Health Care Bills Discussion (On The Actual Proposed Bills)

Discussion in 'Politics' started by superstring01, Aug 17, 2009.

  1. superstring01 Moderator

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  3. Challenger78 Valued Senior Member

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    General question:
    What exactly is the coverage for people earning in the lowest income bracket ?
     
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  5. superstring01 Moderator

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    Now? Or under the proposed program?

    ~String
     
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  7. John T. Galt marxism is legalized hatred!! Registered Senior Member

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    I do understand your point here, but one cannot discuss this without importing the things you are saying cannot be discussed. The various points of the bill includes those discussions.

    It cannot be a platonic discussion. Furthermore, many of the discussions on other threads have centered on what is in the bill. An honest appraisal of those discussions will reveal that most of the side talking stems from the proponents demonizing the opposition and then a return volley. However, by and large the discussion is stemming from the actual refutations of the bill itself.
     
  8. joepistole Deacon Blues Valued Senior Member

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    I think Superstring's comments are right on the mark...keep to the facts. I would like someone on the opposition side to show proof of the "death boards" now being marketed to the public. I would like them to cite where the supposed death boards are created in the bill. I would also like them to show provisions which says government is taking over healthcare in the U.S. and socializing medicine.
     
  9. Alien Cockroach Banned Banned

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    Thank you. The truth is a very dry subject, but it should enter the discussion somewhere. I am going to start with the Senate bill.

    I have a small problem with Pt I; Sub A: Tit I. What bugs me about this is that it defeats the entire purpose of having insurance in the first place. I don't think that a person should be guaranteed coverage except in the event of a life-threatening condition that is terribly expensive to treat, viz certain forms of cancer. One such exception that comes to mind is dental care: if you were already losing a tooth before you signed up for a plan that includes dental coverage, then why should an insurance company have to pay for more work than necessary to prevent life-threatening oral infections? Although I agree that people with pre-existing conditions usually need health coverage the most, perhaps there are cases where the insurance companies are right to deny coverage based on pre-existing conditions. I think that this amendment needs further revisions in order to make it more fair on behalf of the insurance companies.

    Maybe there is some detail in this discussion that I am missing. I am sure that the Senate has given the issue all due attention, but I simply don't see anything in the bill indicating that my concerns have been addressed. I don't think we should be unfair to the insurance companies just because they have been unfair to the people. That would be living down, not living up.
     
  10. joepistole Deacon Blues Valued Senior Member

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    Can you give a page number and paragraph number?
     
  11. Alien Cockroach Banned Banned

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    Oh, just scroll down to page seven. It's the first thing they go into. As emotional as the subject of pre-existing conditions is, I think there is a much more sustainable middle-ground. I'm just not entirely sure what it is.
     
  12. joepistole Deacon Blues Valued Senior Member

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    This is the provision that mandates insurance companies do not descriminate coverage or deny coverage baed on preexisting coverage. This provision does not unfairly penalize insurance companies. In fact it does not not penalize them at all as they have actuarial tables upon which to base premiums....based on actual history. They have a very good idea as to the risk, how many are going to come down with cancer, heart disease, etc. and they know how much it is going to cost. Insurance is just pricing that risk and spreading it out over all insureds. Today insurance companies like to take that portion of the population that is likely to not get sick and thereby do better than what is expected per the actuary tables.

    No harm is being done to insurance companies with this provision, they can price for this risk. The only issue for insurance companies is to make sure they are large enough so their risk is representative of the average...if not they will be at a pricing disadvantage.

    And this should not be a problem as there has been a huge consolidation of the industry in the last ten years. I believe the insurance companies have already agreed to voluntarily accept this change. They did the same when Clinton raised it in the 90's.

    The big issue for the private insurance companies is competition. They don't want more market competition. It makes life rough, they have to compete for business through higher quality or lower costs...much tougher than using government to limit market competition.
     
  13. superstring01 Moderator

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    Mod Note: Thank you.

