posted
I think one issue largely ignored in the health care debate is the negative effect that a employer-based system has on innovation in general in our country. Employer-based health care places a double-whammy on entrepreneurs who want to go out on their own, or operate independently. For one thing, it would mean losing the health care benefits of being a part of a larger company, and needing to provide your own health care. For another thing, it typically means going through the expense of setting up a health care plan for any employees you may want to hire. End result: people are less likely to develop new enterprises, and more likely to stick with established organizations. I think this is one of the hidden benefits of universal health care - if we can detach health care from employment, it will promote innovation as a whole across the economy. Small business owners will be freed of a significant cost that could prevent them from getting of the ground to start out with.
Posts: 8120 | Registered: Jul 2000
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posted
On the preexisting coverage, insurances making things difficult issue, I have had the same insurance for almost 2 years now. Right now, they are being throwing a fit about paying for my drs bill because it is a "preexisting condition". My condition- pregnancy. Apparantly, I am now an elephant.
Posts: 1001 | Registered: Mar 2006
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posted
I noticed something back on page one that went unchallenged, and I think it needs to be addressed:
quote:Originally posted by Jhai: While the US spends more on health care than other nations, it seems that most of this extra cost is due to our poor general health (lack of exercise & diet). The US health care system is more productive than nationalized systems in getting us well - that is, better output of health given the cost.
quote:Now an article published in the Journal of the American Medical Association casts that assumption into doubt. Comparing the health of middle aged Americans and their counterparts in England, the authors make the startling discovery that across the board, the Americans are less healthy. It's a sad fact that minorities have worse health outcomes than non-hispanic whites, so the study only looks at that population group, but despite this the English still come out on top.
Worse yet, these findings held true regardless of socioeconomic status or education level. Poorer English patients might be expected to have better health than their US counterparts due to their National Health Service, but well-off Americans only fared as well as working class English. The differences can't easily be explained away by risk factors either, which are broadly similar between the two nations.
I must admit I'm a little fazed by this study myself. Not so much at the lower end of the socioeconomic ladder, where the NHS would be expected to help out, but the findings that the richest portions of society in the US are worse off despite the almost limitless medical technology and facilities at their disposal is quite shocking.
Added: Also, my employer subsidizes gym memberships as a taxable benefit for up to CDN$400 annually, which basically covers my YMCA membership. I've noticed this kind of thing in my industry before (I'm a fairly recent chemical engineering graduate, but have a variety of internship experience), and think it's a very positive way to promote employee health.
Posts: 10886 | Registered: Feb 2000
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I'm confused. Doesn't your second quote back up the first one?
pH -
Yeah, that's true, but you can't ignore the other benefits, they are tied to cost. If it's cheaper in the end, the people have less to complain about.
Posts: 21898 | Registered: Nov 2004
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posted
I thought that you couldn't be denied medical coverage under an employers benefits for pre-existing conditions (because of HIPPA laws). I know that there are usually waiting periods before certain coverages begin, but I've never heard of anyone being outright denied.
quote: There needs to be a cap on punitive damages. People makes mistakes. I know those mistakes hurt real people, but there's a ripple effect. A doctor in a difficult surgery does the best he can, but the patient still comes out a quadriplegic. In response, the family sues the doctor for millions of dollars. His insurnace, and the hospital insurance pay for the suit, but his premium is jacked up so high that he can no longer afford to practice medicine. The end result is that his collective knowledge is lost from the medical profession.
Spoken like someone who's never been involved in a serious medical malpractice situation. A cap would do more damage than good. A better solution (which is gaining ground in many states) is to have patients sign an agreement indicating that in the event of something happening, a mediator (paid for by the state, I believe) will attempt to reach a reconciliation prior to any lawyers being involved. This allows both parties to reach an equitable arrangement without bogging down courts.
Posts: 1480 | Registered: Dec 2004
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posted
I used to work for people that did this sort of thing for a living.
You can still be awarded the money necessary to pay for any damages done to you, separate from punitive damage. Punitive damage, which includes pain and suffering, shouldn't be millions upon millions of dollars. I've seen some pretty ridiculous cases over the years.
Posts: 21898 | Registered: Nov 2004
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quote:Punitive damage, which includes pain and suffering, shouldn't be millions upon millions of dollars.
