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I wondered what people who do not live in the UK think of a National Health Service.
The idea, in case you didn't know, is that any and every citizen of the UK is entitled to health care on the basis of criticality and need. That service is free. Furthermore, the UK government will pay the costs of health care provided by any other country in the world providing you carry a UK passport.
Do you think it's a good idea?
wish it was, our hospitals have been flooded by British patients because of the shorter waiting times...
its a good idea, there are no reasons to say it isnt.
:) - Just to add the service isnt free, to everyone who works ;) we pay tax :p
Yes, the near continent complains of the same thing.
I was thinking less pragmaically, and more about the concept, though.
It depends on how you measure 'free'. If I walk into a hospital with a broken leg, they're gonna fix it right. They will not question whether or not my NI contributions are up to date. I may be self employed, and avoided NI contributions all my life (not the case, I might add)Quote:
Originally Posted by Pino
It is, for all intents and purposes, free at the point of need. But yes, you are quite right, it is paid for out the UK tax system
Agreed :) I'm still a student, so apart from stealing all my tution fee's next year, I dont pay tax at the mo.
Student=Sponger ;)Quote:
Originally Posted by Pino
lol not next year student = in massive debt.
Because of my parents income I will be having to pay the full amount, 3000 a year plus my living and expensise, works out 22k best case scienario.
It's a lovely idea(l) but unsustainable over the long term.Quote:
Originally Posted by yrwyddfa
Why do you think it's not sustainable? The UK have been at this now for nearly 60 years.
Because you face the same demographics as all the western nations, in 20 years time you will have a huge number of retired people who require a lot of attention.
Ofcourse you could sustain it if you cut it down untill its almost nothing.
Edit: No disrespect but the UK health system has a terrible reputation.
National Health care is crap. There is no accountability. In a private Healthcare system a doctor can be sued out of house and home if he does shoddy work. An Example. My Aunt in England was gettin an injection in her spine. The doctor flinched and paralized her from the neck down. She's screwed for the rest of her life. In the US she would have had a malpractice case and would have been financially compensated for the rest of her life by the doctor. Instead my uncle has to work two jobs for the rest of his. Threaten a doctors pocket book and he will be a better doctor. That's my theory any way. :confused:
Not a bad theory in theory, but does it work in practice?
My cousin went in to the hospital (in the US) for a simple procedure near her eye. The doctors took a wrong turn, cut some of the muscles controling the eye, then nicked the nerves (perhaps the optical nerve, I forget). At that point, they decided they might have taken a wrong turn, and stopped, but sufficient damage was done.
With follow-up surgery, my cousin can now move her eye some, and has some vision, but she will never be the same. The hospital took full responsibility, and have taken care of her well, but the damage was done....and in the accountable US.
Your aunt might prefer compensation over nothing, but I'd bet she'd rather walk.
Nationalized health care is not a good idea.
I actually work in the health insurance industry in the US - and although it is a royal mess right now - it functions well in our capitalist society, and will self-correct in the next decade.
Whenever anything is nationized, it is dumb'd down to the lowest common denominator.
BTW - your system of nationalized health care is not free - it's a "share the cost among everyone". That's called "insurance" in the USA.
There are more then enough ways for the poor to get health care in the US - but those who can afford it should buy insurance according to their means.
I'm sure she would like to walk. Problem is there aren't too many jobs that a paralized person can do. The bills need to be paid somehow.Quote:
Originally Posted by Shaggy Hiker
I'm sure there are plenty of potential malpractice cases in the US every day. I'd be interested to see numbers and how they compare to those with national heatlh services.
True enough. That seems like it would be a good metric.
(i) The free market (the capitalist economy you are talking about) in the US is not just about the self-correct.Quote:
Originally Posted by szlamany
(ii) I don't see 'dumbing' down. There might be problems, but I certainly cannot see any reduction in knowledge, or research inside nationalised health care in the UK.
(iii) Reread other posts. This point has already been covered.
(iv) I see where you're coming from, now. Healthcare and more importantly quality healthcare should be based on the ability to pay, not on need? I think this is appalling. One presumes that you can 'shop around' for insurance? Different levels, different cover? Market forces at their very very best? The poorest and most vunerable people of our society are the ones we should be looking our for, and caring for.
The premise that if you've got money you should pay for it is exactly what happens in the UK tax system - mainly through National 'Insurance' contributions.
