Labour claims credit for the NHS, but Liberals laid the foundations

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One of the enduring myths of British politics is that the Labour Party was uniquely responsible for founding the National Health Service. “It was the Attlee government’s introduction of the National Health Service which will rightly go down as Labour’s greatest achievement,” says the party’s website. “Labour created the NHS,” maintains the party’s shadow health secretary.

But this partisan, somewhat sentimental version of history has been demolished over the years by historians of the welfare state. In 1995, Nicholas Timmins started his magisterial (and recently updated) study, The Five Giants: A Biography of the Welfare State, by highlighting the vital role of William Beveridge, the civil servant and sometime Liberal MP. In 1942, Beveridge produced a comprehensive state plan for social care, which included the first public discussion of a “National Health Service.”

Timmins built on Paul Addison’s ground-breaking work from twenty years earlier, The Road to 1945. Addison showed how the wartime coalition government fostered a strong consensus about the state’s future role in delivering post-war economic recovery and enhancing the peoples’ welfare. The consensus was helped considerably by the expansion of the state’s role into almost every aspect of people’s lives during the conflict. As Seth Thevoz has said, “what cannot be stressed enough is that in the subsequent 1945 General Election, all three parties endorsed the Beveridge Report.”

In 2017, Dr Chris Renwick, Senior Lecturer in Modern History at the University of York, published Bread for All: The Origins of the Welfare State, tracing the story back to the mid nineteenth century, and describing a national project that was a long time in the making. Crucially, many of the important visionaries were liberals, from David Ricardo to John Maynard Keynes. From start to finish, Dr Renwick was clear, “Liberalism was woven into the welfare state’s identity.”.

He highlighted how the New Liberals of the early twentieth century were instrumental in delivering a radical, new approach to health policy. In 1911, the Liberal Chancellor of the Exchequer, David Lloyd George, introduced health insurance for all wage earners aged between sixteen and seventy, with benefits including sick pay for up to twenty-six weeks and treatment from a doctor.

The post-First World War Lloyd George Coalition established, in 1919, the Ministry of Health, with a wide-ranging remit, including medical training and maternity and child services. Lloyd George appointed the UK’s first Minister of Health, the Liberal MP Christopher Addison, who was also responsible for delivering his promise of “homes fit for heroes”.

The Liberal Democrat History Group is delighted that Dr Chris Renwick and Lord Kenneth Morgan, a co-biographer of Christopher Addison and one of Britain’s leading modern historians, will be the guest speakers at our Autumn Conference fringe meeting, The Liberal Party, Health Policy and the Origins of the NHS. The meeting will take place at 7.45 p.m. on Sunday, September 15th in the Purbeck Suite, Marriott Highcliff Hotel, 105 St Michael’s Road, Bournemouth BH2 5DU. We look forward to seeing you there.

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45 Comments

  • John Marriott 7th Sep '19 - 11:30am

    Personally speaking I’m not much bothered WHO actually invented the NHS, as long as it does what it says on the tin, namely, that it is NATIONAL (so the same deal wherever you live), it’s about HEALTH (both curative and preventative) and a SERVICE (meaning that you don’t just have to “ring after 8am” to get an appointment with your GP).

  • Geoffrey Payne 7th Sep ’19 – 3:25pm………………The 1945 Labour government was a great government. Labour should get credit for the implementation. But it was Social Liberalism rather than Marxism that made it great……………..

    On today’s LDV Clement Atlee’s policies would be condemned as Marxist. Jeremy Corbyn’s proposal are nowhere near as radical as those of 1945 and yet the adjective most used in his case is the ‘M’ word; usually from those who have no idea what the word even means.

  • The main problem with the socialist implementation of the welfare state was that, as well as making it a centralised inefficient bureaucracy, they ignored Beveridge’s principles of ensuring it was only a minimum and based on the contributory principle. This is encapsulated in this quote from his pamphlet:

    Social security must be achieved by co-operation between the State and the individual. The State should offer security for service and contribution. The State in organising security should not stifle incentive, opportunity, responsibility; in establishing a national minimum, it should leave room and encouragement for voluntary action by each individual to provide more than that minimum for himself and his family.