    And, I'm sorry JTG, there is already a thread for debating the pro's and con's of the Health Care Bill. This thread is for siting of facts, proving facts and discussion of those facts.

    Sure it's dry, but I have it here for a reason. In this thread, more than any other right now-- if you can't support it with a fact within the bill (not some external source trying to predict where the bill will go or what the moral implications are), then don't bother posting.

    These are the rules!!!!!!
     
  14. Alien Cockroach Banned Banned

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    Okay, so I'm trying to grasp this stuff. I was under the impression that, if you had an insurance policy, they could refuse to treat an illness, such as a cancer condition. I thought the idea behind this amendment was to keep them from doing that sort of thing. I'm not sure I understood your explanation correctly here, but the thought that sprang to my mind was that, hey, maybe the insurance companies are in their rights, in some cases, to not treat a pre-existing condition.

    I'm trying to grasp what you are saying here, but are you saying that the insurance companies had already voluntarily agreed, under Clinton, that they should have to treat these pre-existing conditions?

    Oh, and Superstring, I know what you mean. If you'll allow a digression, just for the sake of analogy, that's one of my points of frustration when I am trying to explain neuroscience to people who think that human intellect comes from this head-ghost, and I'm being quizzed on WHY I don't believe the same things they do. It is so hard to get people to understand that, look, you can't even start discussing that head-ghost concept until you have covered a lot of incredibly dull material regarding how it's possible for the brain to hold information at all. And the thing is, you are sitting there trying to call to mind a lot of half-remembered material that you've started to take for granted, and you wonder if you even KNOW for sure what you are talking about because, in your mind, you've stuffed all of these ideas into this internal short-hand version of it. So then you have to say, "excuse me, but I'm going to have to go and dig throught the bound periodicals for a while, and now I'm going to have to double-check to make sure I REMEMBER how I know that the materials and methods are even considered to be valid today."

    Well, as totally off-topic that sounds, the way I feel here is like this innocent bystander who doesn't understand the subject matter well himself, and he is really just getting this STRONG impression that 1) I kind of know what I'm talking about, even though my knowledge is way far from perfect. and 2) the person who keeps proposing this head-ghost theory is coming across as this huge, overly confident phony who thinks he sounds more intelligent just because he can make up a lot of BS with a straight face.

    Therefore, the intelligent guy is sitting there stuttering and trying to recall stuff he's not sure how to explain, and he looks all uncertain sometimes because he WANTS to make sure he's giving accurate information; and then there is this stuffed-shirt, bogus know-nothing who can't really do anything but SOUND authoritative, right? So I'm in a really interesting position here, where I KNOW I'm very naive and out of my depth, so I am looking at this bill and TRYING to make sense of it.

    So, Superstring, it would help me a lot, understanding this thing, if someone could even explain to me whether my concern even makes any sense in the context of what we're talking about. So Joe here is ME trying to explain the difference between cAMP-dependent protein kinase and AMP-activated protein kinase, one of those subjects I KIND of understand but can't really spit out readily. I won't try to go into the pros/cons thing anymore, but I'm on the same level with your ordinary American when I'm trying to read through this healthcare bill. I know that's a long-ass digression, but that's pretty much where I am with this thing. The only thing that really makes me different is that I am MAJORLY at odds, on this deep, gut level, with all those people who are preying, like these terrible vultures, on the innocence of ordinary people.


    Joe: SO here is what I want to be clear on, Joe. What I THINK you just said was that the insurance companies CAN'T deny a person treatment, IF they are insured already, just because they already HAD the condition when they signed up. If that is the case, then what exactly DOES the amendment do? I don't CARE anything about the rest of the bill at this point, just WHATEVER counts toward me understanding this ONE part of the bill.
     
  15. joepistole Deacon Blues Valued Senior Member

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    Under the bill they/insurance companies cannot descriminate or deny coverage for preexisting conditions period. However, today insurance companies can and to legally descriminate against pre-existing conditions. And they will use preexisting conditions to cancel insurance and not pay claims.

