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Author Topic:   Baby Denied Health Care Coverage For Being "Too Fat"
Jazzns
Member (Idle past 2048 days)
Posts: 2657
From: A Better America
Joined: 07-23-2004


Message 1 of 184 (530123)
10-12-2009 11:23 AM


GRAND JUNCTION Alex Lange is a chubby, dimpled, healthy and happy 4-month-old.

But in the cold, calculating numbered charts of insurance companies, he is fat. That's why he is being turned down for health insurance. And that's why he is a weighty symbol of a problem in the health care reform debate.

Insurance companies can turn down people with pre-existing conditions who aren't covered in a group health care plan.

Alex's pre-existing condition "obesity" makes him a financial risk. Health insurance reform measures are trying to do away with such denials that come from a process called "underwriting."

"If health care reform occurs, underwriting will go away. We do it because everybody else in the industry does it," said Dr. Doug Speedie, medical director at Rocky Mountain Health Plans, the company that turned down Alex.

By the numbers, Alex is in the 99th percentile for height and weight for babies his age. Insurers don't take babies above the 95th percentile, no matter how healthy they are otherwise.

"I could understand if we could control what he's eating. But he's 4 months old. He's breast-feeding. We can't put him on the Atkins diet or on a treadmill," joked his frustrated father, Bernie Lange, a part-time news anchor at KKCO-TV in Grand Junction. "There is just something absurd about denying an infant."

Bernie and Kelli Lange tried to get insurance for their growing family with Rocky Mountain Health Plans when their current insurer raised their rates 40 percent after Alex was born. They filled out the paperwork and awaited approval, figuring their family is young and healthy. But the broker who was helping them find new insurance called Thursday with news that shocked them.

" 'Your baby is too fat,' she told me," Bernie said.


http://www.denverpost.com/ci_13530098

This really hit home with me because I have 2 children who both were/are chubby babies, >95 percentile, breast fed only. Our doctor always proclaimed their weight a sign of GOOD health and predicted that as long as we kept up good eating habits that they would trim out in their toddler years and be better for it in the long run.

My son is now taller than all of his friends the same age as he is, has a balanced appetite as in incredible health. That being said, he is an active 3 year old and plays lots with other kids, falls down, and occasionally needs a doctors visit. I CANNOT imagine not being able to provide health care for my child because some money grubbing insurance underwriter trying to find any excuse to deny people coverage and especially for this reason!

I am not the biggest fan of the health care overhaul that is currently happening because I believe it is a bandaid on the real problem in this country. The real problem is that we ALLOW profit to be made off the blood of our neighbors. Someone is making money right now denying that baby coverage which will potentially deny him care in the case that poor fate might fall upon him. I am presuming that if his parents are struggling to find insurance they probably could not afford the cost of a childhood accident, or unexpected condition.

So we are basically telling these people, if your house is on fire we your neighbors will help you put it out by virture of our public fire system that we have instituted to keep us ALL safe. But if your body is on fire, we would rather see you die or go bankrupt or both because we need to protect the profits of giant corporation who do nothing more than exchange money.

And what is even most infuriating, is that the biggest opponents of reform are Republicans who also claim to be "pro-life". Damn them for being more concerned about this child as a fetus then they are now! Hypocrites!

Free for all please.

Edited by Jazzns, : No reason given.


If a nation expects to be ignorant and free, in a state of civilization, it expects what never was and never will be. --Thomas Jefferson
Replies to this message:
 Message 3 by Modulous, posted 10-12-2009 12:06 PM Jazzns has responded
 Message 10 by Phage0070, posted 10-12-2009 4:35 PM Jazzns has responded
 Message 36 by roxrkool, posted 10-12-2009 8:37 PM Jazzns has not yet responded

  
AdminNosy
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Posts: 4754
From: Vancouver, BC, Canada
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Message 2 of 184 (530125)
10-12-2009 11:32 AM


Thread Copied from Proposed New Topics Forum
Thread copied here from the Baby Denied Health Care Coverage For Being "Too Fat" thread in the Proposed New Topics forum.
  