I disagree. Punitive damages should absolutely be whatever the court feels like awarding, especially in situations where gross negligence or incompetence is involved. I still prefer the mediator method of resolving these kinds of issues, but in situations where it cannot be settled amicably, then it's up the courts.
quote:I used to work for people that did this sort of thing for a living.
Trust me when I tell you that things look entirely different when you're actually involved.
Posts: 1480 | Registered: Dec 2004
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quote:Originally posted by Lyrhawn: Doesn't your second quote back up the first one?
Only if the "starting" level of health is so staggeringly low that there is actually some proportionality between the differences in health outcomes and expenditures. You would expect such a difference in pre-treatment health to show up in the risk factors, but my snippet above notes that they're "broadly similar." As an example, say the risk of an American having a heart attack is comparable to that of a Brit having one (I don't know if this is the case, but it's the sort of thing I would expect to be covered by "broadly similar" risk factors); what the study suggests in such a context would be that after treatment, American heart attack victims have worse health outcomes despite the fact that more money is being spent on them, per capita, than on the Brits. Since they had the same risk of having a heart attack in the first place, this can't simply be attributed to the American having been less healthy to start with.
Obviously that's a completely hypothetical example; I'm just using it to help make my point clear. The basic sentiment I'm suggesting has gone unchallenged is that the vast sums of money spent in the U.S. health care system buy Americans better care -- that is, that the average may be low, but the peaks are high. The study described in my snippet above suggests that this is not the case.
In terms of expenditures, here's some OECD data to chew on. Check out the linked Excel spreadsheet, there's lots of useful and interesting data there. I've compiled two datasets from 2004 here, health care expenditures as a % of GDP and health care expenditures per capita, in USD:
code:
2004 % GDP Per Capita Australia 9.6 3120 Austria 9.6 3124 Canada 9.9 3165 e Czech Republic 7.3 1361 e Denmark 8.9 2881 e Finland 7.5 2235 France 10.5 3159 e Germany 10.6 3043 Greece 10 2162 e Hungary 8 1276 Iceland 10.2 3331 e Ireland 7.1 2596 Italy 8.7 2467 Korea 5.6 1149 Luxembourg 8 5089 e Mexico 6.5 662 Netherlands 9.2 3041 e New Zealand 8.4 2083 Norway 9.7 3966 Poland 6.5 805 Portugal 10.1 1824 e Spain 8.1 2094 e Sweden 9.1 2825 e Switzerland 11.6 4077 e Turkey 7.7 580 United Kingdom 8.1 2508 d United States 15.3 6102
e: Estimate d: Differences in methodology
The extent of the "differences in methodology" isn't clear, though, so we have to take the U.K. figures with a grain of salt. However, the U.S. tops the list in both per capita and % GDP expenditures. Again from my first link above:
quote:The US currently:
Ranks only 23/30 in the most recent OECD assessment for life expectancy
Ranks only 24/30 in the OECD survey for infant mortality, only beating those bastions of medical care, Poland, Mexico, Hungary, Turkey and the Slovak Republic. Sweden delivers premature babies at around the same rate as the US, but their mortality rate is almost half
Again comes 24/30 when it comes to disease adjusted life expectancy (years lived free of disease).
Historically, this sort of thing has been addressed by noting the high number of uninsured Americans, or by suggesting (as Jhai did) that Americans are less healthy to start with. But the study in my first link controlled for these things, and still found that even wealthy Americans fared no better than working-class British.
This suggests strongly, to me at least, that something is wrong with your system.
However, all of this is not to say that our system here in Canada is without problems, nor that the U.K. system is the embodiment of perfection.
Posts: 10886 | Registered: Feb 2000
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quote:Americans spend $5,267 per capita on health care every year, almost two and half times the industrialized world's median of $2,193; the extra spending comes to hundreds of billions of dollars a year. What does that extra spending buy us? Americans have fewer doctors per capita than most Western countries. We go to the doctor less than people in other Western countries. We get admitted to the hospital less frequently than people in other Western countries. We are less satisfied with our health care than our counterparts in other countries. American life expectancy is lower than the Western average. Childhood-immunization rates in the United States are lower than average. Infant-mortality rates are in the nineteenth percentile of industrialized nations. Doctors here perform more high-end medical procedures, such as coronary angioplasties, than in other countries, but most of the wealthier Western countries have more CT scanners than the United States does, and Switzerland, Japan, Austria, and Finland all have more MRI machines per capita. Nor is our system more efficient. The United States spends more than a thousand dollars per capita per year—or close to four hundred billion dollars—on health-care-related paperwork and administration, whereas Canada, for example, spends only about three hundred dollars per capita. And, of course, every other country in the industrialized world insures all its citizens; despite those extra hundreds of billions of dollars we spend each year, we leave forty-five million people without any insurance. A country that displays an almost ruthless commitment to efficiency and performance in every aspect of its economy—a country that switched to Japanese cars the moment they were more reliable, and to Chinese T-shirts the moment they were five cents cheaper—has loyally stuck with a health-care system that leaves its citizenry pulling out their teeth with pliers.