I think that you'll find that doctors (etc) inside the NHS are just as accountable as those in the USQuote:
Originally Posted by Shaggy Hiker
What you are talking about is the 'sue culture' If I trip on a crack in the pavement and break a bone, then in the US there is reason to sue. Most people in the UK wouldn't dream of it. They would've been looking where they were going.
The ability for legal action is not a metric for superior quality, nor is it some sort of measure of accountability.
Accountability is not hurting someone where it hurts (their pockets) it's finding out what went wrong through a transparent process, and ensuring that it doesn't happen again. I do NOT believe that this is achievable in a private business - which is what ensured healthcare is all about.
As an aside do you believe that profits should be made from people at the most vulnerable time of their lives?
I am sad for your inability to understand :cry:Quote:
Originally Posted by yrwyddfa
(i) Your opinion on this point is meaningless to me - and obvious to me. I would expect you to have that point of view and limited understanding of our "health care economy" - which was the "economy" I was tallking about.
(ii) Dumb'ing down was certainly not meant as an indication of "intelligence" - it's a general term I use to indicate when something becomes less then what it could be. I should try to avoid local idioms when talking to an international crowd.
(iii) And from reading your posts, in particular, I saw a flagrant use of the word FREE as if that LABEL made it special, when in reality FREE doesn't fit the BILL at all - you are misinformed about social government if you use the word FREE to describe a SOCIAL service!
(iv) Now you are simply being sarcastic - if you got all those ideas from my one simple post, then you are editorializing for your own benefit. In order to build a strong health-care/provider institution, the individuals involved must be compensated according to education, desire to work, effort put forth - that's capitalism.
When you are offered insurance options at your place of employment, there are levels you can chose from. The single-guy, doing drugs at home, choses more money in his pocket and less coverage. The married guy, with big responsibilities and strong ethics choses more coverage, and drinks less beer every night.
In a social-insurance world, the herion addict gets in line before you for elective surgery to remove a wart. Your's turns cancerous before it's looked at. [oops - sarcasm - sorry - strike this paragraph]
Seriously though - our poor and needy are cared for in regular hospitals just like the rest of us. They don't usually go to doctors, but use the emergency room. But that's part of the social-strata they are stuck in. There are many free-for-use clinics in poor areas of our country for treating people. The "state governments" pay for this with federal and state funds, just like your social health care system. It's not a whole lot different.
But we also have a free-market health care system that is used by the other 80% (I'm guessing) of the country.
Personally, I get my coverage from a well organized labor union - 100% of most fees are paid by that insurance. But I also pay into that particular "arena" of insurance - and I want to pay into that group - at the level I can afford for the 100% coverage I get for it. That's what life here in the USA is all about. I work extremely hard, can buy something special for my family (full coverage) and enjoy the fruits of my labor.
Actually, I think that was my point. I was making an ironic statement.Quote:
Originally Posted by yrwyddfa
szlamany, I think your last few paragraphs are based more on wishful thinking than reality. If you make good money, you have lots of choices. I have alot of friends who are just entering the work force, and make well below the national median income (which is 40k, I believe). For them, their choices on insurance can truly be grim. One gal I know just left here to work for an insurance company. You might think that she could get good insurance, but it isn't the case. The employee policy they offered her has a deductible that is several thousand dollars, and the coverage is mediocre.
Of course, that is not her only option, she could shop around for herself. I did that once about 10 years ago. The cost of insurance was higher than the cost of housing, food, or transportation, and would have amounted to over a quarter of my net income. Costs have risen dramatically since then. For a young, healthy, woman, I would not be at all surprised if the cost of mediocre private insurance wasn't half of her net income. At those costs, you aren't choosing between drinking and health insurance, you are choosing between EATING and health insurance. That's why there are so many uninsured people in this country.
I ran a crew of fish markers for several years. We paid them pretty much squat, so we were drawing from the uneducated pool in economically depressed areas, where even job just over minimum wage was better than nothing. These folks could not afford health insurance, and could not afford to get injured. Yes, they could go to the emergency room, and hospitals cannot turn people away, but the cost is not $0, and the health care is not average.
But those costs you talk about are real regardless of a social health system or a "insured" system.
The UK isn't getting anything for free - it's costing the same 25% of net income (I'm using that percentage as an example - I have no clue).