    Insurance companies have agreed that healthcare reform is necessary and as part of that package they have agreed that it should be illegal to discriminate based on preexisting conditions.

    http://www.ahip.org/content/default.aspx?bc=39|25680

    AHIP is the health insurance industry group. They are for healtcare reform, but very much against a government competitor...a government option.

    Was that helpful?
     
  16. Alien Cockroach Banned Banned

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    Well, what I am not clear on is whether this law applies to all health insurance agencies or simply to the government-run option. I'm sure it's in there somewhere, but I'm not accustomed to picking these things for clear information. I was just womdering, "hey, are there cases where the insurance companies are in the right to refuse coverage based on pre-existing conditions?" It's a topic that you don't hear being discussed very often, but I think it's an interesting note.

    On the bill in general, I thinik it is a very interesting approach to regulation. It would be fun to wait around and see its long-term repercussions. For example, would the private insurance companies try to compete against it, or would more of them try to court the upper-middle class? To me, this opens up a very important question: at what point is health coverage a luxury, and at what point is it a necessity? Because there really isn't any readily visible, fine line here, this is going to be a very fun topic for future generations to discuss.

    "Prohibition of discrimination based on salary" Okay, pretty clear. No questions there. I have been saying for years that it's wrong to penalize people just for being poor, even though they haven't done anything wrong. I don't see why anyone wouldn't want this amendment there. Then again, you run into a lot of oddballs, and I'm sure they think they have their reasons. It's interesting to pick people's brains for WHY they hold the views that they do.

    "No changes to existing coverage" Now, does this essentially prevent the insurance company from changing the coverage you are entitled to based on, for example, your age or your HIV status? That is pretty much how I just read it, down here on page 19.

    If you scroll down on that page, though, you find "c". What does "No additional benefit" mean? It refers me to paragraph numbers and subsection letters, but I'm having trouble putting together what this bit actually means.Does it mean that the insurance company can't give you additional benefits? If that is how it actually reads, then that sounds kind of strange to me. So I'm kind of stuck here, trying to parse the meaning of this bit.
     
  17. Startraveler Registered Senior Member

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    The conversation has shifted to the Senate HELP bill at this point, right? I must say, I'm more well-versed on the House bill (which I think is a bit better organized and better written) but in both cases the regulations of health plans offered by insurers apply to all insurers, not just the public option.

    This section looks to me to be the equivalent of the grandfather clause in the House bill ("SEC. 102. PROTECTING THE CHOICE TO KEEP CURRENT COVERAGE" in H.R. 3200), the purpose of which is merely to assure that the campaign promise of "if you like the coverage you have, you can keep it" is fulfilled and the transition to the reformed health care system is minimally disruptive. The subtitle in the HELP Committee bill that this "no changes to existing coverage" bit falls under describes new provisions that will apply to individual and group insurance plans--Section 131 just clarifies that plans already in existence before this bill goes into effect are exempted from these provisions.

    A very quick reading suggests that this merely clarifies that only individuals already in a grandfathered plan when the legislation goes into effect can be enrolled in that plan (although family members of those people can still enroll)--"c" looks to me like it's just stressing that new benefits (i.e. for new enrollees) aren't allowed.

    That said, the House bill does explicitly prevent grandfathered health plans from changing their terms and benefits once the reforms go into effect:

    (2) LIMITATION ON CHANGES IN TERMS OR CONDITIONS- Subject to paragraph (3) and except as required by law, the issuer does not change any of its terms or conditions, including benefits and cost-sharing, from those in effect as of the day before the first day of Y1.​

    So I wouldn't be surprised if the HELP Committee bill has similar provisions. That may well be another way to take what "c" is saying (as I said, I think the House bill is written much more clearly than the HELP Committee bill).
     
  18. nirakar ( i ^ i ) Registered Senior Member

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    If I understand correctly there are still 3 House Bills and 2 Senate Bills pending on "Health Care Reform". Apparently the Baucus Bill written By Liz Fowler former VP of Wellpoint (the nation's biggest Healthcare corporation) is the only Bill that counts and the others are just distractions.
    The Baucus Bill is also apparently the only bill with no "public option".

