Insurance companies have been raising premiums to cover pre-existing conditions for years. I no longer work; I am 62, had kidney cancer when I was 57. Five years ago, when hub retired, we started paying $9000.00 a year with a 2500.00 deductible for me. My premium has gone up incrementally from $9,000. to $17,000. per year in 5 years!

My husband is 70. He also had cancer 5 years ago, but his former employer covers most of his premium. His Medicare premium is 97. month; his portion of his company insurance premium has gone up incrementally each year from 11.00 a month when he retired 5 years ago to $76.00 a month this year. We are insured by a major well-known health insurance company. Our annual income from Social Security and retirement is $35,000.00; we spend $21,576.00 on insurance premiums, another $900 or so for the copayment on his meds.

Until we had cancer, neither of us had any medical conditions, took no meds. Beyond an annual physical, mammo, pap, we cost the insurance company nothing - except for my pregnancies. Our kids were all healthy, no broken bones or illnesses.

Yes, I hate insurance companies, too. We must have insurance reform now. What just passed is not good enough.

Ours also went up but $500.00!! It costs us almost $3,000.00 a month for a family of 5. If we cut out dental coverage it will cost ONLY $2,700.00!

Our insurance is very expensive too but I just talked to my agent today. The insurance companies have to finish reading the 5,200 page reform still. They are raising rates out of hysteria. They tossed Max off April 15th and didn't even tell us. Luckily I fixed it.

This news makes me just want to pull my hair out. DH's insurance and co-pays have also gone up, and coverage has gone down, this year through his company's supposedly 'high-quality' insurance coverage.

Insurance is a completely unnecessary, parasitical insertion of a profit layer coming between doctor and patient, taking advantage of something necessary for life and thus something the repulsive vultures know will always be a dependable profit engine. As my dear departed public-health-physician mother knew back in the 70s, destroying the insurance industry and having universal healthcare (with options for more treatment/other modalities paid for privately if desired) available is the only way healthcare can truly serve its purpose (not the purpose of the illness-exploitation industry) in this era. It's unconscionable that we've let it get to where it has, but I suppose it's our own fault for not being more vociferous in our protests and falling for lies when it was up for reform.

When dh was self-employed a few decades ago we were confronted with rising rates on a regular basis with Blue Cross.

I agree with you 100%, flyleft. (Want me to write a letter? ;-))

I understand where the self employed are coming from; my dad owned a gas station all my life. He struggled to survived all the time.

With hubby's cancer last year which was a surgery that consisted of a neck dissection; removal of a golf ball sized mass as well as lymph nodes & a feeding tube - over night hospital stay, then 3 more over nights for chemo with one actual admission for 4 days for a fungal infection in his mouth.. then 33 radiation treatments - his insurance maxed out at some point. I can't imagine if he'd been hospitalized a few times for complications. His medication maximum was also reached.

I don't know what the answer is for health care. I know that people in other countries that have managed health care are not getting good treatment & I'm afraid that if I end up with cancer I may not be able to afford the treatment my hub was able to have.

I don't where the Canadian regulars on this forum are today, roselvr, but I bet they'd strongly disagree with you about the care and treatment they get with their system.

I know that people in other countries that have managed health care are not getting good treatment

Do you have first hand knowledge of this?
I know people in this country who don't get good treatment.

Bravo, Fly. I totally agree with you and your brilliant mom. Several of our local Drs (mostly the GPs) have written to our newspaper, saying the same thing.

We are self employed and are taking the hit. Small business has no leverage whatsoever. It's take-it-or-leave-it. Yeah, bend over. We have a group policy. Our group consists of 10 families. Our insurance company wouldn't miss us one bit.

I am wondering which countries you're thinking of, roselvr...there's an awful lot of disinformation out there, which of course gets more play from corporate media than does the actual truth.

As my message sat waiting to be posted, many more people contributed to this thread. I think people in other countries get very decent health care. I think we are fed bull crap by the insurance industry who spends billions feeding us lies.

Max got hit by a car in the middle east. He received excellent health care and it was dirt cheap. My friend lives in Canada. He just got over a battle with cancer and he loves their health care system. He can't believe the people in the USA don't care about each other enough to want everyone to be cared for.

