Latest National Medical News & Politics
[of special relevance to Central Oregon]

Standardized Medicine Doesn't Mean Better Medicine
Jul 22, 2010
Altanta physician writes "to expose Dr. Donald Berwick's suggestions for reform as being naively "cookbook" and unrealistic"


Health Lobbyists Focus on a Once-Obscure Group
[U.S. Preventive Services Task Force]

Jul 15, 2010
Under the new health-care overhaul law, health insurers will be required to pay fully for services that get an A or B recommendation from the U.S. Preventive Services Task Force.  Thus the USPSTF could become a political lightning rod. If it doesn't recommend a service, insurers don't have to pay for it, and advocates might argue the decision is a barrier to care. If the panel does back a service, it might increase patients' access, as well as create new business opportunities.


A Push for Transparency in Doctors’ Fees
Jul 08, 2010
print Share | e-mail Facebook Tweet Digg StumbleUpon Delicious Google Yahoo Buzz Dr. Giovanni Colella, center, co-founder and chief executive of Castlight Health in San Francisco, talks to Castlight employees Heather Kagin, left, and Nita Sommers. Patients using Castlight could search for doctors that offer a service nearby and find out how much they will charge that patient.Jim Wilson / New York Times News Service A push for transparency in doctors’ fees Comparison shopping site aiming to lower health care costs has direct applicability for Central Oregon  


The Feuding Fathers: Venom of Today's Politics Not New
Jun 26, 2010
Ron Chernow of the Wall Street Journal counters how Americans lament the partisan venom of today's politics with how the country's founders were in a league of their own with sheer verbal savagery


Low Medicare Pay for Doctors puts Health Reform at Risk
Jun 19, 2010
Now is not the time for Congress to be penny-wise and pound-foolish, writes Mike Newman, MD, a long-time personal friend of our immediate past society President


Senate Passes Six-Month SGR Fix at The Last Minute
Jun 18, 2010
his legislation provides a 2.2 percent Medicare physician payment update for six months, from June 1 through Nov. 30, in lieu of the 21 percent cut scheduled for 2010.  The House of Representatives must now pass H.R. 3962 for the Senate action to succeed.


Medicare Fees Cut 21%
Jun 17, 2010
In a last-minute shock to physicians, the Senate voted today against postponing a scheduled 21% reduction in Medicare reimbursement to physicians and other health providers.


Fixing Medicare's Physician Payment System
May 31, 2010
The most fundamental problem with the SGR is that its objective is to control total physician spending, which is neither affected nor driven by the spending of any individual physician. If anything, individual physicians are provided with an even greater incentive to increase spending, because nothing they do as individuals can affect overall spending, but their fees will be affected by what other physicians do collectively, irrespective of their own behavior.


Legislative News
May 27, 2010
Congress will debate a provision to stop the 21% pay cut under Medicare scheduled for June 1 and provide payment increases for physicians through 2013.


2010 Health Care Act Summary
Mar 25, 2010
Timeline for Implementing the 2010 Health Care ActCommittees On Ways & Means, Energy & Commerce, And Education & Labor Thanks to Mike Mastrangelo, MD and Medscape Family Medicine, the Central Oregon Medical Society is able to bring you a year-by-year implementation summary of the 2010 Health Care Act


Democrats Consider Setting Larger Health Goals Aside
Jan 23, 2010
Debate highlights administration's difficulty in selling legislation, choosing to focus on costs over benefits for uninsured


Mayo Clinic in Arizona to Stop Treating Some Medicare Patients
Dec 31, 2009
The Mayo Clinic, cited by President Obama as a medical care system to be emiulated for its cost containment and patient care excellence, announced that at one of its facilities (Glendale, Arizona) it will begin to refuse Medicare patients


Health Care Compromised by Crass Payoffs
Dec 27, 2009
David Broder, who covered and wrote up the Clinton effort to reform health care is embarrassed by the travesty of low-grade political theater — angry rhetoric and backroom deals — that occurred in the U.S. Senate in passing their healthcare reform bill


Saving Lives ... or Saving Money?
Dec 27, 2009
UCLA Medical Center is perennially near the top of list of centers ordering needless tests and instituting futile procedures, according to researchers at Dartmouth who rankd medical centers that spend the most on end-of-life care but seem to have no better results than hospitals spending much less