Modulous
Member (Idle past 241 days)
Posts: 7789
From: Manchester, UK
Joined: 05-01-2005


Message 3 of 184 (530136)
10-12-2009 12:06 PM
Reply to: Message 1 by Jazzns
10-12-2009 11:23 AM


the article writes:

Alex's pre-existing condition "obesity" makes him a financial risk. Health insurance reform measures are trying to do away with such denials that come from a process called "underwriting."

Jazzns writes:

But if your body is on fire, we would rather see you die or go bankrupt or both because we need to protect the profits of giant corporation who do nothing more than exchange money.

I'm not going to suggest that this situation is ideal - but for the sake of disagreement, insurance does a lot more than 'exchange money', they manage risks and are massively essential for the economy (20% of the LSE is owned by insurance companies). The article almost makes it sound like underwriting is a bad idea!

Are health insurance companies allowed to make an underwriting profit? Does the health reform seek to change this? Is there some valid acturial justification for not covering babies of these dimensions?


This message is a reply to:
 Message 1 by Jazzns, posted 10-12-2009 11:23 AM Jazzns has responded

Replies to this message:
 Message 4 by Jazzns, posted 10-12-2009 1:39 PM Modulous has responded
 Message 5 by Izanagi, posted 10-12-2009 3:12 PM Modulous has responded

  
Jazzns
Member (Idle past 2048 days)
Posts: 2657
From: A Better America
Joined: 07-23-2004


Message 4 of 184 (530153)
10-12-2009 1:39 PM
Reply to: Message 3 by Modulous
10-12-2009 12:06 PM


I'm not going to suggest that this situation is ideal - but for the sake of disagreement, insurance does a lot more than 'exchange money', they manage risks and are massively essential for the economy (20% of the LSE is owned by insurance companies). The article almost makes it sound like underwriting is a bad idea!

Insurance is not bad as a concept. It is not even bad to make a profit off of it for things such as car/home/boat/etc. But when it has to do with your life it should be a crime to deny basic coverage over the statistical figuring of an underwriter who's goal is profit. Oh wait...it IS A CRIME in every other industrialized nation to make a profit on providing basic health care insurance.

Are health insurance companies allowed to make an underwriting profit?

Only in the USA. And it is a fundamentally disgusting fact of our system. Profit motives in this arena of our economy are incongruent with both our ideals and our best interests. We do not have profit motive in fire/resuce/police for a VERY GOOD REASON.

Does the health reform seek to change this?

Unfortunatly no. Well, not completely. Rather than make it illegal the reform simply subsidizes the losses and forces the companies to grant coverage.

Is there some valid acturial justification for not covering babies of these dimensions?

I am curious if you can think of one? Even hypotheically.


If a nation expects to be ignorant and free, in a state of civilization, it expects what never was and never will be. --Thomas Jefferson
This message is a reply to:
 Message 3 by Modulous, posted 10-12-2009 12:06 PM Modulous has responded

Replies to this message:
 Message 6 by Modulous, posted 10-12-2009 3:22 PM Jazzns has responded
 Message 132 by Hyroglyphx, posted 10-17-2009 9:54 AM Jazzns has responded

  
Izanagi
Member (Idle past 3353 days)
Posts: 263
Joined: 09-15-2009


(1)
Message 5 of 184 (530167)
10-12-2009 3:12 PM
Reply to: Message 3 by Modulous
10-12-2009 12:06 PM


insurance does a lot more than 'exchange money', they manage risks and are massively essential for the economy

The problem are those risks people talk about are people's lives. They're your friends, neighbors, and family. They are the people you love and care about who may one day be denied health care because some guy in an office somewhere looks at that person's chart and says, "Well, we can't cover them anymore because of this or that." This situation is horrific to our basic humanity and to the spirit of being an American. Americans have focused so much on individualism that we have forgotten it was our cooperative nature that built the nation. When the settlers went out west, they did so in groups and protected each other. When towns were formed, people helped each other in times of need because they knew that help would be reciprocated. And Americans still carry those values. But somewhere along the line, greed for money became more important than anything else.

That's why insurance companies are an unnecessary evil. They thrive on the suffering of others. Their profit comes at someone else's loss. The job of the insurance companies is to find every way to get your money while finding every not to pay. And they get fat while good Americans, from Republicans to Democrats, go bankrupt in order to pay for operations that are provided for in other developed states. And this is the system that people want to defend? Why? How can we allow anyone to profit from the suffering from a fellow American and still say that Americans stick together?

