/19/2017 - 4:52pm
That's precisely the (expletive) problem! Again, how much would your cancer treatment cost if I could learn how to treat it for $1,000, got the drugs for another $1,000, and then treated you in my garage? There's an insane amount of money in healthcare, and it stays that way because there's an insanely high barrier to entry. If we're going to spend federal money on this, spend some to lower that barrier. It's like George Carlin said: "Education doesn't help them. They just want you smart enough to run the machines and do the paperwork."
The question "is healthcare a right?" misses the point. It's a business. Humans who demand nice things provide the service. Your life is not more or less important than theirs. 330 million Americans will never agree on how to share wealth.
Millions would be allowed to free-ride on the rest of us
By Bob Leponge
Wed, 07/19/2017 - 10:28am
So Joe decides not to buy health insurance.
He gets sick.
He doesn't go to the doctor while the problem is small, because going to the doctor costs him big bucks.
He gets very sick.
He goes to the emergency room.
The hospital will not turn him away to die in the street.
The hospital treats his condition -- very expensively, when it could have been treated earlier for much less.
The hospital writes off the bill as uncollectible/charity.
Because of the large number of uncollectible/charity writeoffs, the hospital raises its prices. A lot.
I buy insurance.
I get sick.
I go to the hospital and get treated.
The hospital bills my insurance company a price that is grossly inflated to cover the charity write-offs.
My insurance company must charge me a premium that reflects those prices.
I'm paying for Joe's health care.
Joe is free-riding on my back.
I don't like that.
Not to mention
By Bob Leponge
Wed, 07/19/2017 - 10:31am
Not to mention another set of hidden costs. He misses time from work. He is walking around infecting other people when he could be treated.
Did you consider
By Will LaTulippe
Wed, 07/19/2017 - 10:38am
That Joe doesn't have the (expletive) money? If the choice is free or $150 a month, and he can spend $50 a month, what do you think he ends up with? And when government takes away the free, then what does he have?
I would like to have an entire conversation about health care in this country without the word "insurance" being uttered once.
There are really only two choices
By Bob Leponge
Wed, 07/19/2017 - 11:04am
There are really only two choices: Joe pays for Joe's healthcare, or I pay for Joe's healthcare.
If Joe doesn't have the money, it's cheaper, more effective, and better policy for me to subsidize (via my taxes) his coverage so that he gets preventive care, than it is for me to pay for his emergency care through higher premiums.
Also, you use the word "free" but I don't think it means what you think it means. In this case, there is no "free" -- either Joe pays or I pay.
No, there's a third choice
By Will LaTulippe
Wed, 07/19/2017 - 11:13am
Joe doesn't get treatment. I don't love that idea, but, again, there's a finite amount of money to spend, and hospitals and doctors, for a variety of reasons, demand a lot of it.
So, fine, let's pay for Joe now, and then let's also pay for everybody else's birth control so that we don't end up with a generation even bigger than the pool of boomers now who will demand extensive and expensive health services in 75 years.
We need to attack this from both sides. There wouldn't be a bunch of people without health care if we simply had fewer people. The notion that anybody in 2017 should become pregnant or impregnate another person by any means other than through specific forward planning for that specific outcome is a crock. I want rubbers in every nightstand, and a Planned Parenthood in every county.
Yes! It's time to acknowledge
By RoseMai
Wed, 07/19/2017 - 11:57am
Yes! It's time to acknowledge that health care is a human right. Time for single payer or something similar, so that if someone can't afford care, or is in between jobs, they don't go bankrupt trying to get necessary treatment.
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