Here in CT about 6 years ago we enacted a "free to poverty level" insurance coverage for people. That was funded by state taxes. I worked on the software to enable the insurance companies to cover these individuals.
Social health coverage exists in the USA - just as in the UK. It just isn't the only option here.
15 years ago I also purchased my own coverage - and can relate to the excessive fees if you are not in a "group policy". Insurance is a tricky business, but I still would never trade that for the UK social system.
Clinton and his wife promised us that 10 ago - see where that got :sick:
I wouldn't disagree with any point you made there, especially the last one. Anybody who tries to fix the insurance issue in the US has one heck of a fight on their hands. Too many people are making money off the status quo.Quote:
Originally Posted by szlamany
Free to the poverty line is a good thing, but the poverty line is far below the affordability line, so there is still a big chunk that can't afford the hit of private insurance. Interesting, but unsurprising, to note that it is individual states that are leading the way at trying to find solutions.
Medical coverage, of the quality we have available in this country, is going to be SERIOUSLY expensive, no matter who pays for it. I do believe a nationalized system could be cheaper overall, but there are certainly plenty of examples of this type of a system not working.
One thing we would have to consider when looking at any such system is what the true cost would be to the individual. Consider this: I make x dollars an hour. This means that my gross pay is x times 80. However, the gross pay is neither the amount of money I receive each paycheck (that would be my net), nor is it the amount my employer pays to keep me here, because the gross pay does not include the employers contribution to health insurance and SSI. In fact, I currently have no idea what my employers contribution is.
If we were to nationalize health insurance, what would that do to the amount my employer pays to keep me here. If what they pay now for health insurance was turned back to me in the form of a raise, it would probably more than ofset the increase in taxes that I would expect to occur to cover the insurance cost. However, that is based solely on a wild-ass guess at what they are paying, coupled with an understanding of what I am currently paying in taxes. Basically, if my taxes were doubled, I expect that would be less than what my employer currently pays for health insurance.
Because of the high cost of insurance, even for large entities (I'm in state government), there is room to consider other options. A zero-sum change could mean a net gain for me, I just don't know for sure.
One of the customers I have is a self-insured employer group. They collect per hour to cover the cost of coverage they give out to the group.
About 4000 members, 15000 or so covered lives.
The contribution that keeps them afloat is a little over $4 per hour worked - around $700 a month.
Could you afford to give $700 a month to a nationalized insurance system? The transistion, as you said before, would be painful to say the least.
People in other countries fail to realize the vast geographical area that the US covers - the incredible difference in population densities. From the 15 million (or more) that live within 50 miles of NYC to the 15 people that live in North Dakota.
They also fail to realize that we are 50 states - the federal government is not the equivalent of the UK government. The UK government is more the equivalent of the New York or Pennsylvania state governments.
What are you basing this on? How do you know that the ability for legal action is not a metric for superior quality? Show me the numbers and I'll buy that. What I do know that the united states private healthcare system produces the best doctors in the world. That could be mostly attributed to the highly funded education and research system here but I would also bet that doctor accountability factors in somewhere. Of course there are no concrete studies on this so all either of us can do is speculate.Quote:
Originally Posted by yrwyddfa
Yes we have a sue happy system in the us. On thing though, the majority of these cases are thrown out of court before any money exchanges hands or they are settled out of court. I'm talking about doctors really screwing up royally and being held accountable.
Yes, of course you need to figure out what whent wrong and what to do to ensure it never happens again. Of course this is acheiveable in a private business. Ever been to a wrap up meeting for an application you or your company built? You know the meeting where you go over exactly that. The doctors are supplying a product. The patients are buying it. To make more money by expanding customer base and to avoid loosing money in lawsuits, constantly reveiwing procedures is necessary. Remember when a kidney transplant or lasic eye sugery was a big deal? Now doctors can do it with blindfolds on because they reworked and reworked and rewoked the process to make it safer, faster and cheaper. I'm betting that the existing threat of lawsuits helps drive the "safer" part.Quote:
Accountability is not hurting someone where it hurts (their pockets) it's finding out what went wrong through a transparent process, and ensuring that it doesn't happen again. I do NOT believe that this is achievable in a private business - which is what ensured healthcare is all about.