Americans need to wake up and realize that the system needs to change and needs to change now. Americans need to realize that the next person to suffer from the greedy health insurance companies might be someone close to them, or even themselves. They need to wake themselves to the reality that the health insurance companies are not in it to save the person when the person needs to be saved, but to take the person's money and leave that person in a ditch when the person needs help from the health insurance company.

We take care of each other - there is no better reason for universal health care than that. No other reason should ever take precedent over that reason. If ever there is a reason that becomes more important than taking care of each other, then we as a nation have failed.

Edited by Izanagi, : No reason given.

Edited by Izanagi, : No reason given.


It's just some things you never get over. That's just the way it is. You go on through... best as you can. - Matthew Scott
----------------------------------------
Marge, just about everything is a sin. (holds up a Bible) Y'ever sat down and read this thing? Technically we're not supposed to go to the bathroom. - Reverend Lovejoy
----------------------------------------
You know, I used to think it was awful that life was so unfair. Then I thought, wouldn't it be much worse if life were fair, and all the terrible things that happen to us come because we actually deserve them? So, now I take great comfort in the general hostility and unfairness of the universe. - Marcus Cole
This message is a reply to:
 Message 3 by Modulous, posted 10-12-2009 12:06 PM Modulous has responded

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Modulous
Member (Idle past 241 days)
Posts: 7789
From: Manchester, UK
Joined: 05-01-2005


Message 6 of 184 (530171)
10-12-2009 3:22 PM
Reply to: Message 4 by Jazzns
10-12-2009 1:39 PM


Is there some valid acturial justification for not covering babies of these dimensions?

I am curious if you can think of one? Even hypotheically.

Hypothetically? Sure - big babies get dropped more often or there is a correlation between large babies and certain expensive diseases or disorders.


This message is a reply to:
 Message 4 by Jazzns, posted 10-12-2009 1:39 PM Jazzns has responded

Replies to this message:
 Message 7 by Jazzns, posted 10-12-2009 4:07 PM Modulous has responded

  
Jazzns
Member (Idle past 2048 days)
Posts: 2657
From: A Better America
Joined: 07-23-2004


Message 7 of 184 (530177)
10-12-2009 4:07 PM
Reply to: Message 6 by Modulous
10-12-2009 3:22 PM


Hypothetically? Sure - big babies get dropped more often or there is a correlation between large babies and certain expensive diseases or disorders.

And you feel that it is justified for people to make their living off of such "acturial justifications"?


If a nation expects to be ignorant and free, in a state of civilization, it expects what never was and never will be. --Thomas Jefferson
This message is a reply to:
 Message 6 by Modulous, posted 10-12-2009 3:22 PM Modulous has responded

Replies to this message:
 Message 9 by Modulous, posted 10-12-2009 4:17 PM Jazzns has responded

  
Modulous
Member (Idle past 241 days)
Posts: 7789
From: Manchester, UK
Joined: 05-01-2005


Message 8 of 184 (530178)
10-12-2009 4:16 PM
Reply to: Message 5 by Izanagi
10-12-2009 3:12 PM


The problem are those risks people talk about are people's lives. They're your friends, neighbors, and family

And my customers

The risks are not people's lives. The risks in question are specifically financial ones. That is: if there is a 10% chance that you will take a $100,000 loss sometime in the next year then a risk averse individual may want to manage that risk by paying $10,000/year instead.

It doesn't matter why that $100,000 loss occurs.

family. They are the people you love and care about who may one day be denied health care because some guy in an office somewhere looks at that person's chart and says, "Well, we can't cover them anymore because of this or that." This situation is horrific to our basic humanity and to the spirit of being an American

This is a simple fact of reality: You cannot expect that there will be 'no expense spared' to keep all people alive at all times. It'd be nice, but it isn't realistic.

I'm from the UK, so while I can use private medical care, I am also paying some amount of money towards the NHS.

However - there are some treatments which are very expensive (eg., some drugs cost $5,000/month) and they might not be covered. It's people's lives - but money is created by the actions of people's lives. If we spent recklessly, we'd be out of money for little benefit.