My sister doesn't want everyone to have health insurance because she is afraid she will have to wait in line. She has hers (government health care through the VA system) so no one else matters? I guess so. She is the classic person screaming "Keep government out of my health care!" She doesn't take a minute to think that she *is* receiving government health care. My concern is there seems to be many people just like her out there... people who have swallowed the health industry's poison pill.

Meant to add: yes, jen, please do! That should fix it :)

And thanks, golddust. I so wish she were here to have a voice in this debate; she was definitely ahead of her time, although so far ahead they couldn't see her anymore, unfortunately.

Golddust - I totally agree with your friend's sentiments - - "... he loves their health care system. He can't believe the people in the USA don't care about each other enough to want everyone to be cared for."

I'm Canadian and that's exactly how I feel. Our health care system has issues - especially in the Maritime Provinces which are much smaller and generally less wealthy. There are wait times for some surgeries & tests, but in my experience, if your Doctor feels you need something *NOW* you get bumped to the front of the list. A quick example - my cousin was diagnosed with ovarian cancer in late January. Since then she's been refered to a specialist - she did have to drive 4 hours to a larger urban center to see this particular specialist because my city doesn't have one - she's had numerous ultrasounds, scans, etc., surgery to remove the mass, and is into her second round of chemo. She has access to a social worker who works just with oncology patients, and if she needs it she has access to in-home nursing care. None of this has cost her anything, except the trip to see the specialist - and she can claim those expenses on her income tax.

There are absolutely flaws in our system, as there appears to be with every system out there. However, I don't have to worry that a medical illness will bankrupt my family. I purchase supplemental insurance for vision, dental, and prescription coverage for hubby and I for about $50 per month.

It seems to be a fundamental shift in thinking... I'm not sure how to explain it. I've read so many comments & articles out of the US where people seem so concerned that THEIR tax dollars may go to pay for the health care of someone else. As a CDN, I don't give that a second thought. Of course my tax dollars will help pay for *your* chemo.... and maybe someday you'll return the favor for me or someone I love.

The World Health Organization lists the US as 24th in the world in healthy life expectancy behind Japan, Australia, almost all European countries and Canada among others. Most rankings for health (including infant mortality) show the US lagging. I agree that we need to have universal health care, taking the "for profit" out of the mix.

I just checked some statistics on the WHO website, and according to them - 'healthy life expectany at birth' is as follows (M/F):

Canada - 70/74

Germany - 70/74

France - 69/75

US - 67/71

So, I'm not sure where the myth that we don't get good treatment is coming from??

It seems to be a fundamental shift in thinking... I'm not sure how to explain it. I've read so many comments & articles out of the US where people seem so concerned that THEIR tax dollars may go to pay for the health care of someone else. As a CDN, I don't give that a second thought. Of course my tax dollars will help pay for *your* chemo.... and maybe someday you'll return the favor for me or someone I love.

Very well said. I too have read and heard so many comments such as you describe - some from people I have long called my friends and who I thought were compassionate individuals. I have to honestly say that I tend to view them in a different light now. They seem to have no problem with their taxes funding the infrastructure such as the roads we all use - but they so vehemently oppose their tax dollars paying for services that will allow many other people to simply live longer, more productive lives? I don't get it.

I see this utter overreaction by the insurance companies to health care reform the same way the banks handled the credit card holders.

With excellent credit (pre-bailouts) we've been subject to slashed credit lines, quadrupled interest rates, shorter billing cycles and even accounts closed due to little use. Our over all credit scores have dropped by 30-40 points due to these tactics.

This is a classic scam by corporations to get what they can pre-regulation. And we the people pay the price for those Wall Street numbers.

Truly, by the time we pay General Liability Insurance, Worker's Comp Insurance, Health Insurance, Auto Insurance, Life Insurance, Home Insurance, Dental Insurance, I am sure I am leaving another insurance out! That is A LOT of money going for insurance each month. Look who is making the money!

Now, the one that really bothers me the most, is the health insurance. You just don't have any control of it. That is one big reason I am going back to school, so I can get a job that offers insurance for my family.

Yes, pesky, same thing happened here. I went from an 830 to 750 on my credit score and nothing changed except the hysteria of the banks, who closed our unused credit accounts. The credit card reform bill just meant "screw them before the law is enacted."

Same thing with health care. We are months away from changes so it's free for all rate raising time. I have a fantasy that all Americans will revolt and stop paying their insurance bills, bring the profit making insurance companies to their knees. It's a fantasy because I am unwilling to go first.