My point is that my employer may already be paying $700/month or more to give me health insurance (I have no idea, and expect that it might be a bit lower, but not much). While this is not deducted from the gross pay that I see on a paycheck, it IS part of the cost of employing me. If that cost went away, the employer could give me that money as a raise, the government could then take that money in taxes, and use it for a health insurance plan.Quote:
Originally Posted by szlamany
Under that system, the cost to my employer would remain the same, my net pay would remain the same, but the uninsured would be insured. That would have no net effect on my paycheck, no net effect on my employers cost, but a huge positive effect on the general decency of society.
However, having said that, I ought to note that $700/month is far more than I am currently paying in taxes and social security combined. I seriously doubt that the actual cost would be that high, but if it is, then so be it.
(i) I think that the ability to take someone to court is self-evident in all progressive nations. I do not therefore think that private healthcare adds any more 'transparency'. I do not think you need numbers - nor am I able to provide them for this.Quote:
What are you basing this on? How do you know that the ability for legal action is not a metric for superior quality? Show me the numbers and I'll buy that. What I do know that the united states private healthcare system produces the best doctors in the world.
(ii) How do you define 'best'? Those who get sued the least? What function is there that defines what 'care' is? Do you accept that this is subjective?
Read post #5 :rolleyes:Quote:
(iii) And from reading your posts, in particular, I saw a flagrant use of the word FREE as if that LABEL made it special, when in reality FREE doesn't fit the BILL at all - you are misinformed about social government if you use the word FREE to describe a SOCIAL service!
I guess I should say thank you?Quote:
I am sad for your inability to understand
That's not capitalism; that's greed. I recommend you read a little of John Smith's work . . .Quote:
(iv) Now you are simply being sarcastic - if you got all those ideas from my one simple post, then you are editorializing for your own benefit. In order to build a strong health-care/provider institution, the individuals involved must be compensated according to education, desire to work, effort put forth - that's capitalism.
Right then:Quote:
Seriously though - our poor and needy are cared for in regular hospitals just like the rest of us. They don't usually go to doctors, but use the emergency room. But that's part of the social-strata they are stuck in. There are many free-for-use clinics in poor areas of our country for treating people. The "state governments" pay for this with federal and state funds, just like your social health care system.
(i) Do you gain further benefits from subscribing to an insurance scheme? That is do the people who don't subscribe get a worse service. If this is the case then even you should admit that care is about who has the most money. Is this acceptable?
(ii) Do you accept that if people are in their 'social-strata' position that they are 'stuck; there? I find this idea abhorrent (however impractical any solution may be) in any advanced nation in the world.
You are talking about a free market economy here. Which, I am presuming, you are a champion of.Quote:
Social health coverage exists in the USA - just as in the UK. It just isn't the only option here.
My point, whoever ineloquently put, is that the idea of care should not be subject to free market conditions.
I believe that there are somethings that we accept as given. One of those is 'life' Everyone should have the right to life regardless of social position or wealth.
If you gain better treatment through wealth (your insurance system) then you are part of a system that does not put human care first. It puts money first.
Therefore if money is a key indicator you cannot believe that everyone is born equal.
(i) In the UK system is there any kind of cost sharing (co-pay) or deductible involved? Do you have 100% of your bill covered with no out-of-pocket expense?Quote:
Originally Posted by yrwyddfa
(ii) Why people get 'stuck' in a social-strata position is an age-old question. Education? Entitlement? Drug-abuse? I could go on and list these forever... I live in a densly populated area and have seen (and know) of homeless people, and drug-abusers and again - the list goes on. How far are you willing to help the underacheivers in all parts of your country? Going to pay more taxes to raise them up? Are you willing to have less so those who don't try hard can have more?
Hmmmm? Where did this come from?Quote:
Originally Posted by szlamany
What part do you not understand - the real information about cost, or the absurdity I see when people compare the US to their own country?Quote:
Originally Posted by yrwyddfa
(i) In terms of deductible with have a system called National Insurance. This is deducted as part of your tax. It is deducted on the basis of if you earn more you pay more. If you earn less than £4716/yr then you don't pay at all.Quote:
Originally Posted by szlamany
(ii) The argument is not about how to help people out of their social position. The argument is about healthcare. Why do you assume that you can only have good healthcare if you have enough money? If you need it in the UK you get it (there will be, I'm sure, some appalling example of where this hasn't happened, but in the majority of cases it holds true)
I wouldn't compare the US to the UK - ever. As you say it's not worth the comparison.Quote:
Originally Posted by szlamany
Do you? Because clearly their not.Quote:
Originally Posted by yrwyddfa
I forgot to say. If you need treatment in the UK you turn up at the hospital, or you ring for an ambulance. The healthcare from thereon in is on the basis of need. You do not have to pay for anything (it's already been taken care of in the form of taxes)Quote:
(i) In the UK system is there any kind of cost sharing (co-pay) or deductible involved? Do you have 100% of your bill covered with no out-of-pocket expense?