Moral hazards and profit motives. I could open up a diabetic preventative care center in Boston, to coach and treat people diagnosed with diabetes so that they could manage their condition and not end up with costly, reactive surgeries.
Of course, insurance would not pay for this sort of preventative care, so I'd simply go out of business. But if I got into the business of lopping off the limbs of all the untreated diabetics in America that we consequently have, I'd be making money hand over foot.
Our system has bad prioritization that leaves us stuck playing catch-up with poorer nations. We have an infant mortality rate higher than some developing nations. It's no good.
Posts: 15421 | Registered: Aug 2005
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quote:Punitive damage, which includes pain and suffering, shouldn't be millions upon millions of dollars.
I disagree. Punitive damages should absolutely be whatever the court feels like awarding, especially in situations where gross negligence or incompetence is involved. I still prefer the mediator method of resolving these kinds of issues, but in situations where it cannot be settled amicably, then it's up the courts.
quote:I used to work for people that did this sort of thing for a living.
Trust me when I tell you that things look entirely different when you're actually involved.
People shouldn't get rich off accidents. I've seen some RIDICULOUS cases where people won millions and millions of dollars, over and above what they got for medical care, etc, stuff they would need to live their life with the impairment.
If there's negligence or incompetence, I have less of a problem with it, but if it was literally an accident, or if it just didn't go as planned, and nothing was done wrong by the doctor and the results still weren't as planned, those aren't a reason to sue for millions.
It doesn't just go for malpractice suits, which are always the largest. At least one dog bite case would come in a week. Some kid, or adult, would get bit by a dog, and regardless of the damage done, they'd sue. Now if the kid has some major damage of some sort, alright, compensation is due. But even if the bite just broke the skin a little bit, parents still sue for forty or fifty grand, and usually they get it.
I got bit by a dog when I was about 12 and I was on my paper route. It broke the skin, I went to the hospital, I got my tetanus updated, and I went home. I found out a couple years later at my job that I probably could have gotten fifteen or twenty grand for suing the guy's homeowners insurance. Does anyone really think that's fair?
Posts: 21898 | Registered: Nov 2004
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quote:Infant-mortality rates are in the nineteenth percentile of industrialized nations.
This means absolutely nothing. Every industrialized country has a different way of counting infant mortality. In some of those countries, a stillborn baby that is less than 38 weeks gestation is counted as a miscarriage. In other countries, it's not an infant death unless the infant has taken a certain amount of breaths. This is a misleading statistic that is thrown around and it drives me crazy.
Additionally, the US has a huge number of women who use fertility treatments and the number of pregnancy complications among them is high. This has nothing to do with poor health care or insurance. Also, maternal age is rising and I'm sure that is a factor, though I can't speculate as to the degree.
I also want to add that every single preemie born in this country is covered by Medicaid. They'll even take over if your insurance tops out, which it frequently does with micropreemies. We have the most amazing neonatal technological advances and every year it gets better and better. All of the neonatologists and neonatal nurses I've ever spoken to are confident that we're very close to having 20-weekers survive in the near future (we're at about 22-weekers now).
quote:Trust me when I tell you that things look entirely different when you're actually involved.
I have been involved and they don't look different to me at all.
75% of all OB/Gyns are sued. 75%! I very much doubt that 3/4ths of all OB/Gyns are guilty of gross negligence or malpractice. Even an unsuccessful lawsuit can raise insurance premiums and those costs are passed onto the patients. Not only that, but lawsuits have changed the way that medicine is practiced. Due to a wave of lawsuits in the late 80s or early 90s (I always forget), medical students are now taught, "When in doubt, do a C-Section." The suits alleged that doctors waited too long to do Sections, thereby causing complications and harm to the babies.
