Health care in the U.S.


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Sovereign Court

Someone please explain it to me.

Liberty's Edge

What part of it?


Hama wrote:
Someone please explain it to me.

In general, health care in the United States is a contract between you and the hospital. Most people prefer to transfer the risk by purchasing health insurance.

Because health insurance is so expensive, many employers offer it as a perk (favorable tax treatment helps, too). There are a few government programs that provide private health insurance.

If you don't have an employer who buys health insurance for you, though, and you don't fit into one of the recognized demographics entitled to government insurance, your alternatives are basically to buy private health insurance or to pay for medical care out of pocket.

Sovereign Court

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That sounds horrible. Health insurance shouldn't be a perk. It should be a basic human right.


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Note that paying for it out of pocket is actually, totally, a higher cost than paying for it out of pocket while having insurance (insurance never covers everything).

The reason is because a lot of people who don't have insurance are also too poor to pay their medical bills in the first place, so it's more of an expense recovery on the ones who are not.

Also, I don't believe the system actually works that well. The U.S. actually has one of the lowest percentages of general practicioners of the post-industrial nations, while at the same time having one of the highest ratios of doctors. It also has shortages in pretty much every aspect of the medical profession. The result is often long wait times at hospitals for non-emergency patients.


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Oh, the system doesn't work at all well. But I thought the OP wanted a description, not an evaluation.


Lovely. More reason to stay in the socialist dominion of Canada. Despite the hellmouth being created in Alberta.

Sovereign Court

Or any other country with national health care.


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In the U.S., we have two systems.

If you have money, then you have access to the best health care in the world.

If you don't have money, your health plan is best summed up as 'Don't Get Sick.'


Hama wrote:
Or any other country with national health care.

Which is basically any country you'd want to visit, many you wouldn't, excluding the US.


Shouting Off Mountain wrote:
Lovely. More reason to stay in the socialist dominion of Canada. Despite the hellmouth being created in Alberta.

It's in Alberta?

I knew that ritual went awry... but I didn't know we missed the entire friggin' continent! The hellmouth was supposed to be created in Paris!


As others have mentioned, healthcare in the U.S. is fantastic -- as long as you're rich. Otherwise, not so much.

Which isn't terribly surprising, since the goal is to maximize profit, rather than the well-being of our citizens.


Check this out.
www.youtube.com/watch?v=qSjGouBmo0M

The fifth sentence is what gets me.


Internet meme I found amusing even though I've never seen Breaking Bad


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Grey Lensman wrote:

In the U.S., we have two systems.

If you have money, then you have access to the best health care in the world.

If you don't have money, your health plan is best summed up as 'Don't Get Sick.'

Of course, the most obvious answer to that is "Stop being poor!"


Hama wrote:
Someone please explain it to me.

1) Get 7-8 hours of sleep every night.

2) Eat healthy, nutritious food in moderation.
3) Avoid accidents.
4) Engage in exercise on a regular basis, 2-5 times a week.
5) Supplement any key nutrients that you can't get from your food.
6) Avoid toxins as much as possible, and detox your body if necessary.

That about covers it. Unfortunately many Americans don't follow this which means we need a lot of sickness care.

I certainly agree at least half of those above are human rights. For example, no one has the right to deprive you of a good night's rest.


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NPC Dave wrote:
Hama wrote:
Someone please explain it to me.

1) Get 7-8 hours of sleep every night.

2) Eat healthy, nutritious food in moderation.
3) Avoid accidents.
4) Engage in exercise on a regular basis, 2-5 times a week.
5) Supplement any key nutrients that you can't get from your food.
6) Avoid toxins as much as possible, and detox your body if necessary.

That about covers it. Unfortunately many Americans don't follow this which means we need a lot of sickness care.

I certainly agree at least half of those above are human rights. For example, no one has the right to deprive you of a good night's rest.

How about: No one has the right to dump toxins into your air or water supply. Or into your food.

Also: Don't be born with genetic problems.

And of course, no matter how hard you try and how well you live, there's always the chance you'll come down with something nasty anyway. It's smaller, but it's still there. In that, hope you die quickly so you don't run up too big a bill for your family to pay.

Liberty's Edge

6 people marked this as a favorite.
NPC Dave wrote:
Hama wrote:
Someone please explain it to me.

1) Get 7-8 hours of sleep every night.

2) Eat healthy, nutritious food in moderation.
3) Avoid accidents.
4) Engage in exercise on a regular basis, 2-5 times a week.
5) Supplement any key nutrients that you can't get from your food.
6) Avoid toxins as much as possible, and detox your body if necessary.