  • It’s a bit rich to exaggerate the impact of Christopher Addison as a minority Liberal in the Tory dominated Lloyd George Coalition. The bigger part of his efforts was directed to housing despite the Health title. After the Tories complained about his increased public spending plans Lloyd George sidelined him in April 1921 to be Minister without Portfolio. Three months later he resigned as a Minister in protest. Within two years he had joined the Labour Party and stood as a Labour candidate in 1924.

    Sorry Neil, must do better.

  • @TCO. “Only a minimum based on the contributory principle.

    So, given that a transplant operation costs in the higher end of six figures would you limit it to the rich on grounds of economy and ability to pay ?

  • @David Raw “So, given that a transplant operation costs in the higher end of six figures would you limit it to the rich on grounds of economy and ability to pay ?”

    I was quoting Beveridge – directly. What do you think he meant by “The State in organising security should not stifle incentive, opportunity, responsibility; in establishing a national minimum, it should leave room and encouragement for voluntary action by each individual to provide more than that minimum”?

  • Joseph Bourke – I have seen many claims that the post-war Britain should have spent less money on welfare state and nationalization (I completely agree with the critics regarding the nationalization thing, but not sure about the welfare state/NHS thing) and more money on investing in industrial capacity and machinery like France, Germany and Japan had done.

  • Mick Taylor 8th Sep '19 - 7:40am

    Thomas. After 6 years’ of war, the private sector was in no position to put in the investment needed in many of the heavy industry of the time, coal, railways, power, communication, steel, road transport and much more. It is noticeable that of all the industries nationalised by Labour post 1945, that only steel was returned to the private sector by the Conservatives when they came to power in 1951. Many industries across Europe were brought into state ownership post WW2 and not just by socialist/social democrat governments.
    The governments concerned took the view, correctly in my view, that if they were going to provide all the investment they should own the industries as well.
    It is worth noting that, with the exception of BT, privatisation has not been a roaring success, with vital industries pouring money into shareholders’ pockets rather than back into the business. In the case of railways the state has had to step in on many occasions to prevent one part or another from going under.
    This isn’t to argue that the former nationalised industries couldn’t have been run better or that they were perfect, but too often the baby gets thrown out with the bathwater and nowhere more so than in the Liberal Democrats, where nationalisation cannot be discussed dispassionately.

  • TCO 7th Sep ’19 – 11:17pm………………..I was quoting Beveridge – directly. What do you think he meant by “The State in organising security should not stifle incentive, opportunity, responsibility; in establishing a national minimum, it should leave room and encouragement for voluntary action by each individual to provide more than that minimum”?……………………

    Perhaps he meant, at least in the context of medical cover, ALL possible treatment in matters of health. The ‘extras’, you are so keen on pointing out, should be ‘nose jobs’, ‘breast enlargements’, etc. when carried out purely for cosmetic reasons.

    If he didn’t mean that then it’s a good job for most of us that it was a Labour. rather than a Liberal administration. that implemented the NHS/Welfare state.

  • @ecpats “Perhaps he meant, at least in the context of medical cover, ALL possible treatment in matters of health.”

    Your statement implies that every person always gets everything on every occasion. We know this manifestly isn’t the case.

    The reality is that funding is finite and demand is infinite, so healthcare is rationed,

    All across the country, every day, citizens are having to pay for additional treatment over and above a basic minimum due to this simple fact.

    Labour’s mistake was to make this rationing centralised, inflexible and overly bureaucratic.

  • Mick Taylor – nationalization itself was also very costly since a large sum of money was spent on compensating owners. About other countries, France did nationalize or have public share ownership in various sectors, but Germany only nationalized utility and railway sectors and Japan did not nationalize anything. And about France, their dirigisme policy was largely “indicative planning”, using incentives to influence public and private players’ behaviour and the state only seeked to hold minority interests in certain key industries. It was still a capitalist economy driven by market forces. This differed from Labour’s socialist large-scale direct state ownership, command and control. And both parties wasted Marshall Plan aids in wasteful defense spending (and welfare spending according to right-wing critics, about this I am quite skeptical) and colonial affairs. However, Labour did try to use Marshall aid to modernize steel industry, before they lost the election. After that, the Tories’ economic policies during the 1950s could be called “benign neglect” a.k.a laissez-faire again.