Well, I'm UBER-fortunate to have the employer paid-family covered health care I have, so I won't revolt too badly. The trade off is, of course, that I have much lower wages than I'd be getting in private sector. I'm curious to see how the HC reform is going to affect the big pools of insurance buyers, like the State. We've been warned in the past of annual hikes in premiums, and we've been successful to not have to pay out of pocket (good fiscal planning by our benefits board) but that day is likely coming.

Private sector wages in most industries have dried up instantly while government jobs linger, while threatened. At least state and federal job cuts make the news. Small business reality occurs completely below the radar.

What used to be true is no longer true. Be grateful for your security.

"I've read so many comments & articles out of the US where people seem so concerned that THEIR tax dollars may go to pay for the health care of someone else."

It isn't a lack of empathy (sympathy?) for people. It has more to do with half of the US population eligible for taxation pays no tax, so the other half that is taxed is feeling the financial strain of paying the bill. At least we are. We had to scrounge to pay taxes this year, and it's going to get worse. If everybody had to chip in, I'd feel like the new healthcare system is more fair.

stats here

Re the employer-paid health care, they're good until your kids reach the cut off age of 23 for full time students (your plan's cut off age may vary). Then the companies hide behind the ERISA laws and are exempt from state COBRA rules for extending coverage for young adults. Our son with preexisting conditions turns 23 on Tuesday. Wish us luck trying to find decent health insurance for him.

shermann, your story is the same reason why we are so afraid to go without insurance. Boy, you pay some high premiums! Can you imagine walking into a doctor's office or hospital and not having to pay? Imagine the stress the US would be without, if that could happen!

rilie, interesting on the stats of healthy life expectancy. I am so jealous!

golddust, your right, those of you that have it, be grateful for your security!

Well, security is a matter of opinion, of course. States aren't immune from economic downturns! We've been doing more with less for years...first when the economy was so good, we were losing people to the MUCH HIGHER PAYING private sector, but then the next budget cycle came and we lost positions, so we weren't able to fill them. We were finally able to fill two this past month, but it took a looooong time to get them filled because the top four candidates for each position turned the job down...didn't pay enough! And of course, when you work for a regulatory industry, the people pay for our 'security' with less protection and we have to make up the difference by going after uncooperative violators and the angry public. It's not so safe for us to be public sector employees either, since budget cuts also affect our personal safety, too.

Health care...my SIL works for a quasi-(federal)government agency, but she's got only health insurance for her, can't afford the premiums to cover my brother or the kids. So SHE goes to her doc for prescrips for them. I guess she's lucky to have a doctor who will do that, but she's skimping on her own health care too.

My eldest DD is not covered by any insurance, and she's the one who suffers from bad allergies & asthma. She goes to the student health clinic, but it is just a band aid place. My son's DD has no insurance and ended up going to the ER when she got so sick she had missed a week (unpaid) from work to find she had a raging ear infection and early bronchitis. She'll probably ask the hospital for a charity exemption and then get a loan from her grandparents to pay the rest.

And to this day, I have health issues that are a result of me not having HC coverage as a child/young adult, that because of that, my parents didn't get me the medical care I needed back then. Only a couple of years ago did DH and I manage to pay off old medical bills from more than 20 years ago. (Do not EVER let a bill go to collections when you're 24!)

A quote I heard when I was young(er!) that has always stuck with me.

"A nation's greatness is measured by how it treats its weakest members." ~ Mahatma Ghandi

We now have catastrophic coverage only. $500 a month.
The steps our nation are taking toward Health Care Reform aren't perfect, but they are steps. Email your elected officials and make sure they know how you feel.

Here is a link that might be useful: Contact Elected Officials

Deedee, I love that quote. I think this one (which I also hold dear) is highly applicable to this topic as well:

"A nation that continues year after year to spend more money on military defense than on programs of social uplift is approaching spiritual death. -- Martin Luther King

Two former Canadians -- now U.S. citizens -- living without health insurance.

Health insurance companies in the U.S. are legalized Mafia -- in protection rackets. You pay and pay without ANY guarantee of treatment provided.

Go ahead and CHOOSE wisely -- you may have to choose between life -- and your home. Medicine OR food?