That about covers it. Unfortunately many Americans don't follow this which means we need a lot of sickness care.

I certainly agree at least half of those above are human rights. For example, no one has the right to deprive you of a good night's rest.

Yeah.

Everyone knows people only get sick because of their moral failures.


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Oh wow i should have avoided accidents, what was i thinking...


BigNorseWolf wrote:
Oh wow i should have avoided accidents, what was i thinking...

Or contagious diseases.


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NPC Dave wrote:


6) Avoid toxins as much as possible, and detox your body if necessary.

By the way, anyone who says this is a quack who should be in no regard giving medical advice.


Orfamay Quest wrote:
NPC Dave wrote:


6) Avoid toxins as much as possible, and detox your body if necessary.
By the way, anyone who says this is a quack who should be in no regard giving medical advice.

Well, avoiding toxins is good plan.

The "detox" thing does smell of quackery though.


Orfamay Quest wrote:
NPC Dave wrote:


6) Avoid toxins as much as possible, and detox your body if necessary.

By the way, anyone who says this is a quack who should be in no regard giving medical advice.

So lead, arsenic, mercury, don't avoid those things?

You really did made me laugh out loud there.

thejeff wrote:

Well, avoiding toxins is good plan.

The "detox" thing does smell of quackery though.

Chelation therapy would be one classic example used in mainstream medical practice.


Krensky wrote:
NPC Dave wrote:
Hama wrote:
Someone please explain it to me.

1) Get 7-8 hours of sleep every night.

2) Eat healthy, nutritious food in moderation.
3) Avoid accidents.
4) Engage in exercise on a regular basis, 2-5 times a week.
5) Supplement any key nutrients that you can't get from your food.
6) Avoid toxins as much as possible, and detox your body if necessary.

That about covers it. Unfortunately many Americans don't follow this which means we need a lot of sickness care.

I certainly agree at least half of those above are human rights. For example, no one has the right to deprive you of a good night's rest.

Yeah.

Everyone knows people only get sick because of their moral failures.

Strawman argument fallacy.


thejeff wrote:
NPC Dave wrote:
Hama wrote:
Someone please explain it to me.

1) Get 7-8 hours of sleep every night.

2) Eat healthy, nutritious food in moderation.
3) Avoid accidents.
4) Engage in exercise on a regular basis, 2-5 times a week.
5) Supplement any key nutrients that you can't get from your food.
6) Avoid toxins as much as possible, and detox your body if necessary.

That about covers it. Unfortunately many Americans don't follow this which means we need a lot of sickness care.

I certainly agree at least half of those above are human rights. For example, no one has the right to deprive you of a good night's rest.

How about: No one has the right to dump toxins into your air or water supply. Or into your food.

Amen to that.

Now of course, protecting that right is an incredibly complex problem. Anything can be contaminated by accident, and some chemicals may not be known to be toxic until after the fact. No one owns the oceans or the air in the atmosphere and we can't fully protect against toxic dumping into them.

So I can't come up with a good solution, but I certainly agree with the principle.

thejeff wrote:


Also: Don't be born with genetic problems.

While genetics plays a key role, I am being swayed by the science showing that the right balance of factors can balance out your gene behavior through gene activation.

That certainly can't and won't solve everyone's problems but if you do have genetic risk factors you can try and reduce those risk factors.

thejeff wrote:


And of course, no matter how hard you try and how well you live, there's always the chance you'll come down with something nasty anyway. It's smaller, but it's still there. In that, hope you die quickly so you don't run up too big a bill for your family to pay.

Right, you can take precautions and reduce your risks but life doesn't owe any of us anything.


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NPC Dave wrote:


Chelation therapy would be one classic example used in mainstream medical practice classic alternative health scams used by quacks.

From Quackwatch: "Chelation therapy, as discussed in this article, is a series of intravenous infusions containing disodium EDTA and various other substances. It is sometimes done by swallowing EDTA or other agents in pill form. Proponents claim that EDTA chelation therapy is effective against atherosclerosis and many other serious health problems. Its use is widespread because patients have been led to believe that it is a valid alternative to established medical interventions such as coronary bypass surgery. However, there is no scientific evidence that this is so. It is also used to treat nonexistent "lead poisoning," "mercury poisoning," and other alleged toxic states that practitioners diagnose with tests on blood, urine, and/or hair."

Unless you're in the habit of eating cinnabar-flavored cookies, there is no need to "detox your body" and anyone who tells you to do so is a quack.

Liberty's Edge

NPC Dave wrote:
Krensky wrote:


Yeah.

