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Thread: Medicare for all - go Jeff Merkeley

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    Default Medicare for all - go Jeff Merkeley

    David G
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    Default Re: Medicare for all - go Jeff Merkeley

    We need to be a bit careful. Medicare is loved by all who are enrolled, BUT once it determines what can be charged by the provider, it leaves a 20% copay, which is why you see all those ads for supplemental insurance.
    May be some rough water ahead. We're getting new captain.

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    Default Re: Medicare for all - go Jeff Merkeley

    Insurance to cover a 20% copay is lot less than insurance to cover 100% of a service.
    “What, Me Worry?". -. A. E. Newman

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    Default Re: Medicare for all - go Jeff Merkeley

    It's interesting to see how support for single-payer healthcare has become nearly universal in the Democratic Party lately. This wasn't true even a couple of years ago. The proverbial devil's in the details, of course, but compared to what's going on on the right - at best utter incoherence, at worst an attitude of 'f*ck you if you ain't rich', naked cruelty that would embarrass Scrooge - it's a very, very positive development

    Many of our friends here on the right have expressed support at one time or another for single-payer healthcare. Pay attention, guys. Look at what the parties stand for on this issue.
    "For a successful technology, reality must take precedence over public relations,
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    Default Re: Medicare for all - go Jeff Merkeley

    Quote Originally Posted by John Smith View Post
    We need to be a bit careful. Medicare is loved by all who are enrolled, BUT once it determines what can be charged by the provider, it leaves a 20% copay, which is why you see all those ads for supplemental insurance.
    What is it that we need to be careful about? That sounds like great leaps forward from where we are for anyone that struggles with health insurance now.
    Tom

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    Default Re: Medicare for all - go Jeff Merkeley

    The insurance companies are waiting in the tall grass with their knives sharpened. They will fight this with every dollar they have taken from us.

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    Default Re: Medicare for all - go Jeff Merkeley

    Quote Originally Posted by Keith Wilson View Post
    It's interesting to see how support for single-payer healthcare has become nearly universal in the Democratic Party lately. This wasn't true even a couple of years ago. The proverbial devil's in the details, of course, but compared to what's going on on the right - at best utter incoherence, at worst an attitude of 'f*ck you if you ain't rich', naked cruelty that would embarrass Scrooge - it's a very, very positive development

    Many of our friends here on the right have expressed support at one time or another for single-payer healthcare. Pay attention, guys. Look at what the parties stand for on this issue.
    The most important issue is paying for it. I am sure the attitude will be 'f*ck you if you ain't rich' Remember that is what the ACA told those at the median. (The median seems to be $60K now.)

    I suspect those at twice the median ($120K) will be surprised when they are taxed the equivalent of what premiums cost their employers now. And not very happy.
    Life is complex.

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    Default Re: Medicare for all - go Jeff Merkeley

    A big part of this needs to be the legal ability of medicare to negotiate pharmacy prices. The articles I have read so far have not said if getting rid of part D is in the works or not. If not it will likely fail.


    http://www.motherjones.com/politics/...part-d-prices/
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    Default Re: Medicare for all - go Jeff Merkeley

    Quote Originally Posted by switters View Post
    A big part of this needs to be the legal ability of medicare to negotiate pharmacy prices. The articles I have read so far have not said if getting rid of part D is in the works or not. If not it will likely fail.


    http://www.motherjones.com/politics/...part-d-prices/
    As mentioned... the devil is in the details.

    But - while I would welcome a wholesale adoption of an existing functional system from some other developed nation... and I think such a system, revised to fit the structural realities of the U.S., would be the logical next step - I also have no problem with incremental progress. But, as you hint at... the danger is to create something just good enough to tamp down resistance/outrage, without actually creating the kind of high-functioning system that other nations enjoy.
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    Default Re: Medicare for all - go Jeff Merkeley

    Chait makes some very, very good points here, although I think the headline's exaggerated. One major obstacle to single-payer really is the majority of people who get health insurance through their jobs. The more I see of Bernie Sanders, the more I'm convinced that while his heart's certainly in the right place, he's very bad at actually getting anything done. (source) And FWIW, getting rid of Medicare Part D isn't necessary at all, just removing the restriction on negotiating prices.

    Bernie Sanders’s Bill Gets America Zero Percent Closer to Single Payer
    By Jonathan Chait

    The sight of 15 Senate Democrats, including many of the party’s likely presidential contenders, co-sponsoring Bernie Sanders’s single-payer health-care bill may look like a momentous step. “What that means,” writes Jake Tapper, “is that with the notable exception of former Vice President Joe Biden, every top tier(ish) 2020 Democrat is now on board with a policy proposal that Clinton said less than two years ago would ‘never, ever come to pass.’”

