PHM-Exch> How to Sustainably Finance Universal Health Care (Citizens' Health Initiative)

Mon Aug 9 23:39:23 PDT 2021

From: Jomo from Challenging Development+ <jomodevplus at substack.com>

To achieve universal health coverage, a country needs a healthcare system
that provides equitable access to high quality health care requiring
sustainable financing over the long
term. ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌
‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌
‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌
How to Sustainably Finance Universal Health Care. by Citizens' Health
Initiative
<https://email.mg2.substack.com/c/eJxVklGPojAQxz-NvGnaUqA88LB7rnvsLRpXz6z3QqAdpAoUaRHx01_Vl7uk00lmMv9J_r_hmYGD6saoVdo49y81YwtRA4OuwBjonF5Dl0oRETfAyPcDR0RUYOYxR-q06ADqTFaR6Xpw2j6vJM-MVM1jglKGXaeMfFYUBRMYUw9x8DBmJKNunvuiwDzn8Fyc9UJCwyGCC3SjasCpotKYVk_clwlZ2HdUtRJwaatez3Sfa5Px04yr2rZaG6UapkZNdW8bssnyapwWNlvJad9IK6qzauIujDpBM3HnMH5gTnbjN6lO8VGNyY1fk_meLMdB8vfwJhZh--dH7Ce3E0223FvNTzquq1Lca9v9uJr_dpMjvyWbQWbfy5vVkPznTn5uY7ScH67JGOu4WeK9jP24eb1wd214vSv37lebEyqL9exXuevO5GWzjmEjc3TOP0vU-V_18KZ5qT9eh7drvpLwfj4NjowIIhgxjJCHGQ1neBYyznkYIk6B5jxAAQKKCQgCRRFyGkwoqg_kP6ucLrLSfWGyxnYPd3aPskWX2lxbo8yYwt09EE-q5nkcD87pARro7NGINDMR9gnzAhK49jbCJ0SL3Q0ZDkIWOnavUHaqif4B9xeId9Zb>To
achieve universal health coverage, a country needs a healthcare system that
provides equitable access to high quality health care requiring sustainable
financing over the long term.

Aug 10
<https://email.mg2.substack.com/c/eJxVUtuO2jAQ_RryVmQ7JpeHPLRLWUE3UFYrLn2JnPEkMeTWxAbC168DrdRK1ow89pnbOSA05k03RG3Ta2c0iR5ajGq89iVqjZ1jeuwSJSPm-pR4nu_IiEsazAJH9UnWIVZClZHuDDqtSUsFQqumfiA4D6jrFJHgASPejGYZAT6TIIETniKjMmUZQf4sLIxUWANGeMFuaGp0yqjQuu0n7tcJW9hzaqpG4qUtTT_tTdprAecpNJV9Eq2y9kKtGZNZ9-jrS4cCxn4m7kI3Z7R-jsOKAtsNB1ael6dmiO9wi-dHth6uCl7Du1yE7a-XpRffzzz-gNlmfu6X9ao87tdE7ENjMYq37LxUVyX2C2Lvt_VpydcfMKzv8e3tZdWCG6uNWl3lfqnj05Zs5t_v439wd2rEQ7Urju57mzKusu10w7f5q18U95-rw9XP1n1V-nH943Tg8O19ZbK40bfi7eT-DvIJ84yukr4xHaCd5u8e_sQrlMpU45Tj-I6KGGGUBJSQGQ14OKXTMACAMLRMIE_BJ74lgDKUDLMsBO5POKly9t9-nS7qoTCZFrV9zcfMj7DlO7G-MrXSQ4K1SEuUTynop6IeXSQ51thZpclE6Ih6LJj5zHetoMIn81YrbhhQPwxCx9aVjUXV0T9sfwLIMed3>
[image:
Share]
<https://email.mg2.substack.com/c/eJxVUttymzAQ_RrzZo8uGNADD0mdpKTFmVzqifvCCGkxikEiSITgr6-w25l0RpfR2d2zs0dHcAcH009pZ6wL5qNwUwephtE24Bz0wWChL5RMCY0xiqI4kGkocbJOAmWLqgdouWpS1w8QdEPZKMGdMvpcEYYJpkGdMkEoXpdRxELKgCYcKoqZjNFaVsTnXBrzQSrQAlL4gH4yGoImrZ3r7IJeLcitX2-mNRI-umawKzuU1nFxXAnT-lDnd23GpTNLO_iA0rxspmXlb0-5HLTypJY3C3o7uLawZugFLOjmH82CRDPeglRD6_HzVH9BYbQD7ebsmvfgUS7mGb8AzhxhfsN0jwXZTa-kOWZvZspP4jPf7Ml2GpW4Yyd5y7rf37IoPx3D_EWsHzZHm7VNLWfsZT89bH7R_E2c8udR8dftyXMo8X2nfr5kaLs5fOZTZjO9xXuVRZm-_hD00Yl2V-_pU1eSUFWPqx_1rn8nV8-PGTyrEr2XP2vUR0_teGNFbe-vx5vP8kHB3ftxDFRKEMEowQitcRKyFV6xRAjBGBIhhKWIUYwgxAQkgapiIowXIWoP5D_5gz711EPluPbRw6zcGfZ28Nq1rRffTQXMPwLy4hR3MdxZ5eIAGnpvRFlwl-KIJOuYxNT7jV2M4a1EWYJjlrDA95XGV-n0ixn-AOWr8y0>