Everyone knows people only get sick because of their moral failures.

Strawman argument fallacy.

Pro tip: learn your fallacies before trying to use one as a thought terminating cliche.

You should have claimed appeal to ridicule since I was making a sarcastic comment to illuminate the ridiculous nature of your implication that people are always responsible for poor health or illness.

Of course that would be wrong as well because your position [u]is[/u] ridiculous.


NPC Dave wrote:
Hama wrote:
Someone please explain it to me.
I certainly agree at least half of those above are human rights. For example, no one has the right to deprive you of a good night's rest.

Except babies under about a year or so. And you can't explain to them how badly you need sleep either :)


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Back to the OP's question: It's long and complicated and rather depressing.

(1) As others have said, many (if not most) hospitals are for-profit institutions. There are fantastic non-profits out there (my kids go to Children's Hospital in Oakland, for example), but they're the exception, rather than the rule.
Hospitals compete for business, and spend outrageous sums to have the latest-n-greatest technology. As others have said, I *believe* that the U.S. still provides the best health care in the world, if you can afford it.

(2) Similarly, all insurance companies are for-profit institutions. They arrange with hospitals to get massive (80%+) discounts when they pay for your care.

(3) Hospitals are required by law to provide urgent care without regards to whether or not a patient can pay, vastly increasing their costs as people who cannot afford health insurance simply wait until they're sick enough to justify a trip to the emergency room, at which point they're most likely sick enough to require fairly expensive care. *BUT* hospitals are very, very good at tracking down your assets post-care. If you have any money and you go in for care, they're going to find it and squeeze it out of you. But if you go to the emergency room, day or night, in all likelihood the majority of the patients there are going to be people who cannot afford "regular" health care.

(4) Most employers provide health insurance as a perk. As of Obama's health mandate ("Obamacare"), employers of a certain size must provide health insurance, and insurers cannot deny coverage to people due to preexisting conditions. However, Obamacare did nothing to address the fundamental issue (health care is for-profit), so in general health care costs are likely to rise, rather than fall, as health insurance companies recoup their losses for insuring the previously-uninsurable. (The counter-argument being that now that every citizen is required to maintain health insurance, there will be far more insured healthy people as well, offsetting the insurance companies' costs. Leading me to repeat the question: WHY are we going through for-profit insurance companies to pay for health care again?)

====
So here's a real-life example.
My wife went to the hospital to have our second son. It was an absolutely complication-free delivery: a 45-minute labor, no drugs, no special care, so we just stood around in a room, she had a baby, and they made us stick around for 12 hours "just in case" anything untoward happened. (OK, the doctors, nurses, and I stood around. My wife was not standing.)

We then received a bill for $12,000, or $1,000 an hour for sitting around in a hospital room.

We then received the insurance payment information. The insurance company paid $1800 for the delivery. That was the "discount rate" the insurance company had negotiated with the hospital. I was not kidding about the "over 80%" discounts insurance companies get.

So:
(1) If we were middle class but uninsured, we would have paid $12,000.
(2) Because we had insurance, we "paid" $1800.
(3) If we were poor enough to not be able to afford the $12,000 (we wouldn't have had insurance, either, since it costs hundreds or thousands a month), we would have paid very little or nothing.

Make sense now? :-P
=====
P.S. "Decent" health insurance including medical, dental, and optometry tends to run around $600-$1000 per person per month. It depends vastly on where you live, your age, your family's health history, and so forth.

Liberty's Edge

Minor correction, most hospitals are non-profit or government owned (2903 and 1045 compared to 1025).

Not that you could tell with what administrators are paid and what they charge.


Krensky wrote:

Minor correction, most hospitals are non-profit or government owned (2903 and 1045 compared to 1025).

Not that you could tell with what administrators are paid and what they charge.

My numbers are similar, FWIW. But "non-profit" doesn't mean what a lot of people think it does.

A "non-profit" corporation is simply a corporation that doesn't pay money to the owners/stockholders. As an owner of one share of Apple (AAPL), I get a dividend every so often that represents my zillionth of a percent of Apple's profits. As an employee of Apple, I get a salary which represents the value of my work to the company in creating profits for the shareholders. These two are unrelated. My value as a janitor is much less than my value as VP of Corporate Affairs, so the salaries are appropriately different.

A hospital administrator does the same job regardless of whether it's a non-profit or for-profit hospital, and hence draws roughly the same salary. The difference is that money doesn't go back to the local church for owning/running St. Ethebert's Hospital, the way it goes back to me for owning Tenet Healthcare Systems (THC). (What a marvelous stock symbol).