Senate and House Health Care Reform Bills (SB3590 and HR3962)
Dec 24, 2009
A complete copy of the U.S. Senate (2,074 pages) and House of Representatives (1,990 pages) healthcare reform bills, passed by the Senate and House on December 24 and November 21, 2009, respectively (provided by the Central Oregon Medical Society for its members)


Health Bill Clears Major Obstacle in Senate
Dec 21, 2009
The 30-hour maximum to break a filibuster will be played out in the U.S. Senate from 1 am this morning to 7 am tomorrow night, 1 pm the next day and finally at 7 pm on Christmas eve to pass the healtcare reform over the objection of all 40 Republican Senators


Cancer Center Ads Use Emotion more than Fact
Dec 19, 2009
A New York TImes reporter criticizes cancer centers for claiming that they have the 'best' care available withj 'highest cure rates' when there is no evidence for the contentions


Senate Votes to Delay 2010 Medicare Pay Cut Until February 28
Dec 18, 2009
Following the lead of the House, the Senate approved a defense spending bill that, as part of an add-on measure, would push the effective date for a scheduled Medicare pay cut of 21.2% for physicians from January 1 to February 28.


How Backbench Senators are Fixing Health Care
Dec 13, 2009
Eleven freshman senators have banded toigether to provide amendments to the healthcare reform bill that take advantage of current provisions to test pilot programs such as eliminating fee-for-service, and thereby both potential make the bill more effective and economical than auithored by senior senators


These People have Big Ideas about Reforming Health Care, but are They the Right Ideas?
Nov 29, 2009
A Must Read
A well known New York Times columnist finds more benefit in the Senate bill than in the House bill and recommends the easy stuff, what works, a Fed for health, the McAllen problem, choice, and the Cadillac tax


A Milestone in the Health Care Journey
Nov 26, 2009
The Atlantic health reporter reviews what 20 leading health economists wrote, on November 20, to President Obama


Public Option Threatens Reid’s Fragile Consensus
Nov 23, 2009
Within hours after agreeing to block a filibuster and allow debate on the Senate bill for healthcare reform, at least two Senators who voted to proceed are indicating opposition to the public option component


Health Haggling Heats Up
Nov 22, 2009
By GREG HITT and JANET ADAMY  /  Wall Street Journal  /  November 22, 2009Also published in The Bulletin Getty Images Senate Majority Leader Harry Reid (D., Nev.)...


Merkley Bullish, Wyden Quiet on Latest Senate Bill
Nov 20, 2009
Soft-spoken Sen. Merkley pronounced himself “very pleased” with the bill, unveiled late Wednesday in the Senate, while the normally loquacious Sen. Wyden avoided commenting on the massive bill


Overweight Americans Push Back in the Health Care Debate
Nov 19, 2009
Organziations that defend the obese regard current efforts at healthcare reform as unfairly invoking the extra cost of care of the obese


New Breast Cancer Screening Guidelines Significantly Reduce Mammography and Breast Exams
Nov 18, 2009
US Preventive Services Task Force recommends reducing breast cancer screening with mammography, self-breast examinations and clinical breast examinations


Obama Seeking Revision of Plan’s Abortion Limits
Nov 10, 2009
President concerned about amendment that would block federal funds for most health plans that cover abortion


Health care Reform in the Senate: ‘Dead on Arrival’?
Nov 09, 2009
The glow from a health care triumph faded quickly for President Barack Obama on Sunday as Democrats realized the bill they fought so hard to pass in the House has nowhere to go in the Senate since the government health insurance plan included in the House bill is unacceptable to a few Democratic moderates who hold the balance of power in the Senate.


White House Urges Action on Health Care
Nov 09, 2009
But the bill’s road promises to be even rockier in the Senate


Sweeping Health Care Plan Passes House
Nov 08, 2009
Peter DeFaxio (D, OR) is quoted


House Democrats Pass Health-Care Bill
Nov 08, 2009
The U.S. House narrowly passed landmark health care legislation Saturday night to expand coverage to tens of millions who lack it and place tough new restrictions on the insurance industry. The vote was 220-215.  One Republican votes for plan. The Senate will act next on legislation


Deal on Abortion Clears Way for Vote in House
Nov 07, 2009
By David Espo and Ricardo Alonso-Zaldivar / The Associated Press  /  November 07. 2009 WASHINGTON — Capping months of struggle, House Democrats cleared an abortion-related impasse blockin...