  • expats – “If he didn’t mean that then it’s a good job for most of us that it was a Labour. rather than a Liberal administration. that implemented the NHS/Welfare state.” – actually, if the Liberals governed during the 1920s-1930s under Lloyd George (but not under that old and inept Asquith), Britain would have had UHC well before 1945, but under Bismarckian model, simply via expansion of 1911 NI Act to both wage earners and dependants like under Weimar Republic (and well, under Nazi as well) during the same period.

  • Thomas 8th Sep ’19 – 9:20am…………………….expats – “If he didn’t mean that then it’s a good job for most of us that it was a Labour. rather than a Liberal administration. that implemented the NHS/Welfare state.” – actually, if the Liberals governed during the 1920s-1930s under Lloyd George (but not under that old and inept Asquith),…………..

    Thomas, as my mother used to say, “If ifs were horses, beggars would ride..”

  • Peter Martin 8th Sep '19 - 10:34am

    @ Thomas,

    “nationalization itself was also very costly since a large sum of money was spent on compensating owners.”

    It doesn’t work like that.

    In the case of the railway nationalisation in the late 40s, the Government created stock which paid 3% p.a. known as British Transport Stock. It was calculated that the shares of the railway companies also paid 3%. The process of nationalisation, therefore, involves the swapping of the stock for the shares. The Govt then pays 3% to the stockholders which can be covered by the the 3% it receives from the shares. So it doesn’t cost anything! The former shareholders are at liberty to sell their stock in the same way as they previously could sell their shares.

    All this assumes, of course that the stock and the shares are traded at fair value and 3% was a true reflection of the dividend from the shares. That was probably not the case. The share holders would have got the better of the deal from a government which didn’t want any political accusations of confiscation of private property.

    Conversely, just as nationalisation doesn’t, or shouldn’t, cost anything, apart from the admin costs of making the change, so privatisation doesn’t actually raise anything. Again the assumption is trade at a fair value which many would dispute actually happens in practice.

  • Ladies, please! And gentlemen, even more! We haven’t got time for all this jolly game of nice points and little victories, over who did what in what party over seventy years ago. This is now: the situation is desperate: the PM may be planning to flout the Law; the Kingdom is the laughing butt of an astonished continent of cousins; a General Election looms which might consolidate the loony skipper at the helm. The Coffee is now burning!

    So NOW, not next week or next conference or next Spring — NOW is when we must be planning how to seize the opportunity that the next election offers, if we grab it — starting tomorrow (I shall be setting homework for this afternoon or evening: see below).

    Think, for a moment, of the debating points earlier in this very thread. Forget who was in which party — when he switched parties, when she resigned, who was PM at the time (Churchill, of course). Think of the NHS, think of the 1944 Education Act . . . and realise that these grand schemes were being licked into shape by collaborating experts or visionaries while the war was being waged.

    When our current calamity is completed our battered nations will still be here, and needing some grand and radical forward-looking vision to concentrate on: something, perhaps, that can re-unite split families, and MPs at odds with their constituencies and their parties. This UK helped Germany to revive after 1945: its grandchildren will soon have to heal their own — our own — homeland.

    [I break here and resume below.]

  • [Resuming from above.]

    Have we ready some radical plan which might start the climb back into reason and concord? Can anyone suggest anything more promising than UBI? A good foundation or starting point, I believe, is the Report to the Shadow Chancellor, by Professor Guy Standing of the Progressive Economy Forum. It may sound, from that, like a vision of socialism. But it would be very foolish to discount it for that reason, since its ideas are liberal and its tone and tenor. It offers, I believe you’ll agree, the best of Left and Right: a care for fairness for all and for individual liberty. And the way to get to it is not “how do we trim and tweak from here to there?” but ” Starting from scratch, what’s first?”

    What is first is for this party to show the way with clear non-partisan leadership, arguing the novelty of its merits, and softening the initial automatic snort of “Pie in the sky!” which jumps from the lips even of good and thinking people.

    UBI is not primarily Economics — it is a new vision of how a nation ought to live. Guy Standing’s title calls it Transformative — a cautious term for Revolutionary. I believe we should name it the National Income Dividend.

    “Basic Income as Common Dividends — https://www.progressiveeconomyforum.com/wp-content/uploads/2019/05/PEF_Piloting_Basic_Income_Guy_Standing.pdf

    [This ends my two-piece offering.]