NobodysHome wrote:


(3) Hospitals are required by law to provide urgent care without regards to whether or not a patient can pay, vastly increasing their costs as people who cannot afford health insurance simply wait until they're sick enough to justify a trip to the emergency room, at which point they're most likely sick enough to require fairly expensive care. *BUT* hospitals are very, very good at tracking down your assets post-care. If you have any money and you go in for care, they're going to find it and squeeze it out of you. But if you go to the emergency room, day or night, in all likelihood the majority of the patients there are going to be people who cannot afford "regular" health care.

"Obamacare" is designed to hopefully alleviate this. Emergency care is the most expensive part of our system, and by insuring everyone there is a hope that people will use preventative care instead and drop the price. People will use less expensive treatments and free up the emergency care.

Unfortunately, the insurance plans and co-pays are ultimately too expensive for many of the people that use emergency rooms, so their behavior probably wont change much. We will have to wait to see.


Caineach wrote:
NobodysHome wrote:


(3) Hospitals are required by law to provide urgent care without regards to whether or not a patient can pay, vastly increasing their costs as people who cannot afford health insurance simply wait until they're sick enough to justify a trip to the emergency room, at which point they're most likely sick enough to require fairly expensive care. *BUT* hospitals are very, very good at tracking down your assets post-care. If you have any money and you go in for care, they're going to find it and squeeze it out of you. But if you go to the emergency room, day or night, in all likelihood the majority of the patients there are going to be people who cannot afford "regular" health care.

"Obamacare" is designed to hopefully alleviate this. Emergency care is the most expensive part of our system, and by insuring everyone there is a hope that people will use preventative care instead and drop the price. People will use less expensive treatments and free up the emergency care.

Unfortunately, the insurance plans and co-pays are ultimately too expensive for many of the people that use emergency rooms, so their behavior probably wont change much. We will have to wait to see.

As more states expand Medicaid to cover the gap, that will help.

Though judging by past state level Medicaid expansions, we'll see increased usage and costs as pent-up demand is satisfied, much of it initially at the emergency room level, since we're dealing with a population that is used to having that as their only choice for healthcare.
Over time the pent-up demand will fade and people will move away from the ER, as they get used to having other choices.

Liberty's Edge

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Orfamay Quest wrote:
Krensky wrote:

Minor correction, most hospitals are non-profit or government owned (2903 and 1045 compared to 1025).

Not that you could tell with what administrators are paid and what they charge.

My numbers are similar, FWIW. But "non-profit" doesn't mean what a lot of people think it does.

A "non-profit" corporation is simply a corporation that doesn't pay money to the owners/stockholders. As an owner of one share of Apple (AAPL), I get a dividend every so often that represents my zillionth of a percent of Apple's profits. As an employee of Apple, I get a salary which represents the value of my work to the company in creating profits for the shareholders. These two are unrelated. My value as a janitor is much less than my value as VP of Corporate Affairs, so the salaries are appropriately different.

A hospital administrator does the same job regardless of whether it's a non-profit or for-profit hospital, and hence draws roughly the same salary. The difference is that money doesn't go back to the local church for owning/running St. Ethebert's Hospital, the way it goes back to me for owning Tenet Healthcare Systems (THC). (What a marvelous stock symbol).

No, the difference is the money is plowed back into administrator (I mean the equivalent of CEOs here) compensation and larger and larger expansions and capital expenditures which do nothing to increase quality of care or community services.

The vast majority of non-profit hospitals in the US are indistinguishable in actions or management from for-profit hospitals. It's part of why a lot of them are being investigated by the IRS and other agencies.


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Quote:
Someone please explain it to me.

The statistic that got me is that Americans pay a slightly higher percentage of their taxes towards government subsidies of the supposedly-private healthcare system than people in the UK do. However, we get a fully-functioning (when not being starved of resources by the Tories so they can claim it's failing and then try to privatise it, as in the 1980s and now) and pretty good national health service out of it, whilst Americans have to go and pay a ton more money in insurance and/or direct hospital fees on top of that.

That seems to be insane. Not paying any money at all towards health care out of taxes - because it's all private - makes sense. Paying taxes and not having to pay more towards healthcare afterwards makes sense. Doing both is crazy.


Werthead wrote:
Quote:
Someone please explain it to me.

The statistic that got me is that Americans pay a slightly higher percentage of their taxes towards government subsidies of the supposedly-private healthcare system than people in the UK do. However, we get a fully-functioning (when not being starved of resources by the Tories so they can claim it's failing and then try to privatise it, as in the 1980s and now) and pretty good national health service out of it, whilst Americans have to go and pay a ton more money in insurance and/or direct hospital fees on top of that.