House to Vote on Healthcare Reform Bill this Weekend
Nov 06, 2009
House to vote on healthcare reform Saturday night; Republicans submit own bill; Senate may vote on their bill until 2010


House Republicans are Crafting Health Insurance Alternatives
Nov 03, 2009
Chances are that little or none of the Republican plan will become law, since the House has 177 Republicans and 256 Democrats and Democrats control 60 of the Senate’s 100 seats


Progress on Health Reform, But at a Price
Nov 02, 2009
By Robert Pear and Sheryl Gay Stolberg / New York Times News Service  /  November 02. 2009 WASHINGTON — After months of plodding work by five congressional committees and week...


Public Option Estimate Raises Doubts
Nov 01, 2009
Only 2% of Americans younger than 65 are expected to sign up for the public option plan, should it be legistated


Worst Bill Ever
Nov 01, 2009
Epic new spending and taxes, pricier insurance, rationed care, dishonest accounting: The Pelosi health bill has it all


Path Clearing for House to Pass Health Bill — Over Liberal Objections
Oct 31, 2009
After months of saying they couldn’t vote for a bill without the strongest possible government-run insurance option, liberals are putting aside their disappointment over the weaker version in the legislation for a historic chance to remake America’s medical system.


House Democrats Unveil Health Plan
Oct 30, 2009
Republicans said gimmicks had been used to hide the measure’s long-term costs.


House Democrats are Set to Unveil Modified Version of Health Plan
Oct 29, 2009
House Speaker Nancy Pelosi has decided to propose a government-run insurance plan that would negotiate rates with doctors and hospitals, rather than using prices set by the government


Ensuring Progress in Primary Care — What Can Health Care Reform Realistically Accomplish?
Oct 28, 2009
Brigham and Women’s Hospital physician reviews potential of impeding federal legistation to improve primary care


Four Health Care Reforms for 2009
Oct 28, 2009
Health economist Victor Fuchs discusses four specific health care reforms that should, but problably will not, be enacted this year


To be Young, Invincible and Lacking any Health Insurance
Oct 28, 2009
High costs are a deterrent for many young adults


Healthcare System Wastes up to $800 Billion a Year
Oct 26, 2009
"The bad news is that an estimated $700 billion is wasted annually. That's one-third of the nation's healthcare bill," says the vice president of healthcare analytics at Thomson Reuters


House Health Bill Exceeds $1T
Oct 24, 2009
Democrats have touted an unreleased Congressional Budget Office estimate of $871 billion in recent days, a total that numerous officials acknowledge understates the bill’s true cost by $150 billion or more


Under Pressure, Reid says Reform Bill may have Public Option
Oct 23, 2009
Under immense pressure from the liberal wing of his caucus, the Senate majority leader, Harry Reid, has told colleagues that he may include a government-run health insurance plan in a health care


Medicare Changes come into Focus as Overhaul Plan moves Forward
Oct 22, 2009
Despite the clamor, most of Medicare’s 45 million beneficiaries, will have improved coverage from the current healthcare reform measures by beefing up drug benefits, preserving access to physicians, paying for more preventive care and putting Medicare on firmer financial footing


Democrats’ Disharmony over Health Care May Matter More Than GOP Disapproval
Oct 18, 2009
Democrats and Republicans may be at odds over health care. but they’ve got nothing on House and Senate Democrats who are going after each other


Congressional Action to Improve Medicare Reimbursement
Oct 17, 2009
Senator Debbie Stabenow [D-MI] has introduced a bill in the senate that would repeal the Medicare Sustainable Growth Rate (SGR) permanently.