    But this image of progress only holds true if you imagine the process as a series of continuous steps. In reality, single payer has always been, and remains, a political dilemma that nobody has been able to resolve, and there is no evidence the resolution has grown any easier. What looks like a large step forward is actually a party edging closer to a cliff it has no intention of going over.

    The barrier to single payer is that the American health-care system has been built, by accident, around employer-based insurance. The rhetoric of single payer concentrates its moral emphasis on people who lack insurance at all. (“Do we, as a nation, join the rest of the industrialized world and guarantee comprehensive health care to every person as a human right?” writes Sanders today.) But the barrier to single-payer health care is the people who already have coverage. Designing a single-payer system means not only covering the uninsured, but financing the cost of moving the 155 million Americans who have employer-based insurance onto Medicare.

    That is not a detail to be worked out. It is the entire problem. The impossibility of this barrier is why Lyndon Johnson gave up on trying to pass a universal health-care bill and instead confined his legislation to the elderly (who mostly did not get insurance through employers), and why Barack Obama left the employer-based system intact and created alternate coverage for non-elderly people outside it.

    In theory, the transition could be done without hurting anybody. The money workers and their employers pay to insurance companies would be converted into taxes. But this means solving two enormous political obstacles. First, most people who have employer-based coverage like it and don’t want to change. Second, higher taxes are unpopular. Yes, in an imaginary, rational world, people could be reassured that Medicare will be as good as what they have, and the taxes will merely replace the premiums they’re already paying. In reality, people are deeply loss-averse and distrustful of politicians.

    Health-care experts have spent decades trying to grapple with this dilemma. Sanders has not not come even a single inch closer to resolving it. Instead he hand-waves the problem away.

    Asked by Vox about the difficulty of switching people out of employer-based insurance, he scoffs, “It’s not a question of switching plans,” and then segues into a generalized riff about the merits of universal insurance. (In real politics, you can’t answer people’s concerns by denying they’re concerns.) Asked by the Washington Post about the taxes needed to finance his plan, he insists that we have no idea how much it would cost because the only studies so far have been faked by big pharma and the insurance industry: “The truth is, embarrassingly, that on this enormously important issue, there has not been the kind of research and study that we need. You’ve got think tanks, in many cases funded by the drug companies and the insurance companies, telling us how terribly expensive it’s going to be.”

    The bill does not contain any tax increases, leaving those to a separate piece of legislation. A nonspecific health-care plan that lacks a plausible financing system has accomplished approximately zero percent of the necessary work, as the Republicans discovered this year.

    There is nothing in Sanders’s rhetoric that indicates he even recognizes the shape of the political problem. Instead he employs the classic populist technique of imagining the people as a whole standing united around an obvious solution, and only the machinations of an invidious elite can thwart them. Here is what he tells Vox:

    “What this struggle is about really, honestly, is not a health care debate. Should health care be guaranteed to all people? Most people say yes. Are we wasting an enormous amount of money in the current system? Most people would say yes. Can we take on the drug companies and the insurance companies and Wall Street and their unlimited sums of money to influence Congress? … That’s a major political struggle that we have to engage in.”

    And here is what he writes in his New York Times op-ed:

    "Needless to say, there will be huge opposition to this legislation from the powerful special interests that profit from the current wasteful system. The insurance companies, the drug companies and Wall Street will undoubtedly devote a lot of money to lobbying, campaign contributions and television ads to defeat this proposal."

    Evil corporations are the only impediment he acknowledges. At no point does he grant that the most important source of opposition will come from actual American voters concerned about losing their current plan or paying higher taxes.

    There are ways around the problem. Mostly they involve boring, incremental reforms that fall well short of a real single-payer plan: lowering the age at which people can buy in to Medicare, creating a public plan on the exchanges, perhaps creating ways to encourage employers to cover their workforce through Medicare or a public plan.

    Sanders is not a details person, though. He prefers to act as though the important barrier is the abstract notion of government-run insurance, turning every question about specifics into a question about values. But the concept of a government-financed insurance program has never been the controversial part. (This is why single-payer Medicare is a beloved institution Republicans swear up and down never to change, while privatized Obamacare is a detested socialist monstrosity.) The controversial part has always been the mechanics of change.