  • @ Roger Lake “A good foundation or starting point, I believe, is the Report to the Shadow Chancellor, by Professor Guy Standing of the Progressive Economy Forum. ”

    I’ll certainly read it with interest, Roger, but I warn you now you are likely to be branded as a Marxist red under the bed by a certain element on LDV.

  • nvelope2003 8th Sep '19 - 3:45pm

    Why does an operation cost in the higher end of six figures ? Has anyone ever looked into the costings of the NHS ?

  • @ nvelop2003 It costs even more in the U.S.A…… and of course the rich tend to be more favourably treated there.

    As for your question have you ever thought of doing some research and doing a bit of thinking ? If you had you might have discovered this :

    Liver transplant – NICE

    https://www.nice.org.uk › documents › liver-transplant-health-economics2
    Midterm cost-effectiveness of the liver transplantation program of England and … Liver Transplantation 9:1295-1307, 2003. Ref ID … England and Wales (NHS).

  • @nvelope2003

    Third result on DuckDuckGO
    https://www.gov.uk/government/publications/nhs-reference-costs-2015-to-2016

    Now you could have found that – so is your question an inquiry or agitprop?

  • nvelope2003 8th Sep '19 - 8:41pm

    I have not got the time to go through all that stuff, much of which was years old. Having worked in large organisations I would not take their figures very seriously. Only recently I found an organisation which claimed to be short of money and asking for donations was wasting money in a manner which any reasonably intelligent person could have easily rectified by the flick of a switch but most people are completely ingrained with the notion that “we have always done it that way”. That phrase was banned when I was working and massive losses were eliminated with hardly any redundancies or service reductions but there were changes in working practices – sometimes just to ensure people actually did some work which did not always go down too well but when I see my former colleagues they do not cross the road or hide in a shopping aisle but come up to ask how I am or hoot and wave when driving but then I was polite and treated them fairly. I did not see much of that in the public services where bullying and plotting, not work, seemed to be the norm.

  • nvelope2003 8th Sep ’19 – 8:41pm…………………..I have not got the time to go through all that stuff, much of which was years old…………….

    If only you applied the same reasoning to your ‘pet’ subjects.

    David Raw mentioned UK/USA comparisons….A few years ago my wife were in San Francisco where she collapsed. She was hospitalised for three days whilst tests were carried out.
    Cost to our insurance $42,000.
    Result nothing found.

    We have Boris Johnson and Dominic Cummings riding roughshod over parliamentary norms and still have time to play silly denigration games over what happened over 70 years ago. Grow up!

  • @ envelop “I have not got the time to go through all that stuff, “.

    Perfectly understandable. Don’t let the facts get in the way of the barrack room lawyer opinions.

  • Would @David Raw and @expats care to comment on the French, Dutch and/or German insurance-based healthcare systems (the ones with better outcomes then ours)?

  • TCO is correct. It doesn’t matter what a transplant costs, people in the UK are being treated to them when they, personally, have nowhere near the funds to pay for it themselves.
    They only get them because the UK thinks it can “afford” it. In most countries they have a different reality and know they can’t.
    I am sure my words will be denounced as right wing rhetoric but that reality is inexorably coming here too. Unless, by some unimaginable miracle, the relentless decline in the UK’s international earning power somehow stops and begins to turn upwards in a resurrection last demonstrated by Lazarus.
    I’m sorry to turn up with this reality stuff, but someone has to.

  • @ Thomas “if the Liberals governed during the 1920s-1930s under Lloyd George (but not under that old and inept Asquith), Britain would have had UHC well before 1945”

    Welcome to the world of fantasy politics, Thomas, your faith does you credit.

    Well he didn’t did he, to a great extent because of his own actions and decisions…. and when he was PM his ‘Minister of Health’ was moved because of Tory pressure in his Coalition which contributed to destroying the Liberal Party. There’s no mention of Health in the 1939 Liberal Party Manifesto (see below).

    david lloyd george liberal manifesto 1929 private health
    1929 Liberal/SDP/Libdem Party Manifesto – LibdemManifesto.com
    http://www.libdemmanifesto.com/1929/1929-liberal-manifesto.shtml
    1929 Liberal Party General Election manifesto David Lloyd George’s Election Address

    PS. You’re being a bit unkind to Asquith. Whilst failing in the 1920’s but much less inept than you suggest. Try reading ‘Asquith as War Leader’ by George H. Cassar (ISBN: 9781852851170)

  • Typo 1929 manifesto.