Lastly, I also think that requiring employers to provide insurance hurts both the employers and the employees. Dagonee summed it up beautifully in another thread, but I'm just too tired to look it up.
Posts: 3037 | Registered: Jan 2002
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quote:Originally posted by Samprimary: Of course, insurance would not pay for this sort of preventative care, so I'd simply go out of business. But if I got into the business of lopping off the limbs of all the untreated diabetics in America that we consequently have, I'd be making money hand over foot.
Don't hear a lot of free market economists admitting the "Invisible Hand" may be bearing a bone saw, do you... Posts: 3826 | Registered: May 2005
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quote:This suggests strongly, to me at least, that something is wrong with your system.
I wonder what the other possible explanations could be. The one that jumps out at me is lifestyle differences.
Posts: 5462 | Registered: Apr 2005
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quote:This suggests strongly, to me at least, that something is wrong with your system.
I wonder what the other possible explanations could be. The one that jumps out at me is lifestyle differences.
Again, these were controlled for. As I've already noted, medically significant lifestyle differences would show up in risk factors.
Posts: 10886 | Registered: Feb 2000
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posted
That's not entirely true. From the AMA summary:
quote:This conclusion is generally robust to control for a standard set of behavioral risk factors, including smoking, overweight, obesity, and alcohol drinking...
Those are great, but I was specifically thinking about stress as a risk factor, which, as far as I can see wasn't controlled for. I'm not sure there is a reliable way to control for it. I read something years ago correlating workweek length and lifespan in first world nations, and it's been percolating ever since. I don't think that that is a primary or even secondary cause of our general poor health, but I wonder what effect our being a 'high octane' society does have.
Are Americans significantly more stressed than, say, Brits or Canadians? I have no idea. But I think it's possible.
The other risk factor that I didn't see controlled for is diet*. I think, no, I know, that Americans eat a lot more junk food and fast food than almost every other nation. That's not something that will be fully represented by the risk factor assessment, because (I'd guess) a substantial percentage of those who eat fast food regularly are not obese.
*Obesity was controlled for, but I'm mainly concerned about the skinny people who aren't as healthy as they appear. I'd guess America has more of that demo than anywhere else.
Posts: 5462 | Registered: Apr 2005
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posted
I'm not sure you're considering that the British diet consists primarily of fish and chips. And beer.
I'm extremely skeptical that differences of this magnitude can be explained away by "lifestyle differences." We're talking almost 50% more in expenditures as a percentage of GDP than the next largest spender. Surely Americans aren't 50% less healthy in ways that can't be controlled for.
Posts: 10886 | Registered: Feb 2000
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posted
I am considering that. I don't think we fully realize what the various food additives in processed foods do to our bodies yet.
quote:I'm extremely skeptical that differences of this magnitude can be explained away by "lifestyle differences." We're talking almost 50% more in expenditures as a percentage of GDP than the next largest spender. Surely Americans aren't 50% less healthy in ways that can't be controlled for.
As well you should be. I didn't say that the entire difference could be explained by the other variables I brought up, because I don't think it could be. But I wonder if there aren't serious contributing factors beyond America's shoddy healthcare system; factors that were outside the bounds of those studies. And I wonder what percentage, if any, those outside factors account for.
I'm just following the direction of the thread title and ruminating.
Posts: 5462 | Registered: Apr 2005
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posted
Ah, okay. I took your phrasing to imply that you were looking for alternative explanations to use in place of "something is wrong with the healthcare system," rather than in addition to it.
Posts: 10886 | Registered: Feb 2000
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posted
Oh. I didn't even touch on the healthcare system because I take it as a given that it's screwed up beyond repair. So, yeah, in addition to that.
Posts: 5462 | Registered: Apr 2005
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posted
El JT is on the right track. Fixing America's healthcare system would only do so much if other contributing factors are not fully considered. On the contrary, considering those factors would probably yield a better healthcare system with more emphasis and spending in smarter areas.
A tradeoff with national healthcare that I think people fail to consider is the varying amounts of freedom they would lose, depending on the nature of the system.
Economic freedom is one. Also, you may have the government influcing everything from your exercise habits to the foods you eat. By placing the burden of your health on society, you become subject to society's rules regarding your health.