Go ahead and just see how much the top executives in the insurance companies are paid. AND then check the boards of directors too -- and see how many of them are on many major corporations -- and simply shift amongst themselves -- and therefore this tight-knit club simply "rules the whole school"

Yes -- Canadian health care does have its problems -- as does EVERY single health care system in the world. But in the cases of our far-reaching and extended families and friends -- I can honestly say that the system has worked very well indeed.

The main problems? Fraud and Waste. As in every system of ANY type in the world. The Canadian system was built years and years ago -- and our population has grown and changed -- and of course -- aged. Again -- the same issues as in many systems throughout the world.

Frustrated and scared here.

Jan

Awm03, I read the article you linked & I understand what youÂre saying. I can see how that could cause bitterness. Maybe tax reform would have to go hand-in-hand with HC changes IÂm sure we pay higher taxes here in Canada (in varies from Province to Province) to fund such things as our HC system  however, when I read about people paying $500/mn for catastrophic coverage only, or premiums of $1,200, $1,700, $2,500 per month I would think a (small?) tax increase with guaranteed coverage would be a relief for many people..?? At least you wouldnÂt have to worry about dramatic premium increases or your coverage being denied. Just to be free of the personal stress of dealing with the insurance companies, HMOÂs, co-pays, etc., etc.! I donÂt know I certainly donÂt have a complete understanding of all the details of either system. I do know that as much as I love to visit and vacation in your beautiful country  I wouldnÂt trade health care systems for the world!

Agreed aj!

It is ridiculous that health care in this country is directly linked to employment! It is ridiculous that those of us who do have insurance have to select the level of insurance we want, as if we could predict our future needs! It is ridiculous that we have to make these choices every year! And it is ridiculous and inhumane not to include everyone.

As it is, the uninsured cost more money in the long run because the get sicker and require more expensive treatment. And we all pay for that with higher prices in premiums and hospital charges.

AWM, Max was cut off our insurance April 15th. He has a preexisting condition as well. (Neurocardiogenic syncope). I contacted our agent and demanded she look inside that 5200 page document because I know part of the reform includes allowing children to be on their parents insurance policy until age 26. I just didn't know when it kicked in.

The wording of the law is muddy. This particular aspect of the reform bill takes place "six months after the reform bill passed (that would be September 25th) OR when the policy renews. In our case, renewal came first, on April 15th. Max was allowed to stay on our insurance without interruption.

Get on the telephone to your agent/rep today. The new law says adult children can remain on their parents insurance regardless if they are out of school. married, etc. until the age of 26. While it hasn't been 6 months since the bill passed, YOUR policy is renewing so your son should qualify to stay on your policy. Force the issue. It worked for us.

As part of the new reform, there will be (cheaper) insurance available for people with preexisting conditions who have no insurance. Yes, it is through the government. That said, private insurance companies may no longer place caps or kick people off when they get sick. They even have to insure people with preexisting conditions but they can charge an arm and a leg. This will make the government healthcare option better, I think. It will operate as a non-profit. This aspect of reform will take awhile to kick in but if you can get him back on your plan, you will have time to breathe.

Don't be surprised if your agent pleads dumb. Just push them to investigate and call you back. Max is covered because I insisted they check into the new law as it pertains to this and get back to me. It took 3 days but I won. Woo!

Neurocardiogenic syncope -- ooh, sorry to hear your fine son has to deal with that. It sounds debilitating. Our son has ADD & keratoconus (needs $3000 contact lenses, perhaps corneal transplants down the road).

DH just spoke to the benefits people, & evidently w/ the new law, our son's benefits CAN be extended, but he can't start coverage until Jan. 1. So we just have to shop for temporary coverage, something that will cover his Ritalin expenses. We rushed him in last week to update his lenses - phew!

Previously, private employer-provided health benefits were a whole 'nother animal that was exempt from all kinds of state regulations, including COBRA laws, because these plans fell under the protection of ERISA:

"The Employee Retirement Income Security Act (ERISA) is a federal law regulating the administration of private employer-sponsored benefits including health benefits (i.e., health insurance offered by an employer). In general, since the federal government has exercised its authority to preempt state regulation of the administration of private employer-sponsored health plans, states are blocked from enforcing laws interfering with ERISA.
As many states pursue health care reform experiments, ERISA preemption becomes relevant as a potential limit on the scope and type of reforms states are able to enact. The dominant trend in ERISA litigation has been to preempt state legislation and litigation interfering with the administration of private employer sponsored health plans, making large-scale state health care reform initiatives difficult. "

So the fact that our son now can get COBRA coverage through DH's plan is a huge change. Nothing was said about costs, though, so we remain cautiously optimistic.