  • nvelope2003 9th Sep '19 - 10:50am

    expats and David Raw: You will now be pleased to know that I have gone through all that stuff and I did not find the information I was seeking. I did not think I would because big organisations like to hide things in masses of words. What I wanted to know was how these huge costs were reached – for example the cost of labour, equipment, consumables etc and the number of people needed to carry out complicated operations. What the suggested sites provided was the total cost which though interesting is not very helpful and did not answer my question which is very important and not intended to provoke anyone except to provide an answer which many thoughtful people are asking. The cost of all professional services has soared in the last few years and I would like to know why though I can make a very good guess.
    I am not sure what the reference to 70 years meant. I am interested in the here and now. The cost of dental treatment has soared for example. I am totally opposed to the introduction of the health system used in the USA but it does produce good results for those who can afford it – not sure private health care here is value for money though.
    The use of the term barrack room lawyer is totally inappropriate as I am normally very careful to check my facts but I was feeling very unwell yesterday after a long journey and now I am feeling a little better though rather tired.

  • @nvelope2003 “What I wanted to know was how these huge costs were reached – for example the cost of labour, equipment, consumables etc and the number of people needed to carry out complicated operations. What the suggested sites provided was the total cost which though interesting is not very helpful”

    You raise a highly pertinent point. It doesn’t state whether it was incremental or total cost. If, as seems likely, it was the latter, it’s important to know what cost apportionment methods were used to derive the total cost. These can vary widely and as a consequence the apportioned cost can vary widely.

    @expats do you have a view on healthcare rationing and how it should be carried out?

  • Hard Rain 9th Sep ’19 – 10:00am……………I’m sorry to turn up with this reality stuff, but someone has to…………………..

    This ‘reality stuff’ does that apply to a UK ‘independent’ nuclear arsenal, trident, foreign wars (Iraq which this party opposed and Libya/Syria which it supported)..
    May I suggest that your ‘reality’ is really ‘priorities?

  • @ Neil Stockley Thank you for responding, Neil.

    Of course decent housing is a prerequisite to good health, but not remotely like the universal health care provided by the 1948 NHS. Addison did leave his bit of a divided Liberal Party to join Labour in 1922/23 and assisted John Wheatley with the 1924 Housing (Financial Provisions) Act now regarded as the biggest success of the first Labour Government. The tragedy is that the permanent secretary of the new Health Ministry, Robert Morant, died of pneumonia in 1920.

    When Lloyd George left office in 1922, his government had amounted to little, especially in housing. Lord Morgan points this out in his ‘Consensus and Disunity: The Lloyd George Coalition Government, 1918-1922.

    After six months of the house-building programme there was a gulf between calls for half a million new homes and the 10,000 under construction, let alone the 180 actually occupied. The final figure of 170,000 was nowhere near the scale agreed as necessary, and a long way short of the hopes roused by Lloyd George’s rhetorical, ‘Homes fit for Heroes’..

    My issue is, please don’t over claim or ‘big up’ – as the headline to your article does – the split Liberal Party’s contribution to health care. I’m sure Lord Morgan as a Labour peer will make this clear.

    I’d add, I have strong personal feelings about it. Two of my uncles died as children in 1926 because my grandfather couldn’t afford the doctor’s fees.

    @ nvelop I’m glad you’re feeling better. As you say, “the cost of dental treatment has soared for example. I am totally opposed to the introduction of the health system used in the USA but it does produce good results for those who can afford it – not sure private health care here is value for money though.”

    Which is why it’s sad that successive governments, Labour, Coalition and Tory have allowed the NHS side of dental care to run down. As usual, “it’s the rich wot gets the pleasure……. It’s the poor wot gets the fillings and the rich wot gets the crowns”.

  • David Raw, 8th at 3.41

    Thanks for your comment and warning, David. I shouldn’t be surprised: perhaps I ought to follow Guy Standing and use the less alarming word, “Transformative”.