*How to Sustainably Finance Universal Health Care*

By Mary Suma Cardosa, Chan Chee Khoon, Chee Heng Leng and Jomo Kwame
Sundaram
<https://email.mg2.substack.com/c/eJwtkduOhCAMhp9muBvDSYELLvZmX8MgVGVXwXAY49svM27StE2bP3_z1ZoCS0yXPmIu6J3Gch2gA5x5g1IgoZohjd5pygTBwyCQ09wR2Uvk8zgngN34TZdUAR112rw1xcfwUXAuCUOrpmQwbFJ2psphmHBP-4FwJhRVoLBit7GpzkOwoOEF6YoB0KbXUo4H-3rQ7xbneXb-yO_bugClTUwta0yt2U26nrnu5mlNcjG3uprQEsDzd43xv10hLM8NmgB5TTElWBKMeyK56kinpLVWKWw58MkKLDBwQsFRmGdluXhwvC-0y3XKxdjfzsYdJZ3tWudiQtsubxSfcSMxtrrX4Ms1QjDTBu6GVG7WH2zjAgFS-4EbTdFkoLIXVLCGWt1MGkWmJBFKKtR8XWyqoH_iHh28jq3mP5YKlsw>

PENANG and KUALA LUMPUR, Aug 10 2021 (IPS)- To achieve universal health
coverage
<https://email.mg2.substack.com/c/eJwtkM1uhSAQhZ_msjSAyM-CRTd9gW66MwjjvbQKhp9rfPuiNpCZyWEOJ_msKfCM6dBbzAWdZSzHBjrAnhcoBRKqGdLonaa9IJhzgZxmjshBIp_HOQGsxi-6pApoq9PirSk-hsvBmCQ9emk-zQMAPw-fRPtkoG7is4WZUDaw4Q421XkIFjS8IR0xAFr0q5QtP_qPB_1sd9_3LttryfkEtnQ2rk3_19pkUvF2OafN-1a_KCWMYPVNVI8Z7ynymmJKsCQYD0Qy1ZFOSWutUtgyYJMVWGBghIKjMM_KMvFgeH3SLtcpF2N_z1CUdLavOhcT2uvzRHDJjcDY-lqDL8cIwUwLuBtOuRlfuMYnBEiNvRtN0YRTOQgq-oZY3SwavV5JIpRUqOW62FxB_8Q1OnhvS81_r76SJw>,
a country needs a healthcare system that provides equitable access to high
quality health care requiring sustainable financing over the long term.
Publicly provided healthcare should be on the basis of need, a citizen’s
entitlement for all regardless of means.