Americans have focused so much on individualism that we have forgotten it was our cooperative nature that built the nation...

That's why insurance companies are an unnecessary evil.

These two assertions are contradictory. Insurance is by definition anti-individual. The entire point is that many individuals protect each other from large unmanageable losses by sharing risk. They are cooperative in nature.

The job of the insurance companies is to find every way to get your money while finding every not to pay.

Not necessarily. If that is what they are doing - then your financial system is to blame. The purpose of insurance is to manage risks by pooling them using the principle of large numbers with a view to indemnifying people for genuiune losses while repudiating the very large numbers of fraudulent claims. The premiums should be proportional to the payouts (ie., there should be little to no underwriting profit), and the only profit created should be in investments the insurer has invested in using the premiums that its customers supply.

And this is the system that people want to defend?

Yes - the system in the US has seems to be broken. To be perfectly fair, there are many broken systems throughout the world - the US's system maybe broken and it may be fixable - but its still not close to the worst system out there

Americans need to wake up and realize that the system needs to change and needs to change now.

I don't know about the US but you only need a million quid to start your own insurance company up over here. I'm sure you could start up your own if you think you have found a better way. Still - there are probably some legislative necessisities before it is possible for such an ideal system to exist.

We take care of each other - there is no better reason for universal health care than that.

While I prefer having the NHS and optional private cover - it must be pointed out that having the government make these decisions is not ultimately superior to having private companies make them. They will still need to mitigate their losses somehow and that will mean people will have to sacrifice more of their own money to pay for an increase in coverage.

To be clear: I'm not defending the US system - but it is easy to get carried away criticising it!


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 Message 5 by Izanagi, posted 10-12-2009 3:12 PM Izanagi has not yet responded

Replies to this message:
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 Message 12 by Jazzns, posted 10-12-2009 4:43 PM Modulous has acknowledged this reply

  
Modulous
Member (Idle past 241 days)
Posts: 7789
From: Manchester, UK
Joined: 05-01-2005


Message 9 of 184 (530179)
10-12-2009 4:17 PM
Reply to: Message 7 by Jazzns
10-12-2009 4:07 PM


And you feel that it is justified for people to make their living off of such "acturial justifications"?

Of course. I do


This message is a reply to:
 Message 7 by Jazzns, posted 10-12-2009 4:07 PM Jazzns has responded

Replies to this message:
 Message 13 by Jazzns, posted 10-12-2009 4:47 PM Modulous has responded

  
Phage0070
Inactive Member


Message 10 of 184 (530183)
10-12-2009 4:35 PM
Reply to: Message 1 by Jazzns
10-12-2009 11:23 AM


Settle in, because I am going to lay out some hard truths for you.

Conceptually everyone, even the "terrible Republicans", want people to have healthcare. They want people to have food on their plates, roofs over their heads, and cars in their driveways. We can all agree that the world *should* be this way. However, and this may shock you, it isn't for one very simple reason: Limited resources.

We only have so much food, so many cars, and so many houses. We can make more, but that requires work, and there is again a limited amount of that. So how do we decide who gets what? There are many different ways of deciding how to distribute what is available, but the error I want to highlight is the idea that the argument presented in the OP ("Everyone deserves ______") is socialist. It isn't. A socialist method of distribution would require that everyone get the same amount of the limited resources, and the proposal in the OP is that everyone should get "enough" of the resource. It isn't socialist, it is naive.

Requiring insurance companies to cover people who they consider to be undesirable investments is the same thing as taxing people to pay for their medical care, just through a private company. The insurance companies are not denying coverage just because they are greedy, they are denying coverage because it would require raising the rates of the healthier people to pay for the fat babies. Those fat babies *can get insurance*, provided they are willing to pay a higher rate. The complaining isn't that they cannot get insurance and healthcare, it is simply that they cannot get other people to pay for it.

That is greed, plain and simple. Not on the part of the insurance companies, but on the part of the OP who thinks that others should be forced to pay for your healthcare.

**

Ok, next hard truth: People can consume a ridiculous amount of healthcare.