    Apparently Obama has not written any proposed legislation and the Republicans have not written any proposed legislation. When Obama or the Republicans talk about their plans we should consider them to be bullshitting until they release their "plans" to public scrutiny.

    What Obama talked about in his speech sounded like a national version of the Massachusetts plan. I have seen it written that the Baucus plan also forces people to buy insurance and is a Massachusetts style plan.

    As far as I can tell the Massachusetts plan is a policy failure and should not be repeated on a national scale unless the goal is to increase insurance industry profits.

    But on to the really important news: How many tea baggers can fit on the head of a pin?
     
  19. nirakar ( i ^ i ) Registered Senior Member

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    HR 3962 - http://docs.house.gov/rules/health/111_ahcaa.pdf
    Above is the link to the final house bill as it was on October 29 and as it still is not including the 42 page "managers amendment".

    Manager’s Amendment - http://docs.house.gov/rules/health/111_hr3962_dingell.pdf
    Above is the 42 page manager's amendment.

    http://thomas.loc.gov/cgi-bin/query/D?c111:1:./temp/~c1118xxeFi::
    Above is a possibly more easy to read method of looking at the full house bill not including the manager's amendment.
     
  20. superstring01 Moderator

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    Wow. That stuff's pretty dry. Can you break it down?

    Thanks.

    ~String
     
  21. nirakar ( i ^ i ) Registered Senior Member

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    No, I really can't break it down. I had the same reaction that you did.

    I don not believe the congress people will read this bill because the human mind is simply not equipped to read this sort of writing. Reading the bill may be even more mind numbing as reading the tax code.

    I have none the less tried to be informed and tried to think about whether the "Reforms" that the House and Senate seem to be moving towards will be good for America. What this had led me to is a clarification in my mind of what the important questions are. Unfortunately every important question has two or more answers being given that can not both be true. So much disinformation is coming from both sides and as usual winning and "hurray for my side" seems to be more important than truth.

    I don't truly know anything I say below because there are no trustworthy sources and there is little consensus about what are facts and what are lies so these are just my best guesses at what is reality.

    The conference committee has the last chance to rewrite the health care bill after the Senate and the Hose pass their versions. A few years ago a effort at reform was passed that tried to reaffirm that the conference committee was not authorized to add to the final bill items that were not in either the Senate or house versions of a bill. This reform apparently is not binding and the conference committee still has the power to do whatever they want and add whatever they want as long as neither a sense of shame nor political pressure deter them.

    On the political front the Abortion issue has once again risen to being the crucial factor in the fate of 3962 in the house. Despite wildly different stories being told by the different factions I think I understand what is going on. The Hyde Amendment from the 1970s bans using federal money for abortions. That was later amended to allow federal money to be used to do abortions that save the woman's life and also in cases of rape and incest. Medicare and Medicaid may not fund abortions in other cases unless they do so using state rather than federal money which up up to the states. Private health insurance usually pays for abortion because abortions cost less than pregnancies.

    I believe the "managers amendment" to HR 3962 added a compromise to how abortion funding would be handled. The compromise was that the various insurance policies available in each state that are eligible for being subsidized (for poor and semi-poor people who are not offered insurance threw their employer) by the federal government, must include at least one insurance policy that covers abortion and one insurance policy that does not cover abortion.

    Technically I think the abortion opponents are correct to say that any subsidy of a private insurance policy that covers abortions is a violation of the Hyde amendment. I am not exactly pro abortion but as long as I must pay for wars that I don't believe in I have only limited sympathy for the abortion opponents horror at the idea of being forced to fund abortions through their tax dollars. Abortions do save the taxpayers money but murdering poor people might also save the taxpayers money and I don't support that.