*Health inequalities growing*
But recent decades have seen health care trending towards a two-tier system
– a perceived higher quality private sector, and lower quality public
services. One typical consequence is medical doctors, especially
specialists, leaving public service for much more lucrative private
practice.

This ‘brain drain’ has led to longer waiting times and complaints of
deteriorating public service quality, as more people with means turn to
private facilities. As costs in private hospitals are high and increasing,
this causes those who can afford private health insurance to turn to it to
hedge their bets.

If these trends are not checked, the gap between private and public health
sectors in terms of charges and quality will grow, increasing polarisation
in access to quality health care between haves and have-nots.

*Health care financing*
Financing arrangements are key to developing an equitable healthcare system
that is financially sustainable in the long run. For universal coverage and
equitable access, health financing should be based on social solidarity
through cross-subsidisation, with the healthy financing the ill, and the
rich subsidising the poor.

Experience the world over shows health markets functioning poorly, both in
financing and providing healthcare. Furthermore, heavy reliance on market
solutions has contributed to spiralling costs and constrained healthcare
access.

*Private health insurance*
A voluntary private health insurance (PHI) scheme cannot be financially
viable in the long term as individuals with lower health risks are less
likely to buy insurance from a scheme which they see as primarily
benefiting others less healthy.

Since voluntary schemes are usually based on PHI, government support for
such schemes would strengthen these companies. There are good reasons to be
wary of the growing influence of PHI interests in healthcare financing
discussions.

Premiums for PHI are risk-rated, meaning that individuals with pre-existing
conditions and higher risks – such as the elderly, or those with family
histories of illness – will face un-affordably high premiums or be denied
coverage.

‘Moral hazard’ and ‘supplier-induced demand’ in a ‘fee-for-service’
reimbursement system encourage unnecessary investigations and
over-treatment, or costly monitoring to limit such abuse. Hence, PHI
companies use ‘managed healthcare’ services to contain costs by limiting
investigations and treatments.

Voluntary PHI schemes charge high premiums while fee-for-service payments
escalate costs which inevitably raise premiums. Thus, the US spends the
most on health in the world, but with surprisingly modest health outcomes
to show for it.

Much public expenditure is needed to insure the poor, especially those with
prior health conditions. Achieving UHC would require costly public
subsidisation of such profitable arrangements. This would not be
cost-effective, let alone equitable.

Government support for PHI companies would strengthen their growing
presence and influence, typically involving transnational insurance
conglomerates. PHI companies are likely to try to undermine others
threatening their interests.

*Social health insurance*
Unlike VHI, social health insurance (SHI) is usually mandatory to cover the
entire population. Although often proposed and promoted with the best of
intentions, the limitations and problems of SHI
<https://email.mg2.substack.com/c/eJwlkEFuxCAMRU8zLCMMJMCCRTe9RkTAydASiIBMlduXmUjWt2XL-vrP2YZbLpc5cm3kLXO7DjQJ_2rE1rCQs2KZgzeMS6DTJIk3woMaFQl1XgvibkM0rZxIjnOJwdkWcvp8CKGAk6dBDoxz1NMyqsk64Aw05UojgnN-lLexPX3A5NDgC8uVE5Jonq0d9cG_Huy7V04xJIxhKbZcw1-IeA0u7_3ic-hql9oV6ACUsj490Q0gNCPBMMqAqr4fQQk9wKCVc05r6gSKxUkqKQpg6Bmuq3ZCPgTdNzbUc6nNut-3Dymmuue5Npv6dXvn_qx77Ln3_UyhXTMmu0T0N5F2g_0wmjdMWDpwP9tmYGJqlEzyzlXfADoyrhVIrTTpvj73r2R-8p49vo541n9shY28>
are
also important to consider.

SHI would effectively require collecting an additional ‘payroll tax’ from
the public. This could be designed with various distributional
consequences, e.g., if flat, it would be regressive. As an additional tax
would reduce take-home incomes, SHI schemes have been difficult to
introduce.

Like PHI, SHI also has inherent tendencies for over-treatment and cost
escalation due to ‘moral hazard’ and ‘supply-induced demand’. These require
costly, strong and typically bureaucratic administrative controls.