Time for President to Put His Stamp on Health Care Reform
Oct 15, 2009
Our President needs to deserve the domestic equivalent of the Nobel Peace Prize


Health Plan
Oct 15, 2009
Bend resident and small-business man defends current efforts at healthcare reform


Senate Finance Committee Sends Healthcare Reform Bill to Congress
Oct 14, 2009
The last Congressional Committee to finalize its version of healthcare reform legislation votes, 13-9, to send it for Senate debate


Comparing the Health Care Plans
Oct 14, 2009
Excellent summary of the healthcare reform bill emerging from the Senate and House and how the majority leaders are steering them


Tort Reform can Cut the Deficit
Oct 14, 2009
It is irresponsible for the bills in the Senate and House to cost in excess of $820-$900 billion over the next decade without considering the potential savings that would accompany tort reform


Tort Reform Key to Affordable Health Care
Oct 13, 2009
Sen. Orrin Hatch (R-Utah) points to new Congressional Budget Office analysis of mdical malpractice that clearly documents how tort reform can allow more Americans to access healthcare along with a reduction of federal spending by $41 billion over ten years and a decline in the federal deficit by $54 billion.


So What is it the Lobbyists are Looking to Gain?
Oct 12, 2009
Why have most of the serious proposals to fulfill President Barack Obama’s original vow to curb costs have fallen victim to organized interests and parochial politics?


Bentham vs. Hume on Reform in Washington
Oct 11, 2009
David Brooks at his best, eloquently caricaturizing the healhcare reform conflict ala Jeremy Bentham and David Hume, and concluding that 1) the debate is not between socialism and free-market purism but about how to promote innovation, and 2) the Bentham side will win


If Reform Passes, Wait for Benefits is 3 Years
Oct 11, 2009
If passed, federal tax credit legistation to won't help make health insurance affordable for millions of low- and middle-income households until 2013 or later


Democrats Consider an Additional Tax on Insurance Companies
Oct 09, 2009
‘Windfall profits’ levy would help provide coverage to uninsured


Why Republicans and Businesses Differ on Health Care Reform
Oct 08, 2009
One of the intriguing mysteries of this year is why the initial broad support from American business for overhauling the health care system has not translated into more than a handful of votes from Republicans in the House and Senate


Michael Newman. MD, Interview after Meeting with President Obama
Oct 05, 2009
Michael Newman. MD, a personal friend, was interviewed outside the White House after physicians met in the Rose Garden with President Obama.  Mike was in the Peace Corps before he went to medical school.  Tim Russert was one of his many patients from the political arena.


2 Sensitive Issues Add Complexity to Reform
Oct 04, 2009
Bend reporter in Washington, DC, identifies abortion and illegal immigration as particularly divisive topics that could subterfuge health care debate


Senate Panel Votes Down Public Option for Health Care Bill
Oct 02, 2009
•Finance Committee strikes down second amendment to bill •Reform bill with public option couldn't win in Senate, Baucus says •House Democrats plan meetings on merging three versions of reform plan •Republicans say Democrats' overhaul proposal is too expensive


Why Medical Malpractice is Off Limits
Sep 29, 2009
A prominent lawyer blames his colleagues in the profession and those in Congress for blocking tort reform in all current versions of proposed health care reform


Doctors for America Weekly Update
Sep 26, 2009
The 1st edition of Doctors for America Weekly Update.  Whether you are for, against, or on the fence about reform, your Senators and Representatives need to hear from their physician constituents.  Join physicians across the country in making 5,000 contacts with Congress! 


Physicians’ Views on a New Public Insurance Option and Medicare Expansion
Sep 17, 2009
Of 2,130 physician surveyed, 63% favored a public option (along with private insurance) for Americans, a higher or equal proportion of the 52 to 69% of Americans themselves.


Physicians on Call for Health Care Reform
Sep 06, 2009
Mike has been a close friend since we graduated from medical school together 40 years ago.  He was Tim Russert's physician and takes care of many of our famous politicians ("somebody has to").  He attends and teaches at Johns Hopkins, in Baltimore vs. his office in D.C. and home in Bethesda.  Mike's letter should be read by us, member and spouse.Archie Bleyer, MD2009 President, COMS


Climbing the Hill on Health Care
Sep 02, 2009
In this outstanding editorial, former Senator Tom Daschle urges Democrats to pursue reform with or without Republican support


5 Myths About Health Care Around the World
Aug 23, 2009
T. R. Reid, Washington Post Correspondent and author of "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care" who traveled the world to learn how America can improve its healthcare system, debunks major arguments again health care reform


Separating Fact from Fiction in the Health Care Debate
Aug 20, 2009
Here is a guide to the main fight points in healthcare reform, as of the congressional break*, August 2009*literal and figurative


Health Care Reform 2009 News Center
Aug 17, 2009
The Health Care Reform Center at healthcarereform.nejm.org provides a growing series that includes almost 100 N Engl J Med  articles and online features by a diverse group of authors representing all parts of the health care system and all points of view and who have wrestled with the issues the country faces.