    Obama himself said many times that, if he were starting a health-care system from scratch, he would prefer a single-payer system. Sanders’s single-payer bill is vague enough that the Democrats co-sponsoring it are really doing nothing more than saying the same thing Obama did: A single-payer plan would be nice, in a world that looks nothing like the one we inhabit.
    "For a successful technology, reality must take precedence over public relations,
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    Default Re: Medicare for all - go Jeff Merkeley

    If other civilized Western countries can do single payer successfully, with better overall medical outcomes than we do, I fail to see the issue, unless one is hung up on Ronnie Reagan 60s-era invective against " socialized medicine '.
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    Default Re: Medicare for all - go Jeff Merkeley

    Pelosi is not on board. I'm sure she has her reasons.
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    Default Re: Medicare for all - go Jeff Merkeley

    Quote Originally Posted by Gerarddm View Post
    If other civilized Western countries can do single payer successfully, with better overall medical outcomes than we do, I fail to see the issue, unless one is hung up on Ronnie Reagan 60s-era invective against " socialized medicine '.
    In a rational world, that would certainly be true. But sometimes when you've gone down one road for a long time, it makes changing much harder. Switching people off of employer-paid insurance is not a trivial problem. I'm all in favor, but it's not going to be easy.
    "For a successful technology, reality must take precedence over public relations,
    for nature cannot be fooled."

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    Default Re: Medicare for all - go Jeff Merkeley

    I have been fortunate enough to be covered under an employer-sponsored plan for most of my working life. (My current coverage is really quite good but then my union manages the plan for the long term benefit of our members, a little socialism in action?). The ACA has done a decent job of narrowing the gap between types of plans but I remember the days of bargain-basement plans that covered very little and folks getting sick, losing their jobs and finding themselves un-insurable. So, "Medicare-for-all"? Bring it on, lets see what it offers, the current Medicare system seems to be doing a pretty good job of taking care of those it covers now. Imagine what could happen if we freed the average worker to go out and work at the jobs that most appealed to them without having to consider whether or not the job came with health insurance?
    Steve

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    Default Re: Medicare for all - go Jeff Merkeley

    Can we take on the drug companies and the insurance companies and Wall Street and their unlimited sums of money to influence Congress? … That’s a major political struggle that we have to engage in.

    That's really the ONLY thing standing in the way - bought out politicians.
    "Why, sometimes I've believed as many as six impossible things before breakfast." - Alice

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    Default Re: Medicare for all - go Jeff Merkeley

    Quote Originally Posted by John of Phoenix View Post
    Can we take on the drug companies and the insurance companies and Wall Street and their unlimited sums of money to influence Congress? … That’s a major political struggle that we have to engage in.

    That's really the ONLY thing standing in the way - bought out politicians.
    And THIS issue, in my estimation, is a very good place to engage.
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    Default Re: Medicare for all - go Jeff Merkeley

    You're going have to fix Citizens United to get anything done and that's all but impossible.
    "Why, sometimes I've believed as many as six impossible things before breakfast." - Alice

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    Default Re: Medicare for all - go Jeff Merkeley

    Quote Originally Posted by Keith Wilson View Post
    One major obstacle to single-payer really is the majority of people who get health insurance through their jobs.
    People in general like their insurance. They can always change their insurance. It is going to be hard to convince those with good plans to accept an unknown plan that is subject to change with no alternatives for those whom the plans don't provide sufficient benefits.

    Quote Originally Posted by Gerarddm View Post
    If other civilized Western countries can do single payer successfully, with better overall medical outcomes than we do, I fail to see the issue, unless one is hung up on Ronnie Reagan 60s-era invective against " socialized medicine '.
    As has been pointed out several times, US costs are much higher than in other Western countries. Those countries with single payer started their programs when costs were much lower and controlled the costs. It is going to be very hard to lower costs in the US enough to make tax rates attractive.

    HSAs were/are popular with those where the tax break brought the cost of insurance to below market rates. To make single payer popular one needs to do the same. It is possible to do by either taxing the rich - and no one is rich enough to be willing to pay the tax, or by running up large deficits.

    While single payer might have been a good idea at one time, I think that time has passed.
    Life is complex.

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    Default Re: Medicare for all - go Jeff Merkeley

    David G
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    "It was a Sunday morning and Goddard gave thanks that there were still places where one could worship in temples not made by human hands." -- L. F. Herreshoff (The Compleat Cruiser)

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    Quote Originally Posted by Too Little Time View Post
    People in general like their insurance. They can always change their insurance. It is going to be hard to convince those with good plans to accept an unknown plan that is subject to change with no alternatives for those whom the plans don't provide sufficient benefits.