Surviving SHI schemes owe their ‘success’ to specific reasons, e.g.,
Germany’s evolved from its long history of union-provided health insurance.
But most working people in developing countries
<https://email.mg2.substack.com/c/eJwlkMluxCAMhp9muDViDXDg0EtfIyLgZGgTiFgmytuXmUiWV_2y_TlbYU35MkcqFb3dVK8DTISzbFArZNQK5Cl4Q5kkeBwl8oZ7ooRCoUxLBtht2EzNDdDR5i04W0OKHwXnijD0NILrkdmFCbYsWi-Kwygst8oqsggQ5F5smw8QHRh4Qb5SBLSZZ61HebDvB_3pdp7nUFyALZVjSHntLZtrcBv0bD6fqQeKMR1eCkfaCy2_CBY9gdgdCoZiSrAiGAuiuB7IoJVzTmvsOPDZSSwxcELBU-inOi4fHO8rHUqbS7Xub3BpR9kU92xLtbFP1_f7n3b_fupxbzHUa4Jo5w38DabefD-ophUi5M7dT7YaMlIlJJWs49U3h06OaUWkVhr1vT51VTS_aU8eXsfWyj8BK4-C>
are
not in formal employment, let alone unionised. Hence, SHI would have
difficulty gaining broad acceptance.

In any case, Germany and other countries with successful SHI in the past
have been moving to greater revenue funding of healthcare as formal
employment and unionisation decline with changing labour arrangements.

With SHI, government revenue would still have to cover the indigent and
poor. It is difficult to collect premiums from the self-employed, or the
casual and informal workers not on regular payrolls. But universal coverage
would not be achieved without including them.

*Revenue financed healthcare*
Inherited revenue-based healthcare financing is basically sound and should
not be replaced due to other healthcare system problems. In most societies,
revenue-sourced healthcare financing can be retained, reinforced and
improved by:

o increasing government health care allocations.
o reducing ‘leakages’ by eliminating waste, corruption, ‘cronyism’, etc.
o promoting ‘developmental governance’, competitive bidding, etc.
o raising government revenue, especially from more progressive taxation,
e.g., wealth, ‘windfall’ and ‘sin’ taxes, especially on activities
worsening health risks such as tobacco and sugar consumption.

*Revenue financing better
<https://email.mg2.substack.com/c/eJwtkUluxCAQRU_TLC3AmGHBIptcIAewGMrdJDZYDLF8-9B2JPQp_arSl145U-GZ8qn3VCp6y1zPHXSEo6xQK2TUCuQ5eE1HQTDnAnnNPJGTRKHMSwbYTFh1zQ3Q3uwanKkhxWuDMUlG9NIWe2qtZZYzoIrQcZqU4iDZwoSnjN_BpvkA0YGGX8hnioBW_ap1L4_x40E_-zuOYyjuGvIhg6uDS1v3_71emVyDW6_Klq57CF2_MOGCU8WVxBizcUJBU0wJlgTjiUimBjIo6ZxTCjsGzDqBBQZGKHgKy6IcEw-GtycdSrOlGvfzjkZZF_dqSzWxd59vEJfdOcz931oM9ZwhGruCvxHVm_QFbX5ChNwv4GdTNeFUToKKsYNWN5HOcFSSCCUV6rk-9a2ov9OWPPzuayt_O4GTTQ>*
Revenue-financing avoids many administrative costs incurred by PHI and SHI.
It has no need for an elaborate parallel system, costly mechanisms and more
staff to register, track and pay SHI contributors and beneficiaries, and to
deter selfish opportunistic behaviour.

Compared to PHI, SHI seems like a step forward for countries with weak or
non-existent public healthcare systems. But moving from revenue-financing
to SHI would be a step backwards in terms of both equity and
cost-effectiveness.

SHI requires additional layers of health care system administration – to
enrol, collect, ascertain coverage, determine benefits and make payments –
which incurs unnecessary costs compared to revenue-financing.