Is ‘Health’ Missing from Health Care Debate?
Aug 16, 2009
As debate crescendos over health care reform, there is a more fundamental questionn: what about health? Could policymakers change our medical system in ways that would make America a healthier country?


Understanding How Americans View Health Care Reform
Aug 12, 2009
Most Americans do not think the current reform legislation will improve their own health care or lower their costs. In addition, more than three fourths believe that their own taxes will increase. Uncertainty about the potential effect of legislation appears to be leading to volatility in the level of public support for the reform plans of President Obama (with 42 to 56% in support) and Congress.


Keeping the Patient in the Equation — Humanism and Health Care Reform
Aug 06, 2009
The low ranking of the United States in health care has not emphasized that we are rated first in responsiveness — that is, in providing patients with choices that are meaningful to them. We scored poorly on the variables related to economics and fairness in distribution of services, and these factors will be addressed through the reform measures that are now in the works.


A Bumpy Road for Reform
Aug 06, 2009
Despite the current turmoil, the modern presidency's powers of persuasion and punishment, the ability of Democratic leaders to marshal their majorities in Congress, and the support — however reluctant — of private interests give the edge to those favoring action. What form that action will take, however, is entirely an open question


A Time for Revolutions — The Role of Clinicians in Health Care Reform
Aug 06, 2009
How lessons learned in the United Kingdom can help the United States


U.S. Psyche Bedevils Health Effort
Aug 04, 2009
Although the public loves to complain about health care, it's no surprise that people are afraid of changing the health care system. Capital Journal columnist Jerry Seib outlines several reasons for the foot-dragging.


Two Sides Take Health Care Debate Outside Washington
Aug 03, 2009
With Republicans mobilizing against the proposed health care overhaul, President Obama, Congressional Democrats and leading advocacy groups are laying the groundwork for an August offensive against the insurance industry as part of a coordinated campaign to sell the public on the need for reform.


Reactions to Alliance of Area Doctors, Hospital Hint at Obstacles
Jul 29, 2009
News of an alignment between a group of doctors and the region’s hospital system was met this week with both applause and disdain, foreshadowing the long and bumpy road facing local health restructuring efforts.


Area Doctors, Hospital Form Alliance
Jul 22, 2009
In a medical community that has come to be known for divisiveness, a group of physicians has come together with Cascade Healthcare Community hospital system to adopt a shared vision for improving health care in Central Oregon.


Harbingers of Change in Health Care
Jul 22, 2009
The now infamous New Yorker report by Atul Gawande about overutilzation of medical procedures, tests, referrals and consults as exemplified by McAllen, Texas is reviewed by Joseph Simone in his editorial in Oncology Times.  Joe also reviews Julie Weed's New York Times piece about primary care physicians who have left the high-volume imperative without leaving medicine


Health Reform Deadline In Doubt
Jul 22, 2009
Process Could Be Slow And More Contentious     By Shailagh Murray, Paul Kane and Michael A. FletcherWashington Post Staff Writers Friday, July 24, 2009


Ten Questions on the Health-Care Overhaul
Jul 21, 2009
The effort to change the system enjoys more support than past attempts, but the complications are as acute as ever.   By JANET ADAMY / Wall Street Journal / July 21, 2009


A Bumpy Road for Healthcare Reform
Jul 21, 2009
CBO Director Douglas Elmendorf testified that, far from "bending the cost curve," the current legislation "significantly expands the federal responsibility for health care costs."  Ten Democrats on the 59-member House Energy and Commerce Committee said they would not vote for or had serious concerns about the reform proposal in its current form.  The only prospect for winning much Republican support lies in ongoing negotiations within the Senate Finance Commiittee.


A Time for Revolutions — The Role of Clinicians in Health Care Reform
Jul 21, 2009
Over 10 years ago, Britain's National Health Service had to confront reform on a scale as challenging as that being contemplated in the U.S. today.  Professional responsibility for health outcomes in the hands of clinicians, rather than beaurocrats or insurance companies must be the ambition of any new structure.  Clinicians must educate both policymakers and the wider public about appropriate levels of care.  