It does need to be fixed, but it needs to be considered in far greater depth than I usually see it done. Heck, I've spent about 8 hours in the last few days researching a computer I'm building, trying to get the best gaming system for under $1000. Most people I discuss healthcare with haven't done much beyond read a Time magazine article, and this is for a multi-billion dollar system that would effect 1/3 of a million people.
Posts: 1412 | Registered: Oct 2005
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quote:Originally posted by BaoQingTian: A tradeoff with national healthcare that I think people fail to consider is the varying amounts of freedom they would lose, depending on the nature of the system.
Economic freedom is one. Also, you may have the government influcing everything from your exercise habits to the foods you eat. By placing the burden of your health on society, you become subject to society's rules regarding your health.
I don't automatically agree, mostly because I don't think national healthcare will ever been the ONLY choice. There will always be private companies that offer a different kind of, or better service, with different rules, and you'll always have the choice to use them instead.
As far as exercise habits and foods you eat, you'll always have personal choice when it comes to those. If you make a poor choice and have to pay for it, monetarily or when you die from making those poor choices, that's your choice. The amount of exercise and good food needed to be healthy is different for everyone, so there'll never be more than federal guidelines for how much you need. We're not Soviet Russia.
Posts: 21898 | Registered: Nov 2004
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quote:I didn't say that the entire difference could be explained by the other variables I brought up, because I don't think it could be. But I wonder if there aren't serious contributing factors beyond America's shoddy healthcare system; factors that were outside the bounds of those studies.
Well, if you cut out what health issues are the product of a lack of preventative care, you get left with stuff like obesity and smoking and other clear and macro health issues.
We got examples of nations with greater obesity than the U.S. -- we also have a couple of very westernized, postindustrial gems with health habits which border on being worse than the United States -- the UK and Australia.
I'll go and see what comparable and contrastable data exists, see if I can't evidence anything for or against your claim.
Posts: 15421 | Registered: Aug 2005
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posted
Are you saying that in your plan people would have an option whether or not to 'pay into' national healthcare? Because if not, then you'll pay for national healthcare as well as private if you want that.
In regards to the second paragraph, there is a current sin tax on cigarettes. We're still free to use them, however, there is ~50% tax against them. There is data that shows that this tax is responsible for decreasing smoking.
Remember the fast-food tax thread awhile back? I don't think it's too far of a leap to think of the government levying extra taxes against junk food/fast food in order to partially recoup associated healthcare costs. In the case of cigarettes, the tax collected offsets something like 10% of the associated healthcare costs. It would make sense to either drastically raise prices on cigarettes to make the offset closer to tax collected.
If the price is increased to make the products reflect their true cost to healthcare, then they'd probably be unaffordable. And in reality, that's about as bad as making it illegal.
Posts: 1412 | Registered: Oct 2005
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posted
You already pay into national healthcare and for private, ever see the medicare tax on your paystub?
You still have the choice to use them. Sin taxes aren't new, and I don't think they are unfair. Smoking is bad for you, and it's bad for people around you, and the financial and physical well being of the nation. You have the choice to do it if you want, but if you do, you have to pay a lot for it, and you suffer the ill health consequences. That's exactly what I said.
Posts: 21898 | Registered: Nov 2004
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posted
The comparable data shows minimal comparisons to the American system's particular weaknesses. Australia has an issue with getting modern healthcare over amazingly rural areas, but they've got nothing compared to the non-universalized healthcare woes of this country.
There's an interesting thing that actually happened to me after I made this thread, and I didn't really want to bring it up before now. I was driving home from out of town when I was struck with chest pains which were so terrible that I could not breathe right or drive, and I ended up managing to pull up beside a policeman and ask for a ride to the hospital.
Once there, they ran a battery of tests on me, including a "less than stellar" EKG, followed by chest X-ray and blood checks and the whole gamut, to rule out any immediate health concerns. They found a heavy dose of enzymes in my blood corresponding to heart tissue damage, but eventually ruled out any heart issues (the first EKG had been an echo misprint, or something) -- at least I managed to worry them for a while!
After spending a night in excruciating pain (they got a urine sample to make sure that I wasn't a drug addict on a hideous crash) I ended up transferred to my PCP, who found out on subsequent days in subsequent visits that I had 1. GERD, 2. Ridiculously bad GERD, and 3. IBS. I'm now on an intense regimen to restore a malfunctioning, acid-burned stomach valve which I have apparently been blessed with via genetics.