    As has been pointed out several times, US costs are much higher than in other Western countries. Those countries with single payer started their programs when costs were much lower and controlled the costs. It is going to be very hard to lower costs in the US enough to make tax rates attractive.

    HSAs were/are popular with those where the tax break brought the cost of insurance to below market rates. To make single payer popular one needs to do the same. It is possible to do by either taxing the rich - and no one is rich enough to be willing to pay the tax, or by running up large deficits.

    While single payer might have been a good idea at one time, I think that time has passed.
    Medical costs in the us are much higher because the insurance companies are ripping us off for 20%.

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    Default Re: Medicare for all - go Jeff Merkeley

    Quote Originally Posted by oznabrag View Post
    Medical costs in the US are much higher because the insurance companies are ripping us off for 20%.
    It is funny how that works out. The ACA rips off the poor, young, healthy and gives to the rich, old, sick. I lot of people liked that.

    For most of my life I thought the premiums were out of line for my risk. I did not have insurance at those times. I did have insurance when HSAa were available and I was earning enough to get a good tax break (and earning enough that I did not care about the cost). So too some extent you are right about insurers. On the other hand insurance is a business like any other. You are (at least were) free to negotiate price with providers and pay out of pocket.

    Perhaps you would like to address flood insurance. The government provides it at below cost rates and those who need it the most don't buy it.

    Perhaps you could offer suggestions for food insurance. To help out those who cannot afford food.

    I am all in favor of helping the poor a lot more with free healthcare, free food, and even free disaster assistance. But most people want a better deal for themselves and not much for the poor. So I am not in favor of below market rates for the rich passing as middle class.
    Life is complex.

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    Default Re: Medicare for all - go Jeff Merkeley

    Quote Originally Posted by Too Little Time View Post
    Perhaps you would like to address . . .
    I am all in favor of helping the poor a lot more with free healthcare, free food, and even free disaster assistance. But most people want a better deal for themselves and not much for the poor. So I am not in favor of below market rates for the rich passing as middle class.
    Perhaps you would like to address the yawning pit of a hole in your 'logic'?

    As has been pointed out several times, US costs are much higher than in other Western countries.
    This statement is accurate.

    Those countries with single payer started their programs when costs were much lower and controlled the costs. It is going to be very hard to lower costs in the US enough to make tax rates attractive.
    This statement is inaccurate. To state that the reason those countries' health care costs are lower because they started earlier and ignoring the effect of the Insurance Ripoff Scam Of The Century is so far beyond 'disingenuous' that it is nearly into 'deliberate dissembling' territory.

    The single largest factor driving US healthcare costs into the Stupid Money Stratosphere is Insurance Industry Profit.

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    Default Re: Medicare for all - go Jeff Merkeley

    Quote Originally Posted by oznabrag View Post
    Perhaps you would like to address the yawning pit of a hole in your 'logic'?



    This statement is accurate.



    This statement is inaccurate. To state that the reason those countries' health care costs are lower because they started earlier and ignoring the effect of the Insurance Ripoff Scam Of The Century is so far beyond 'disingenuous' that it is nearly into 'deliberate dissembling' territory.

    The single largest factor driving US healthcare costs into the Stupid Money Stratosphere is Insurance Industry Profit.
    I did not see a yawning pit. I gave my reasoning. You need not accept it, but I do.

    We will see if my statement is accurate or not. Several years of single payer will either reduce costs or not. I am betting on not. I think the ACA was intended to reduce costs. But after passage the words changed.

    All insurance is a scam in that it makes profits for the insurer. Until the ACA we all had the option of participating in the scam - on the losing side, or not. Perhaps you and your friends could start a mutual insurance company and pass out the profits to the insured.
    Life is complex.

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    Yawning pit.

    Just blithely breezing past $6B in profits to private insurers FOR THE SECOND QUARTER OF 2017 ALONE!


    Combined, the nation's top six health insurers reported $6 billion in adjusted profits for the second quarter. That's up more about 29 percent from the same quarter a year ago — far outpacing the overall S&P 500 health care sector's growth of 8.5 percent for the quarter, according to Thomson Reuters I/B/E/S data.
    Gaping abyss.

    My only question is whether you are being dishonest with yourself, or everybody else.