BTW, if anybody else is dealing with keratoconus, Boston Foundation for Sight's scleral lenses cost an arm & a leg, & you'll have to battle your insurance company to get them, but they are worth every penny & minute of fighting for.

I am so sorry to hear about your son's vision issues. What a frightening situation!

Our GD has had eyes issues since she went blind at 3 years old because of cataracts. It's been one thing after another with her vision. I swear she has million dollar plus eyes. She, too has had those expensive lens replacement contacts along with the thickest available coke bottle glasses for night. Last year she had surgery for a detached retina. It seems she has every complication possible ("It's just a fluke"). She is 16 now and her last surgery was for a dislocated lens, three weeks ago. With each surgery, her vision gets worse. We're hoping to call it quits at 7.

Max's situation is nothing compared to vision issues... The biggest issue is with people who don't understand his condition call an ambulance instead of laying him flat. $$$$$$.

"I don't have to worry that a medical illness will bankrupt my family"

rilie, that's pretty much it in a nutshell. We are a world laughingstock.

And yesterday's Senate vote is just another punch line for the world's amusement. I can't believe how this country has changed.

"...I understand what youÂre saying. I can see how that could cause bitterness."

I'm not bitter, more skeptical, I guess. The post office, Amtrak, the IRS, the Army Corps of Engineers & the NOLA levees... You've heard the arguments by now, I'm sure. Billions of dollars worth of mediocrity & red tape, somehow always "underfunded."

Also frustrated because DH wants to retire soon after 32 years of long stressful hours & hard work, but that may be postponed.

golddust, your GD's vision problems are heartbreaking. Such serious issues at such a young age.

Awn03 - I just quickly wanted to say that I certainly didn't mean YOU our your post sounded bitter in any way... I hope you understood that. :)

I think sometimes writing thoughts & opinions out as opposed to speaking... things get 'lost in translation'. lol

Oh good, rilie! I feared that I came off as bitter. (I'm easy going actually).

awm, if gov'ts incompetence makes you want to drown it in a bathtub, Grover Norquist's work is finished.

Our gov't needs to recover from years of deliberate mismanagement.

It's the nature of governments & the kind of people who seek power, I'm afraid. Read Robert Caro's The Power Broker for insight into the operations of NY State & City & magnify it on a federal scale.

I can send a letter across country for 44 cents. How much would UPS or FedEx charge me for that?

Thanks, Awn03. Eye issues are terrible and it sounds like your son's condition is very serious. How is his vision now? Can he drive? Is this condition hereditary? My grand daughter wants to drive so badly. We won't know if she will be able to drive for another four months (to her, four months seems like forever).

We've witnessed Eileen and roselvr go through a terrible time with health and health care. I agree with the notion that USA is the laughingstock of the world right now. To think, we are still so arrogant.

What truly puzzles me is how in the world anyone who is accepting Medicare benefits can possibly stand up and say, with a straight face, that the government should stay out of health care.

Corollary: I seem to have missed the news coverage on the many, many conservative/Tea Party members who presumably are now sending back their Social Security checks to make the point that government is overspending wildly on people who don't necessarily need the money.

Ann

My friend's son receives government health care. (Remember Lord Daniel?) For $236. per month, he gets state of the art treatment and medications. Me? For $1200 a month, not counting my deductibles, my policy relegates me to generics only. Since the law passed that allows drug companies to keep new medications out of the generic market for 10 years, I am now limited to medical technology that is a decade old.

I'd give my eye teeth to have Daniel's insurance plan and I'd be willing to spend good money to have it.

Profit making companies who have the ability to meet behind closed doors to determine prices takes out the spirit of free enterprise. The only way to introduce competition is to expand medicare as a non profit option, available to all.

I am not opposed to paying for medical insurance. I just don't want to buy jets and caviar for the rip-off execs who are pilfering money at the expense of everyone's health. They use my premium profits to hire people whose sole job is to try to kick me off the second I no longer make them a profit. Health insurance is an oxymoron in the USA.