Although it's straying from the debate a little . . .Quote:
Originally Posted by davebat
I believe - like the American constitution - that everyone is born equal. That includes equal rights to life, and the care of such life.
So YES, I do.
I have to wonder why you think that 'clearly' they're not? By this statement you are indicating that some humans are inferior to others.
That does not make me comfortable. At all.
Compensation based on participation is a good thing in my opinion. I have employees - if they don't participate they get fired. I don't have a clue how you got "greed" out of my description of building a solid health care/provider institution.Quote:
Originally Posted by yrwyddfa
From hereQuote:
Originally Posted by szlamany
Quote:
the individuals involved must be compensated according to education, desire to work, effort put forth - that's capitalism.
So there is cost sharing. And you pay into the system.Quote:
Originally Posted by yrwyddfa
This is just like insurance here.
But the UK government decides how to serve it out to the people.
And those below a certain poverty line don't pay but still get services - just like here.
Ok - back to your original question - do we think that having the government run the health care system is better then having the health care system run itself? No - I don't think that's a good idea.
I think that every time the government puts there hands into something it gets political, and I certainly don't want my health-care needs served by political agenda.
That may well be true, but your description of capitalism is not accurate.Quote:
Originally Posted by szlamany
Read John Smith's work.
Yes, I agree that the political nature of the UK health system is flawed. Surely there must be some 'in-between' ?Quote:
Originally Posted by szlamany
Perhaps I have the wrong idea of the US 'insurance' scheme?
I understand insurance as the concept that you pay a premium on the understanding that if something goes wrong, the insurance company will pay for resulting cost.
If you can have different levels of insurance, which I presume have different premium costs, then you will get a different level of insurance cover.
If you cannot afford the 'A' cover then you don't get the 'A' treatment.
That, to me, is those with money get it, those without don't.
Am I right with this assessment?
No you are not.Quote:
Originally Posted by yrwyddfa
Your national-level of pooling funds to pay for service is absolutely the exact same things a private-insurance company pooling of funds to pay for service.
In your system, the government decides what to cover (oh, we don't pay for mammograms unless the women is 40).
In a private system, the companies decide what to cover (with many state and federal guidelines) - and you can purchase from whatever company fits your whims.
That's where the real difference comes in. Not how to pool the funds - both ways are exactly the same - pooling funds to cover expenses for health care.
OK, but the point remains that if you don't have the money you cannot choose a 'company [that] fits your whims'Quote:
Originally Posted by szlamany
If you have money you get healthcare, if you have less you get less healthcare?
This is not the same premise as the UK. Regardless of the financial state of the individual they will receive the same quality of care as a trillionaire who exercises his rights under the same system.
Do you really believe that a trillionaire in your country does not purchase health care from a provider that is deemed by that trillionaire to be better then other providers? And pay for that service out of pocket?Quote:
Originally Posted by yrwyddfa
I'm sure that the trillionaire would pay to go to the US for the 'best' doctors. :rolleyes:Quote:
Originally Posted by szlamany
Do you not agree that if you have money you get better treatment?
In an ideal world everyone would be born equal. I say that clearly they're not because I wouldnt class an African child born with AIDs whos going to spend every minute of his short life suffering from starvation and the extremes of poverty to have a life equal to someone born in a more developed country.Quote:
Originally Posted by yrwyddfa
I didnt indicate they are inferior, but they certainly have not been dealt a fair or equal hand in life.
We're not talking about Africa, nor AIDS.Quote:
Originally Posted by davebat
What we're talking about is people born in 'developed' nations. I can't think of an excuse that someone should be deemed 'less-equal' in either the UK, or the US let alone anywhere else.