Compare the concept of a free clinic run with public funds to that of a soup kitchen. People can go to the soup kitchen and eat the soup, which will be filling but hardly thrilling to the pallet. They don't serve lobster at soup kitchens for obvious reasons, but in the clinic it is different. What if someone should get an MRI? Who knows if they *need* the MRI, it would certainly be helpful. A toxicology workup would be nice, along with some blood tests for possible genetic conditions.

All of those things are nice, and have good arguments going for them. But did you notice how the goals have changed from the soup kitchen? The soup kitchen's goal was simply to prevent people from starving to death; if the clinic had similar goals they would just be patching people up so they would live for the next day or two. Instead now the objective has morphed into providing a fulfilling life for the clinic patient, and that involves things like surgery to set a spiral fracture, something that isn't life-threatening but would make the limb useless. Who is to say where to draw the line? There is always something that would be helpful to do, like surgery to cover the scar, or physical therapy to aid in recovery.

We have limited resources. We *cannot* afford everything that can be done to help people, and we don't have the ethical right to choose for them what can be done. The choice should be made by the person themselves, according to how many resources they choose to devote to it of their own.

Claiming that "everyone deserves healthcare" is like proposing a soup kitchen where you can order anything you wish.


This message is a reply to:
 Message 1 by Jazzns, posted 10-12-2009 11:23 AM Jazzns has responded

Replies to this message:
 Message 17 by Jazzns, posted 10-12-2009 5:01 PM Phage0070 has responded

  
Phage0070
Inactive Member


Message 11 of 184 (530184)
10-12-2009 4:41 PM
Reply to: Message 8 by Modulous
10-12-2009 4:16 PM


Modulous writes:

The premiums should be proportional to the payouts (ie., there should be little to no underwriting profit), and the only profit created should be in investments the insurer has invested in using the premiums that its customers supply.


Why little to no underwriting profit? They are providing a service, are they not? Assuming there are other health insurance providers who can be used, competition should keep the margins low since they are interchangeable. If one company tries to charge more than the premiums and coverage warrant, then they would simply be unable to compete with the prices for their competitors.

Legislation should focus on making sure health insurers fulfill their contractual obligations, there is no need to regulate profit margin in a free market.

(People often overlook the ability to get insurance for practically anything. Assuming the risks are well-documented and they are not going in blind, an appropriate payment rate and payout amount can be arranged. It will involve overall profit on the side of the insurer, but that is to be expected when they are providing a service.)

Edited by Phage0070, : No reason given.


This message is a reply to:
 Message 8 by Modulous, posted 10-12-2009 4:16 PM Modulous has responded

Replies to this message:
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Jazzns
Member (Idle past 2048 days)
Posts: 2657
From: A Better America
Joined: 07-23-2004


Message 12 of 184 (530185)
10-12-2009 4:43 PM
Reply to: Message 8 by Modulous
10-12-2009 4:16 PM


This is a simple fact of reality: You cannot expect that there will be 'no expense spared' to keep all people alive at all times. It'd be nice, but it isn't realistic.

Nobody is suggesting this. But every single individual should expect some level of basic care above and beyond the emergency room when it may very well be too late.

Insurance is by definition anti-individual. The entire point is that many individuals protect each other from large unmanageable losses by sharing risk. They are cooperative in nature.

Izanagi may be generalizing too much. The main point is that profit motive in private insurance encourages collecting permiums while denying coverage wherever possible. The only things standing in the way is government regulation defining what is or is not allowed in terms of the contract between the insurer and claimant.

Not necessarily. If that is what they are doing - then your financial system is to blame. The purpose of insurance is to manage risks by pooling them using the principle of large numbers with a view to indemnifying people for genuiune losses while repudiating the very large numbers of fraudulent claims. The premiums should be proportional to the payouts (ie., there should be little to no underwriting profit), and the only profit created should be in investments the insurer has invested in using the premiums that its customers supply.

That would be nice if that is how it worked in the US but its not. And it has nothing to do with our financial system as it has to do with our insurance regulation and the profit motive. Profit motive is fine as long as insurers are not allowed to scam people by issuing policys with a million little caveats in which they are allowed to deny claims, not required to demonstrate they have the appropriate capital to manage their risk, and as long as people do not DIE because of the decision of a bean counter!