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    Default Re: Medicare for all - go Jeff Merkeley

    Quote Originally Posted by Too Little Time View Post
    The most important issue is paying for it. I am sure the attitude will be 'f*ck you if you ain't rich' Remember that is what the ACA told those at the median. (The median seems to be $60K now.)

    I suspect those at twice the median ($120K) will be surprised when they are taxed the equivalent of what premiums cost their employers now. And not very happy.
    Bear in mind that the way most western nations do it, they're spending less than half of what the USA does per person, so the tax that goes to healthcare will be a lot less than the insurance premiums currently paid.

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    Default Re: Medicare for all - go Jeff Merkeley

    Quote Originally Posted by john welsford View Post
    Bear in mind that the way most western nations do it, they're spending less than half of what the USA does per person, so the tax that goes to healthcare will be a lot less than the insurance premiums currently paid.
    I think I addressed that. Other countries started their single payer when costs were low. They did not lower costs. I don't expect US costs to drop.
    Life is complex.

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    Quote Originally Posted by oznabrag View Post
    Yawning pit.

    Just blithely breezing past $6B in profits to private insurers FOR THE SECOND QUARTER OF 2017 ALONE!

    Gaping abyss.

    My only question is whether you are being dishonest with yourself, or everybody else.
    $6 billion of profit from 100 million families is $60/family. So $24/family/year. That seems to be reasonable for the risk they are assuming. (Feel free to provide a different estimate.)

    But as I said I think insurance is overpriced so I did not have insurance for a good part of my life. Since you agree that insurance is overpriced, perhaps you should think about dropping your insurance.
    Life is complex.

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    Default Re: Medicare for all - go Jeff Merkeley

    The US has two problems with health care (wildly oversimplified, but OK for a first approximation) the cost is about twice what the rest of the developed world pays, and a whole lot of people aren't covered - much fewer than before the ACA reform, but still way too many. The insane complexity of the insurance system is a subset.

    But TLT's right on this one. We've gone down this road for 40 years and more, and dialing back the costs to the levels of the rest of the world is not going to be easy, not even close. Merely switching to single-payer of any kind won't do it by itself. There are a LOT of people who are making their living off the current system, not just overpaid CEOs, and the transition will be complicated. I think it will take a generation at least, even with good will and cooperation - a perhaps overly-optimistic assumption, when the current Republican party has not one single useful idea to contribute.
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    Default Re: Medicare for all - go Jeff Merkeley

    The only near term fix possible for US health care is to fix the problems with the ACA.

    Jeff C

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    Quote Originally Posted by Too Little Time View Post
    $6 billion of profit from 100 million families is $60/family. So $24/family/year. That seems to be reasonable for the risk they are assuming. (Feel free to provide a different estimate.)

    But as I said I think insurance is overpriced so I did not have insurance for a good part of my life. Since you agree that insurance is overpriced, perhaps you should think about dropping your insurance.
    Aside from leaving off a zero, your estimate seems 'ok'.

    Let's take that $24B/PA and add another $24B in wasted paperwork, $24B in bonuses to the army of ghouls whose job it is to take your money and watch you die, another $28B to bonuses for the ' I''m alright, Jack' CEOS of the entire fraudulence, subtract that $100B in gross inefficiencies/waste from $3.35T, and what's left is STILL damned near twice what the rest of the world pays.




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    Quote Originally Posted by oznabrag View Post
    Aside from leaving off a zero, your estimate seems 'ok'.
    You are correct. I misplaced the decimal.

    But as you noticed the overhead items you enumerate while large don't amount to much of the total cost.
    Life is complex.

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    Quote Originally Posted by Too Little Time View Post
    You are correct. I misplaced the decimal.

    But as you noticed the overhead items you enumerate while large don't amount to much of the total cost.
    The numbers are 'large' to this carpenter, but they are likely a small percentage of the real numbers.

    Why is this acceptable?

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    Quote Originally Posted by oznabrag View Post
    The numbers are 'large' to this carpenter, but they are likely a small percentage of the real numbers.

    Why is this acceptable?
    It is what people are willing to pay.

    The TV was talking about Sanders' Plan. An example they gave was a family earning $50K was paying $5K for insurance and the employer was paying $13K - total of $18K. I am sure you have some idea of how that cost is going to be divided up with single payer.

    If costs are cut in half, it might happen that the employee will pay $9K (and be unhappy) and the employer will be happy to reduce costs by $13K. Sometimes perceptions of the future prevent change.

    You might explain why you kept paying for insurance - if and when you had it. And why you did not form a mutual insurance company with your like minded friends.
    Life is complex.

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