Can you?
go ahead and roll your eyes smartarse. The US spends more oney on Medical Research and Education than your countrys GNP. That is not an insult to you or your country, It's just the way it is. education + research + practice = better surgeons go ahead and argue or call it subjective or whatever. It is obvious you have no clue and need to resort to smart asrse comment. I don't know about you but If I needed a liver transplant, I'd rather have it don in a hospital that does more liver transplants per year than the entire UK does. And I's also like to have it done by a doctor that realizes if he screws up and kills me he will loose every penny he has and never work again.Quote:
Originally Posted by yrwyddfa
You mean to tell me this entire fooking time you've been arguing against private healthcare and you have absolutley no Idea how it works? Whatever man. If you don't have money you get the same basic care as a person with money. Paying more for better insurance coverage means you get more services other than the base stuff you need to live a healthy life. Sorry welfare case, I'm not using my taxes to pay for your Breast implants and face lift.Quote:
Do you not agree that if you have money you get better treatment?
MasterBlaster - thanks for that - I kind of gave up on this thread ;)
How did this turn into a US vs UK healthcare debate?
Anyway, to answer yrfw's concern about poorer people receiving less health care - they generally do not receive the best health care. They do not schedule routine doctor visits, they generally only go to the hospital in emergency situations. In such situations, the hospitals are required to treat them. That does not mean the poor person gets off free - they will be billed - but the hospital generally never intends on seeing the compensation. To fill that gap, they jack the prices for everyone else who does pay.
Many states offer a state-wide care system for their poor. In Wisconsin here, its called 'BadgerCare'. It mainly helps single mothers with newborns, but it covers poor families nonetheless. And its graduated past a certain point - so under x amount of dollars, you pay nothing. Between x and y, you pay a percentage of the billed amounts. The system additionally covers routine visits and procedures.
Whether its better for private entities or a public entity to administer health-care, I have no idea. Both systems are in use here (on a State level anyway). Our state system seems to operate just as well as the private systems. So in my opinion, there probably is little difference - its still one big administrative mess no matter who looks at it.
They are both well off western nations and are just an example of each type of system. And for the most part they are the only systems most of us talking here have participated in.Quote:
Originally Posted by nemaroller
Then please explain to me how I had knee surgery done by the Orthopedic sugeon who's clients included the Pittsburgh Steelers and Pitt Panthers while I was on state provided health care and didn't pay a penny? Pretty damn good surgeon if you ask me. Rebuilt my knees 3 times and hardly left a scar. I've been on both ends of the spectrum in my life. I've been treated and operated on for various injurys while having the best insurance money can buy to no insurance at all shortly after college. Bottom line. If you are sick you are going to be able to get health care and odds are you're getting a good doctor.
I believe that is because of our free-market health care/insurance system.Quote:
Originally Posted by MasterBlaster
That's only my opinion - I personally am friends with several doctors and have been involved in many meetings where insurance companies decide how to cover what with the dollars they have to cover it with.
This appears rather confusing. For a start I'm slightly puzzled by your belief that a doctor will do a better or more reliable job because he works under the threat of dissmisal and losing everything he ever has. I would prefer (and feel much more comfortable) with a doctor who is skilled (like the vast vast majority of them are) and does what's in the best interests of his patient regardless of consequence.Quote:
Originally Posted by MasterBlaster
What you are talking about is not subjective (or whatever) as they are metrics that can be measured reliably. I am pleased that you have faith in your healthcare system as I do in mine.
No I am not arguing for or against private healthcare: you would do well to remember that you can get private healthcare in the UK, too. Why you (apparently) see this as some sort of personal attack bewilders me, I must admit.
I am trying to ascertain whether it is true or not that if you pay, in the US, you get more. This is certainly true in the UK. If you pay for private healthcare at the very least you get seen, and treated quicker because you've paid extra money - and not on the basis of clinical need. Is this the same in the US?
What this has to do with breast implants and facelifts I have no idea.
Noone is arguing the competence of the practising doctor. The discussion, I presume, is about if you pay do you get better treatment.Quote:
Originally Posted by MasterBlaster
This is a good example where you haven't paid but still had excellent treatment.
Which is the crux of the matter really. Is it morally right to profit from other's misery?Quote:
Originally Posted by szlamany
No the crux of the matter is that richer people have more benefits than the poor. Just the way it is.