Three perscriptions, three PCP visits, one ambulance trip, one night in the ER. Total cost for me was $85, all co-pay. I'm insured by my family. If I had not been insured by my family, I would not be insured. If I was not insured, then I would quite objectively have been financially wrecked by this, at least to the extent of having to quit college.
Colors my view of the subject matter a bit, methinks. Oh, by the way, GERD hurts so bad. So, so bad.
quote:Originally posted by BaoQingTian: A tradeoff with national healthcare that I think people fail to consider is the varying amounts of freedom they would lose, depending on the nature of the system.
Economic freedom is one. Also, you may have the government influcing everything from your exercise habits to the foods you eat. By placing the burden of your health on society, you become subject to society's rules regarding your health.
posted
I'm not entirely convinced that's a bad thing, to varying degrees.
It's a curious thing to defend the right of the individual to put a harmful burden on society, but to attack any measure of responsibility or burden that society might try and place back on the individual to balance the equation.
Making poor choices about your health often adds a negative burden to society, regardless of what insurance you have. Everyone still foots the bill.
Posts: 21898 | Registered: Nov 2004
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posted
"Making poor choices about your health often adds a negative burden to society, regardless of what insurance you have."
I'm with you, Lyr. One of my big complaints with accross the board national coverage is the number of people who treat their bodies terribly and then go to the doctor for a magic pill. People eating McDonald's twice a day. People staying stressed all the time. People getting antibiotics for the flu cause they don't want to take a day off. My 300 some odd pound friend who smokes, won't eat a vegetable, and won't exercise is going to end up with diabetes or a heart attack.
I like the idea of refunding the health departments to be primary care providers for the poor. They used to do it. I'm sure they could do it again. (They also offer free and low cost child vaccines, so our low vaccine numbers should have nothing to do with cost. It might still be related to the perceived autism link.)
I like the idea of coverage for people who have things go catastrophically wrong. I watched a show on TLC about a girl born with Treacher-Collins Plus who basically had no face. I have no problem with my tax dollars going to help build her one. I don't remember how many millions of dollars they said she had required by age two, but she was only about 5% done. No one can plan for that.
I remember it really hitting me on Little People, Big World when Matt mentioned he, his wife, and their son Zach couldn't get insurance because they're little. It's pre-existing, and all their surgeries have to be paid for out of pocket. That's not right.
Those are the kinds of things we as a nation should provide. Not so every hypochondriac with the sniffles can take a pill and ignore the stresses they put on their bodies.
Posts: 2283 | Registered: Dec 2003
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quote:Originally posted by Lyrhawn: I'm not entirely convinced that's a bad thing, to varying degrees.
It's a curious thing to defend the right of the individual to put a harmful burden on society, but to attack any measure of responsibility or burden that society might try and place back on the individual to balance the equation.
Making poor choices about your health often adds a negative burden to society, regardless of what insurance you have. Everyone still foots the bill.
I hope you don't think I'm defending the right of the individual to put the burden on society. That's not my point at all.
My point is simply that if we want a national healthcare program, we better be prepared to give up some freedoms for it. If you've considered it, and don't think it's a bad thing, fine. I just think a lot of people don't think about it that way.
I'm really not too keen on paying for someone's bypass surgery cause they loved those big macs, or paying for cancer treatments for those who smoked their whole lives. A lot of the same people that really push for national healthcare would cry bloody murder if you made their big mac cost $9.
Posts: 1412 | Registered: Oct 2005
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quote:Originally posted by mackillian: A lot of folks can't plan for chronic illnesses, either.
Or mental illnesses. I mean, I can see so much potential for abuse. The state-run mental facilities are bad enough already though. People get lost in the shuffle a lot. I'd be really, REALLY uncomfortable with the government having ANYTHING to do with my care.
posted
I think chronic illness also has the component of making sure to always, always, always be covered by health insurance. No gaps in coverage ever or you're screwed. At least with government insurance, that problem would be alleviated.
Posts: 14745 | Registered: Dec 1999
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posted
I wouldn't consider chronic illness to be a poor choice. It's one of those things that just happens. You can't plan for it, why should we as a society mind picking up the tab?
Posts: 2283 | Registered: Dec 2003
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