Hence, such insurance systems involve much more per capita health spending,
raising it by 3-4%. Despite being much more costly than revenue financed
systems, they do not have better health outcomes.

As SHI effectively imposes a payroll tax, it discourages employers from
hiring employees with ‘proper’ labour contracts. Hence, SHI was estimated
to reduce formal contracts by 8-10% and total employment by 5-6% in rich
countries.

International evidence clearly shows progressive tax-funded public health
systems are more equitable, cost-effective and beneficial than SHI
<https://email.mg2.substack.com/c/eJxFkEluxCAQRU9jlhaTDSxYRIr6GhZD2U1ig8WQyLcP3V5EQlCq0q_Pf85U2FK-9JlKRa9rqdcJOsJv2aFWyKgVyEvwmjJB8DwL5DX3RE4ShbKsGeAwYdc1N0Bns3twpoYU3wrOJWHoqYnoxcxsF1m2zmZWyoqJA_PKcuHsbWyaDxAdaPiBfKUIaNfPWs8ysI-BPvo5zQm5jKXkOLp09E5JO_sfuPUY2MPYUrNxtX9hYJ-EMSIlRkFTTAmWBOOJSK5GMirpnFMKOw7cOoEFBk4oeArrqhwXA8fHRsfS-kLjvl-WKOvinm2tJvbp9or-bvfkS3-PFkO9FojG7uBvKPVm-8a0bBAhd-Z-MVWTmcpJUME6WnUz6NSYkkQoqVD39amrov5KR_Lwc-6t_AEP0o_k>.
Public health programmes needing popular participation, e.g., breast or
cervical cancer screening, have worse outcomes with SHI compared to
revenue-financing.

This can be best achieved by improving or developing a revenue-funded
healthcare system, with additional resources deployed to expand and enhance
primary health care, and better service conditions for medical personnel.

Strengthening public healthcare services can do much, not only to improve
staff work conditions, but also morale and pride in their work.

*Mary Suma CARDOSA
<https://email.mg2.substack.com/c/eJw9kc2K7CAQhZ8m7jqoMVEXLgaGgVkMNAzMNhgtu703UfFnmn77a3fDBbGwDlXH-sroCpeY7yrFUtHjWus9gQpwKzvUChm1Ann1VtGJE7wsHFnFLBGzQL6sLgMc2u-q5gYotW33Rlcfw7OCMUEmdFWGzVwYYERjQ0EujomZgZsdsxL4Ql7GulkPwYCCX8j3GADt6lprKsP0NtCPfm6329jFUIvJfoPRxKNnKaa4h8-37_Ppx-fa9H76huyhnGI4nbUPXXXlHFNLoy5pmD6-ooVhek8ZSu8G-TO4ONDl_P_93lVJqRQL8qobECwIxjMRTI5klMIYIyU2DNhmOOa4z0bBUnBOGsYHho8LHUvbStXm7-OfKKtirs1VHbp6eTB7pjuytcejBV_vKwS97WBfNOtrKU--6wUC5L4su-qqyELFzCmf-k7kC17HPUlBuBQSdV8be1VQf-LRJ_1Neyv_AFvJo4w>
is
a medical doctor specializing in pain management and past President of the
Malaysian Medical Association. CHAN Chee Khoon
<https://email.mg2.substack.com/c/eJwlkMtuxCAMRb9mWEZASIAFi2qk_gbi4SS0CUQ8GuXvy8xIlg22rHt9nKmwpnyrM5WKXknX-wQV4So71AoZtQJZB6_oyAmeZ468Yp6ISaBQ9JIBDhN2VXMDdDa7B2dqSPG9wZggI9rUYok0zizeMiOEGSfrCRYcPBcLZXj-CJvmA0QHCv4g3ykC2tVW61ke49eDfve4rmvIUMBkt63d-RCh9vaZ0xJ26K_nBqCfm4lz_7gUaw62vewUFBTFtKsSjCcimBzIIIVzTkrsGDDrOOYYGKHgKSyLdIw_GD5WOpRmSzXud3DpQFkVt7Wlmtin6-v0d7tfrns9Wgz11hCN3cF_oNQP2zcmvUKE3J17baoiMxUTp3zsaOWHQac2SkG4FBJ1XZ_6VlQ_6Uge_s69lX_vZpLa>,
ScD, is a health systems and health policy analyst with postgraduate
training in epidemiology. CHEE Heng Leng
<https://email.mg2.substack.com/c/eJwlkN2OhCAMhZ9muBtDEQUuuNibfQ2DUB12FQw_s_Htl1FS2qZNc3I-awquMZ36iLmQT5rKeaAO-Jc3LAUTqRnT5J1mvQA6joI4zR3IQRKfpyUh7sZvuqSK5Kjz5q0pPobrgnMJPXlpCsB7NYoFYEDBuVgoIhfGKsWQS3YLm-o8Bosa35jOGJBs-lXKkR_914N9t4jJetfFtLaetvdsH56j6OEpBePEa0YZUAmUDiC56qBT0tomQy1HPltBBUUODB3DZVGWiwen-8q6XOdcjP3tbNxJ0tm-6lJMaNv1Y-8aN3dTq3sNvpwTBjNv6G7j5eZ3oZhWDJgaVzeZomFkchBM9A2fun02Mr2SIJRUpOm62K6C_ol7dPg-tpr_AQR4g5M>,
PhD, is an academic researcher working in the area of health and health
care policy. All are members of the Citizens Health Initiative.*