    But I do feel that a bit of provocation is needed now, to startle us into more vigorous movement FORWARD! Since your comment, Parliament’s prorogation has been announced A General Election looks likely — and very soon, in terms of preparing a Manifesto which proclaims not what worthy tweaks we would promise, but what usefully radical measures: Transformative ones! UBI is not Economics, it is how we ought to live together, as a commonwealth of equals — equals in standing, that is, with everyone over 16 paying income tax to finance the shared national life.

    The Lib Dem UBI (or National Income Dividend) would not mean that everyone had the same disposable income, since it would be open to everyone to earn more than the UBI, according to his or her abilities and energy. But Income Tax would reduce the unacceptably wide gap between the biggest and the smallest incomes. All parties seem to be agreed that the gap needs narrowing, but not all seem to realise that there are, essentially, only two ways to achieve this. There may be parties which would restrict the sizes of high incomes. But Lib Dems, I believe, would narrow the spread by taxing high incomes, to get funds for distribution to the poor.

    I have been challenged, in one or two other Threads this summer, for not having proposed a figure for the UBI. That is because I am looking beyond tomorrow. I am suggesting (it seems to me) an enduring Mechanism, not a set of figures. Parliament would operate the mechanism. A Lib Dem government would, I suppose, operate it more generously than a Conservative one since our desire to narrow the gap is greater than theirs. I would propose (as my name for it, the National Income Dividend, implies) that an annual Budget would declare what percentage of the NI (or GDP if you like) was to be distributed to each and every one of us (bar children) in the coming year.

  • @Neil Stockley “But Income Tax would reduce the unacceptably wide gap between the biggest and the smallest incomes.”

    You’re firing at the wrong target

    It’s not income that’s the issue; it’s wealth. If wealth is generated from income, then you tax the wealth.

    Earned income is productive activity; unearned wealth is not, and should be taxed.

  • TCO at 10.17

    You make an important point (which I hint at above), but I think you are a bit hard on Neil Stockley. Surely both sources of income ought to be taxed, and surely they are? And aren’t we here talking about three politically significant sources of Revenue? Income Tax on earned Income, Income tax on Unearned income, and a different kind of tax on Wealth

    And I believe “the issue” is indeed primarily Income. It is that and not Wealth that bedevils life in the UK today. I think every party talks about fairness, as if it thought that mattered. They clearly don’t all mean it, for a decade of Austerity has grossly and needlessly amplified the unfairness. And the pain in unfairness is the one suffered by those with paltry incomes, hungry and cold. Such suffering would be tolerable, if all endured it owing to some natural catastrophe. It is rendered hideous and unforgivable, when the cold and hungry are jostled and abused by those around them who manifestly, blatantly, this evening and tonight have Incomes more than ample, and secure.

    The real problem, perhaps, is neither Wealth nor Income, but Spending. Spending is visible.

  • @Roger Lake no-one is saying income should be untaxed. And you’re right to highlight fairness. But …

    There are many people in this country with low incomes, but relatively low outgoing, and high wealth. I’m talking about the unearned wealth locked up in property.

    Then there are those with potentially higher than average incomes, but with high outgoings and low wealth.

    For example – the pensioner with £25k per annum, no dependents and no mortgage, in a house worth £750k, vs the single wage earner on £45k, with a spouse and three children, and mortgage or rental costs.

    Why is it fair that the former should pay less tax than the latter? That is why we must tax unearned income and wealth more than earned income.

  • David Raw – I should have also added the fact that Asquith was always more conservative, more right-leaning, and more of an establishment politician than Lloyd George. DLG, for all of his faults, was always a natural radical and a reformer, and I would call him a leftist. The same cannot be said about Asquith. You can see the difference in their attitudes towards the 1926 General Strike. Also, regarding pre-war social reforms, most of the grunt works were done by Lloyd George and others, while Asquith just presided over those achievements.

    Comparing Asquith and Lloyd George as war leaders during ww1 is quite similar to comparing Neville Chamberlain and Churchill during ww2.

  • expats,
    Quite right, all those will have to go and the UN security council seat, the Royal Family, the NHS, the BBC, maternity leave, paternity leave, statutory sick pay etc
    Pretty much anything a rich country thinks it is entitled to by some God given right disappears when aforesaid nation finally hits the bankruptcy buffers.
    No nation has ever survived when its desire to spend so far exceeds its ability to earn and this little island has far too high an opinion of itself. It is going to end in tears.
    The signs are all around if you choose to see and not look away.

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