Wyden’s Health Care Plan is Back
Jul 18, 2009
Wyden’s back with his health plan, now seeking wider appeal.  By Keith Chu / The Bulletin /  July 18. 2009


Democrats' Plan Would Add >$230 Billion to Deficit
Jul 18, 2009
House Democrat Health Bill Adds to Budget Deficit, CBO Says.   By GREG HITT / Wall Street Journal / July 18, 2009


Budget Blow for Democrat's National Healthcare Reform Plan
Jul 17, 2009
Congress's Chief Fiscal Watchdog Warns of Overhaul's Cost; Ammunition for Critics


Summary of Health Care Legislation in Congress
Jul 17, 2009
Summary of Health Care Legislation in Congress, and Oregon's Role, as Summarized by The BulletinJuly 17, 2009


End the Medical Civil War That’s Embarrassing Bend
Jul 06, 2009
"One could take either the BMC or CHC side of the civil war, but this is a fool’s choice. ... instead of waiting for this medical civil war to continue to tear apart our community and compromise patient care, let us put an end to this battle."


A High Turnover at BMC
Jul 02, 2009
The sudden, unexplained departure of dozens of physicians from Bend Memorial Clinic in the past year has many patients wondering what’s going on within the walls of the clinic, and many are following their doctors to their new practices in town.Bend Bulletin, July 12, 2009


2nd Chance for Wyden’s Health Plan?
Jun 21, 2009
Turmoil over reform efforts in D.C. could make Oregon senator’s bill mandating coverage more alluring, despite criticism from left and right. Sen. Merkeley (D., OR) is sticking with the President's plan. Jim Diegel says Cascade Healthcare Community is not going to wait.


Getting in The Way of a Doctor’s Calling
Jun 19, 2009
Physicians are spending more time on financial remuneration issues than on patient care


President Obama Reminds Physicians of Their Mission at AMA Annual Meeting
Jun 15, 2009
Highlighted by the attendance of President Barack Obama on Monday, June 15, the Annual OMA meeting featured contributions by OMA members Judge Hicks, immediate past-Vice President and former Speaker of the OMA HOD, Past-President Dick Allen, President Chuck Hofmann, Past-President Dave Lindquist, and OMA Executive Director Jo Bryson


Health Care Reform: How Physicians Can Help
Jun 12, 2009
Elliott S. Fisher, M.D., M.P.H., Donald M. Berwick, M.D., M.P.P., and Karen Davis, Ph.D. of Darmouth, Harvard and Commonwealth Fund provide suggestions


Shortage of Doctors Proves Obstacle to Obama Goals
May 04, 2009
Proposal to increase Medicare payments to general practitioners, at the expense of high-paid specialists, has touched off a lobbying fight.


Sen. Rockefeller Introduced Legislation Requiring Universal Electronic Health Record
May 02, 2009
Rockefeller Introduced Legislation Calling For Universal Adoption Of Electronic Health Records The Health Information Technology Public Utility Act of 2009 will make Health IT more accessible ...


Kathleen Sibelius Accepts HHS Secretary Post
Mar 01, 2009
Obama Selects Kansas Governor Kathleen Sibelius for HHS Sectretary after Daschle Withdrawal


Obama Removes MDs Abortion Protections
Feb 27, 2009
LifeNews, February 27, 2009, by Steven Ertelt
To be overturned are protections President Bush put in place to ensure medical staff and centers from being forced to do abortions


Obama Healthcare Budget Proposal
Feb 26, 2009
Washington Post, February 26, 2009, by Ceci Connelly
$634 Billion Fund For Health Care to be Paid by Capping Personal Tax Deductions and Insurers


Wyden, Kitzhaber Touted for Health Post
Feb 05, 2009
Bend Bulletin, Febuary 5, 2009, by Keith Chu
Wyden or Kitzhaber next DHHS Director? Secretary of Health? White House Advisor?


How the Stimulus Stands to Help
Jan 29, 2009
U.S. House approves Obama recovery plan, 244-188,  strctily along party lines, with an $87 billion provision increasing the federal contribution for Medicaid costs is expected to go a long way toward helping states close their budget gaps


Reform is More than Hospitals
Jan 28, 2009
The impact of the proposed 4 percent tax on hospitals would only fall on Oregon’s 25 largest hospitals, including St. Charles in Bend.




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