    Today's issue the Stupak amendment would ban abortion funding by any private insurance policy that receives subsidies. This if passed could end up having the effect of removing abortion coverage form almost all of the insurance polices offered to individuals whether subsidized or unsubsidized.

    Most articles and most pro or anti "Health care reform" (and or pro or anti Obama) advocates have not seemed to be interested in adding discussions of the Massachusetts experience into their debates. This lack of discussion of Massachusetts just reaffirms my opinion that we are a nation of idiots who are unqualified to even have opinions. Among people who didn't make up their minds based on partisan and ideological loyalties, knowing what happened in Massachusetts is the most important thing to be known to determine whether these reforms are good. The Massachusetts experiment is the only place in the world that anything like what is being proposed has ever been tried. As usual the reports as too what happened in Massachusetts are contradictory to each other.

    Before Massachusetts passed it's "Health care reform" in 2006 Massachusetts already had the highest insurance premiums in the nation. Since 2006 the price of Insurance premiums in Massachusetts have continued to rise faster than the national average rate of increase in insurance premiums. The cost to the Massachusetts taxpayers was also higher than expected.

    The Massachusetts plan still has the support of the majority of the people in Massachusetts but the plan only has the support of half of the people who were affected by the plan. The two most prominent "Taxpayers organizations" take different stands on the plan. Upon further inspection I found that the taxpayers group with better credentials (got prop 2 1/2 passed) accused the other Taxpayers group of being a fraud funded by corporations. The corporation backed astro turf taxpayer group actually tried to raise personal taxes in order to lower corporate taxes. This information was part of my coming to the conclusion that the large employers see benefits to themselves from this style of health care reform at the expense of the taxpayers and at the expense of the uninsured young who will be forced to by insurance.

    My conclusion is that the Massachusetts plan was a net negative and therefore the federal plan will also be a net negative.

    A high quality article on the Massachusetts plan: http://www.pnhp.org/mass_report/mass_report_Final.pdf

    It is my understanding that large corporations tend to have insurance plans that already cover pre-existing conditions. In small companies when an employee gets cancer everybody's premiums go up.

    Many advocates for the "health insurance reform" think it is OK to ask for previously uninsured young healthy but not wealthy people to over pay for insurance so that 50 somethings with pre-existing conditions can be subsidized for their massively expensive insurance policies. That does not sound so fair to me. Aren't the Young already doing enough by paying for Social Security and Medicare even though they don't trust that it will be there for them when they get old? To the best of my knowledge neither the Federal House nor Senate nor the Massachusetts plan in any way take a position on whether some segments of the insured shall be forced to subsidize other segments of the insured. I believe that these questions of who subsidizes who through private insurance are left up to the Insurance companies and up to the state insurance regulators. It is my belief that the insurance industry is largely in control of the State legislators and the State insurance regulators.

    Removing pre-existing conditions as a cause for denial of coverage is the most significant change that will occur if "Health care reform" passes. Opponents of "reform" point out that according to game theory if pre-existing conditions are eliminated as a cause for denial of coverage then people should stop paying for insurance and instead pay the penalties because the penalties are cheaper than insurance and you can always buy the most deluxe insurance policy after you get sick and have a use for the insurance policy. If people behaved this way the cost of insurance would go up. In Massachusetts, Harvard health reports that many people are only insured for part of the year and that they go on medical spending during the few months that they are insured and then stop seeing doctors while they are uninsured. The Insurance Industry would like penalties high enough so that not buying an insurance would cease to be an option. Mostly the phenomena of paying the penalties and not buying insurance until sick has not been the case in Massachusetts but there has been some of this behavior and it may increase as people learn to game the system. Massachusetts has higher penalties for not purchasing insurance than the federal plans do.

    Who can be bothered to buy insurance after they are sick? When you must go to the hospital you must go now, not two weeks from now when your new insurance plan kicks in. Will somebody trying to game the system understand that?