http://www.ipsnews.net/2021/08/sustainably-finance-universal-health-care/
<https://email.mg2.substack.com/c/eJwlkU2OwyAMhU9Tdo2A0GIWLGYz14gIOA0zCYn4mSi3H6eVkJ9keH7Wh3cVX1s-7b6Vyq4y1HNHm_AoC9aKmbWCeYjByl4L_nxqFqwKAh7AYhmmjLi6uNiaG7K9jUv0rsYtvR1KgejZbCU4I_tp5E-AEbjiD4CJj04LCYHL8RPsWoiYPFr8w3xuCdli51r3W_91k990juPo4l6u3bqElTqSS0HCgUpppbqY3Lic94mUJt1bijSruOU-o1vqfPcuI71l0V5WDoLzhwBlOtEZ8N4bw71CNXrNNUclJAaJ02S80jfF15fsShspx_92fltZtsXPbaou0e3rAvFuE4eBdKX4eg547YThg6h-SL-hDS9MmOkHwuCqFU8JDy11T6DNhwgx7A0IbcAwyg0buZL92dYt4N--tPIPeAqVQQ>
<https://email.mg2.substack.com/c/eJxVUtuO2jAQ_RryVmQ7JpeHPLRLWUE3UFYrLn2JnPEkMeTWxAbC168DrdRK1ow89pnbOSA05k03RG3Ta2c0iR5ajGq89iVqjZ1jeuwSJSPm-pR4nu_IiEsazAJH9UnWIVZClZHuDDqtSUsFQqumfiA4D6jrFJHgASPejGYZAT6TIIETniKjMmUZQf4sLIxUWANGeMFuaGp0yqjQuu0n7tcJW9hzaqpG4qUtTT_tTdprAecpNJV9Eq2y9kKtGZNZ9-jrS4cCxn4m7kI3Z7R-jsOKAtsNB1ael6dmiO9wi-dHth6uCl7Du1yE7a-XpRffzzz-gNlmfu6X9ao87tdE7ENjMYq37LxUVyX2C2Lvt_VpydcfMKzv8e3tZdWCG6uNWl3lfqnj05Zs5t_v439wd2rEQ7Urju57mzKusu10w7f5q18U95-rw9XP1n1V-nH943Tg8O19ZbK40bfi7eT-DvIJ84yukr4xHaCd5u8e_sQrlMpU45Tj-I6KGGGUBJSQGQ14OKXTMACAMLRMIE_BJ74lgDKUDLMsBO5POKly9t9-nS7qoTCZFrV9zcfMj7DlO7G-MrXSQ4K1SEuUTynop6IeXSQ51thZpclE6Ih6LJj5zHetoMIn81YrbhhQPwxCx9aVjUXV0T9sfwLIMed3>
[image:
Share]
<https://email.mg2.substack.com/c/eJxVUttymzAQ_RrzZo8uGNADD0mdpKTFmVzqifvCCGkxikEiSITgr6-w25l0RpfR2d2zs0dHcAcH009pZ6wL5qNwUwephtE24Bz0wWChL5RMCY0xiqI4kGkocbJOAmWLqgdouWpS1w8QdEPZKMGdMvpcEYYJpkGdMkEoXpdRxELKgCYcKoqZjNFaVsTnXBrzQSrQAlL4gH4yGoImrZ3r7IJeLcitX2-mNRI-umawKzuU1nFxXAnT-lDnd23GpTNLO_iA0rxspmXlb0-5HLTypJY3C3o7uLawZugFLOjmH82CRDPeglRD6_HzVH9BYbQD7ebsmvfgUS7mGb8AzhxhfsN0jwXZTa-kOWZvZspP4jPf7Ml2GpW4Yyd5y7rf37IoPx3D_EWsHzZHm7VNLWfsZT89bH7R_E2c8udR8dftyXMo8X2nfr5kaLs5fOZTZjO9xXuVRZm-_hD00Yl2V-_pU1eSUFWPqx_1rn8nV8-PGTyrEr2XP2vUR0_teGNFbe-vx5vP8kHB3ftxDFRKEMEowQitcRKyFV6xRAjBGBIhhKWIUYwgxAQkgapiIowXIWoP5D_5gz711EPluPbRw6zcGfZ28Nq1rRffTQXMPwLy4hR3MdxZ5eIAGnpvRFlwl-KIJOuYxNT7jV2M4a1EWYJjlrDA95XGV-n0ixn-AOWr8y0>