If a nation expects to be ignorant and free, in a state of civilization, it expects what never was and never will be. --Thomas Jefferson
This message is a reply to:
 Message 8 by Modulous, posted 10-12-2009 4:16 PM Modulous has acknowledged this reply

Replies to this message:
 Message 15 by Phage0070, posted 10-12-2009 4:56 PM Jazzns has responded

  
Jazzns
Member (Idle past 2048 days)
Posts: 2657
From: A Better America
Joined: 07-23-2004


Message 13 of 184 (530186)
10-12-2009 4:47 PM
Reply to: Message 9 by Modulous
10-12-2009 4:17 PM


Of course. I do

I was about to reply a bit harshly but figure maybe it has something to do with the literal ocean between us.

Let me just ask you this, in the UK basic health care is essentially a right is it not? If so, do you agree that it should be?


If a nation expects to be ignorant and free, in a state of civilization, it expects what never was and never will be. --Thomas Jefferson
This message is a reply to:
 Message 9 by Modulous, posted 10-12-2009 4:17 PM Modulous has responded

Replies to this message:
 Message 16 by Modulous, posted 10-12-2009 4:56 PM Jazzns has responded

  
Modulous
Member (Idle past 241 days)
Posts: 7789
From: Manchester, UK
Joined: 05-01-2005


Message 14 of 184 (530187)
10-12-2009 4:52 PM
Reply to: Message 11 by Phage0070
10-12-2009 4:41 PM


Why little to no underwriting profit? They are providing a service, are they not? Assuming there are other health insurance providers who can be used, competition should keep the margins low since they are interchangeable. If one company tries to charge more than the premiums and coverage warrant, then they would simply be unable to compete with the prices for their competitors.

Yes, ideally. But profiting from insurance (either as an insured or as an insurer) is against the principles of insurance and leads to precisely the problems the OP points out (among others - such as large insurers artificially increasing the premiums to mutually increase their profits).

Legislation should focus on making sure health insurers fulfill their contractual obligations, there is no need to regulate profit margin in a free market.

Not only is there no need - but it is fundamentally against the principles of a free market.

Thankfully, neither the USA or the UK are entirely free markets. Regulation of the financial industry, it should be readily obvious, is essential. The concept of the moral hazard doesn't go away because of a dream of a perfect free market state.


This message is a reply to:
 Message 11 by Phage0070, posted 10-12-2009 4:41 PM Phage0070 has responded

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Phage0070
Inactive Member


Message 15 of 184 (530189)
10-12-2009 4:56 PM
Reply to: Message 12 by Jazzns
10-12-2009 4:43 PM


Jazzns writes:

But every single individual should expect some level of basic care above and beyond the emergency room when it may very well be too late.


Why? Tell me your justification for why someone deserves something they cannot afford.

Jazzns writes:

The main point is that profit motive in private insurance encourages collecting permiums while denying coverage wherever possible.


The profit motive for a grocery store is to get as much money from you while providing as little food as possible. The profit motive of a customer at a grocery store is to get as much food as possible while parting with as little money as possible.

(Gasp!) Welcome to the world, Jazzns. Everyone is looking out for their own goals.

Jazzns writes:

Profit motive is fine as long as insurers are not allowed to scam people by issuing policys with a million little caveats in which they are allowed to deny claims


They have to live up to their contract, and they don't have to cover things they don't include. What if the person buying the policy didn't want to pay for the chance occurrence of walrus attack, who are you to force them to cover it, and the buyer to pay for it? Or were you thinking the insurance company should just be forced to pay for it out of pocket, for no good reason?

Jazzns writes:

not required to demonstrate they have the appropriate capital to manage their risk


Ok, that is a good one. But insurance covering their risk should count, right? (Oops, thats the problem...)

Jazzns writes:

and as long as people do not DIE because of the decision of a bean counter!


And there we get to it. If you gave all your money to me, I could save at least one person with it.

Oh, you don't want to? How do you like being a bean-counting murderer?


This message is a reply to:
 Message 12 by Jazzns, posted 10-12-2009 4:43 PM Jazzns has responded

Replies to this message:
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