I am guilty of buying medication from Canada. It's much cheaper than using my insurance to "help" buy it in the USA. Other than my mortgage payment, my health insurance gets most of my money.

I dare the tea baggers (and my sister) puts their money where their mouth is and send their social security and medicare benefits back. I'd love to see that news bleep. What happened to humanity in the USA?

I was just thinking of asking how Lord D. was doing. I'm glad to hear he's getting treatment he needs. Reading this thread, I am struck that your family (including friends) sure does have their share of medical travails, golddust ((((you and yours)))

(There was a lot more I wrote but my new computer saw fit to highlight it and erase it suddenly. I HATE it when it does that!)

Fly, thanks for asking about Daniel. I have the absolute pleasure of reporting that he is doing sensational! I haven't talked to him yet but he just returned from a giant medical conference on Behcets in Orlando, Florida. He went by himself!!!

He is almost the picture of health, weighing in at a trim but steady 142 pounds. He had his bag removed in February so he has nothing but scars to remind him of his ordeal. He is taking regular medication, eating well and even works a little with his dad. (The Doctors don't want him working at all but he does.) His tummy looks like a giant scar tissue but he has healed. Woo!

As far as our own medical travails, we feel extremely blessed. Things could be so much worse. Many families deal with so much more.

DH said the other day, "We'll pay for it in our taxes or we'll pay in the ER" which is true. I don't mind at all paying taxes to cover more american's health care costs...but I do mind paying taxes to fund thee deaths of thousands of our youth in wars we shouldn't be fighting.

My biggest issue with this debacle is that it's not health care reform (call it that all you want but it's not!) It's just a screw around issue with insurance companies that obviously isn't working terribly well for most. I like parts of it, but the ability to hop prices up the day after the bill passed should have been addressed if our congress wouldn't have tried to rush this through. Goldie shouldn't have to "win"...it should have been a clear mandate to be enforced immediately. This staggered crap just means that when we have a new administration, and we will, it will be available for debate and for new laws to remove all that this bill might have done good.

Health care reform though was desperately needed. At every hospital we visited we saw this need. Families that weren't devistated by costs so much as they were by lack of a good system of diagnosis. No standard of care from state to state, no central records keeping....transfering records from hospital to hospital is a nightmare! And that pile of lost paperwork (they forgot to include an early bloodwork result in our package and that carried over from hospital to hospital because we were copying the original package with the forgotten piece). that one little slip was the answer to our son's pain taken within the first month of his life, he suffered for three years because the other doctors didn't see that one piece. And this is not the first case of a medical clue gone astray.

So many things aren't covered, so many issues of health care and drug costs that were swept under the table....terrible stuff.

And as to the life expectancy issue.....life style does come into play there. I know that at all of the hospitals we went to for rare diseases, the beds were full of children from other countries. Most paid cash to get to America for the quality care of someone who actually specialized in their condition. At Johns Hopkins half or more (it varied) of the children in the program we were in were from other countries, including Canada, Japan, Quatar, Mexico, England and Germany. They paid cash to get in because it was the best program in the world. America is tops in many many areas of the medical world, but getting the kids or adults who need the special care to the specialist facility is an exercise in futility most often.

My frustration shows :) I know that many know what real medical trials are....and I can easily say I'd probably view the insurance reform differently if I hadn't experienced what we did. But my experiences led me to see that this is all a silly joke without addressing the real issues that needed to be addressed.

I don't have many pts. left whose copays didn't go up by at least $5. Many are $50. Multiply that by 3X/wk for PT - I feel so bad for them.

We've been w/o coverage for a # of yrs. now and I feel overall made out better w/ the Dr.s because we were able to get 'direct or reduced' rates since they didn't have to deal w/ an insurance co. I even bartered my medical office experience to help pay down the pediatric bill for DD's birth. It's been 1 1/2yrs and I'm still paying. They have been so good w/ us as long as we make an effort whether it be $5 a month or $100 a month.

Dealing w/ the Ins. companies on a daily basis makes me want to go bullistic - there is so much waste!

A co-worker of mine married a Frenchman. The company he worked here folded and she found out that she was pregnant w/ their first child. I asked her if they would consider moving back to France for the delivery and asked what the healthcare system was like over there. She said no way - it takes forever to get an appointment.