    The Senate plan (looks like the house plan also) would shift millions of more people into Medicaid without providing Medicaid the funds it would need for these people. The States would be forced to pay part. All sorts of greedy heartless conservatives are jealous of evry dollar that goes to those lazy poor people on Medicaid now. What these jealous taxpayers don't know is that Medicaid is not like Medicare. Medicaid is garbage insurance. Real doctors don't take Medicaid. The Medicaid mill clinics don't practice anything recognizable as medicine. Medicaid is only good for the Emergency room and pharmacies. You could get a procedure done in a hospital using Medicaid but the hospital would resist if they can get away with it.

    Medicaid patients show up at the ER something like three times more per capita than the uninsured do. This is because Medicaid patients don't leave the ER with unpaid medical debts as an uninsured patient that used his real name would and yet like the uninsured Medicaid patients can't find any better place than the ERs to be treated for their non-emergency illnesses. The ER and any doctor who tries to practice real medicine will lose money on every Medicaid patient that they see. Privately insured people and too a lessor degree Medicare patients end up paying for the losses that the Medicaid patients create.

    Some hospitals end up closing their ERs just to get rid of the Medicaid and uninsured patients but the Senate plan wants to create more Medicaid patients.

    My wild but not completely uniformed guess is that Medicare pays hospitals and doctors more than the stingier third of private insurance does and less than the less stingy third of insurance plans do. Many doctors in the Bay area are dropping coverage for Medicare and the stingier insurance plans and are just accepting the more generous insurance plans and cash.

    Currently the cash paying uninsured are billed at higher rates than anybody else. Medicare and the private insurance plans have negotiated discounts from the fictitious cash price. It is my understanding that whenever doctors and hospitals allow cash paying patients to pay less than the fictitious cash price they become in violation of their contracts with the Private insurance companies and Medicare. Hospitals often insist on receiving the fictitious cash price from their uninsured patients which would result in the uninsured patient either paying 2 to 3 times what Medicare and blue cross would pay or defaulting and having their credit ruined. Usually the uninsured have no money and therefore don't pay but sometimes they do have money and pay the highest rates.

    One of the reasons why the uninsured cost the system so much is that included in the uninsured are all the people who lost their insurance because they lost their jobs when they got sick. I would like to know what percentage of employers fire their workers when they are too sick to work for prolonged periods of time. When you get fired you can keep your insurance through the COBRA program if you can pay for the insurance. In a nation where middle class people have credit card debt, mortgages and car loans what percentage of people can afford to pay indefinitely for insurance after they lost their jobs?

    An astounding proportion of people receiving insurance through their employers are under the false impression that the premiums that they pay are the cost of their insurance. They don't realize on a day to day basis that their employer is paying 75% of their insurance.

    Even with the employers paying 75% of the premiums the deductibles and co-payments of some policies can quickly financially wipe a insured middle class person if they get a serious illness. "New regulations would cap yearly out-of-pocket medical expenses for individuals at $5,000 and families at $10,000." Who is supposed to pay for that cap? I guess that will show up as an increase in insurance premiums.

    Not addressed by this bill is the ever rising cost of medical care and the fact that Americans have been forced to overpay for each component of their medical care via government imposed limitations to competition. We can't import drugs. We can't use unlicensed medical providers. Until recently the government was cooperating with a program to reduce the output of doctors from medical schools under the assumption that we had too many doctors. We can't buy insurance across State lines. This Bill grants that permission if the state legislatures give permission but they won't give permission and as far as I know they already had the state legislatures already right to grant that permission. We pay more for every aspect of medicines than other nations do.

    All nations must face the fact that there is no end to how of GDP could be consumed to prolong life as available medical technologies will endlessly increase in complexity as long as there is money to be made in prolonging life. No society is ready to discuss when it is time to die.

    A pretty good summary from http://www.pbs.org/newshour/updates/health/july-dec09/billsummary_10-29.html

     
  22. nirakar ( i ^ i ) Registered Senior Member

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    The Stupak amendment passed just before the House bill passed so the subsidized private insurance policies will not be allowed to fund abortions.
     
  23. joepistole Deacon Blues Valued Senior Member

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