If you liked this post from Challenging Development+
<https://email.mg2.substack.com/c/eJxVkMluxCAMQL9mOEZsGeDAoZf-BmJxMrQJRCxT5e_LTC6tZNmSLdt6z9sGay6nPnJt6JVMOw_QCX7qBq1BQb1CMTFoygTB97tAQfNA5CxRrGYpALuNm26lAzq626K3Leb03uBcEoYeGqxXBBxhM1uoFISBUxhLG_isqHdwPbY9REgeNDyhnDkB2vSjtaPe2MeNfo74ynsO8Dy2XqfaXW3Wf08-72OEoqaYEiwJxjORXE1kUtJ7rxT2HLjzAgsMnFAIFJZFeS5uHO8r_XcJFV39oy_NpjFdX2jv9iAzo-49xXYaSNZtEC7odrl7azArJCjDaTC2aXKnchZUsKFOXYzDClOSCCUVGn9DHltJ_-H6BRYhhvA>,
why not share it?

Share
<https://email.mg2.substack.com/c/eJxVUdGOpSAM_Rp5uzeAqPjAwySb-Q1ToSq7AkZgJv791ntfZhKg6Wnaczi1UHBN52WOlAu7n6lcB5qI33nHUvBkNeM5eWdkOwje9wNzRjmhO818npYTMYDfTTkrsqPOu7dQfIqvDqW0aNlmOodW89YtDoQEJx1Ar2QH3WAX2S3zmxiq8xgtGvzC80oR2W62Uo7ctB-N_KTzN4Xk8OvYa37mOucC9t_TpkClg-6Wvh8lPXKlgo8w79djoUgjHzV6Gpphb9rPWsIU0PkamvbPS30j-xu0EA7wayTYFiAQ7P0VSvMGJzJvJJeCa8F5J7Qan-I5amvtOHKrUM124ANHJSQ6icsyWjU0iodV_hLLTpPtVpcCkarrzf-CybyJYiCp5Zrw1o_u7Wt5r-eldVox4klrcxMUI3qpu0EOLW1nfNtIxrejFsOoR0a8LlFXND-s-w8D4at7>
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://phm.phmovement.org/pipermail/phm-exchange-phmovement.org/attachments/20210810/cf729bc3/attachment.html>