That seems to be insane. Not paying any money at all towards health care out of taxes - because it's all private - makes sense. Paying taxes and not having to pay more towards healthcare afterwards makes sense. Doing both is crazy.

Yeah, that's pretty much it.

The problem with " Not paying any money at all towards health care out of taxes - because it's all private" is that it doesn't work. At least if you actually care about making sure your population gets health care. But we hold private health care as an ideal, so we try to keep that, but then use the government to shore up the gaps and it winds up being even more expensive.
In theory, there's nothing wrong with a mixed system. A lot of countries actually do it that way, cover some of it with taxes and then the rest with strictly regulated private insurance. We're not to good at the strictly regulated part either.


I should have said that doing both without the cost benefits (i.e. paying a lot less either in taxes or private fees, or both) is what's insane. The 'part and part' system is used successfully by quite a few nations - most notably I believe France - but there are clear cost benefits to the consumer to doing it that way. Not so much the American model, where the prices of the two systems seem to be almost combined, as well as the worst features of both (government bureaucracy and commercial interests dictating what drugs are developed and bought).


And now of course with Obamacare, there's even more regressive taxation going on to keep the burden of healthcare costs on the lower and middle classes, only because its paid to a corporation is not considered a tax.

Bob, Alice, Janet, and Phil are all young and relatively healthy and working.

Sam has some very expensive cancer to treat

Oliver is out of work.

Addie is old and requires a lot of medical care.

Insurecorp overcharges Bob, Alice, Janet, and Phil for their healthcare, and puts it towards sam, and Addie. Taxes pay insure corp for Oliver, but over charge the government so they can pay for sam and addie (and blame oliver)

So the cost to the average person isn't going anywhere. The entire system is designed to keep corporate and upper income taxes low.


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thejeff wrote:
Well, avoiding toxins is good plan.
NPC Dave wrote:

So lead, arsenic, mercury, don't avoid those things?

You really did made me laugh out loud there.

Given that the blanket statement is both overly-simplistic and physically-impossible, some clarification might be needed.

ALL substances, natural and artificial, are have deletorious effects on the body in high-enough concentrations or doses. This includes pure water. Also, there is no such thing as a concentration of "zero" -- the best we can do is "below detection limits," and the best that exists on a realistic scale is "below threshold that magnifies the risk of health problems to a statistically-significant degree."

Granted, for some substances, that concentration threshold is lower than for others. Take arsenic, for example. It causes problems at relatively low concentrations. It is also ubiquitous in rice and other other grains, but at concentrations below the health-based limit. So, in a realistic sense, one CANNOT simply "avoid arsenic," or you starve to death. (And die of axphyxiation, if we want to be pedantic, because wind-born dust particles also contain minute amounts.)

We give the blanket name "toxins" for those things out of convenience, but it's not really a meaningful term beyond that, and probably shouldn't be invoked in a serious discussion.


BigNorseWolf wrote:

And now of course with Obamacare, there's even more regressive taxation going on to keep the burden of healthcare costs on the lower and middle classes, only because its paid to a corporation is not considered a tax.

Bob, Alice, Janet, and Phil are all young and relatively healthy and working.

Sam has some very expensive cancer to treat

Oliver is out of work.

Addie is old and requires a lot of medical care.

Insurecorp overcharges Bob, Alice, Janet, and Phil for their healthcare, and puts it towards sam, and Addie. Taxes pay insure corp for Oliver, but over charge the government so they can pay for sam and addie (and blame oliver)

So the cost to the average person isn't going anywhere. The entire system is designed to keep corporate and upper income taxes low.

Well yeah. Can't really argue.

Though I'd say it's more designed to at least keep Sam and Addie cared for while still being possible to pass. Let's be honest and admit that a system paid for healthcare with taxes on the rich wasn't going to happen. It was some hodgepodge like this or nothing.

I do think it would have been better to have had an actual singlepayer proposal on the table, just to have the debate and shift the Overton window a little bit, but I don't pretend it would have actually passed.

And what you describe is basically how all insurance works: Those who wind up not needing the payout, pay for those who don't. The larger the pool the better. The more narrowly risk groups can be defined the worse it is.

Sovereign Court

Hurray for socialism...


Hama wrote:
Hurray for socialism...

Yeah. Free market really doesn't apply when you have a hunk of metal piercing your eyeball or a searing pain in your gut.


Martin 1, Burr 0.
That's a Burrn...?
Okay, bad pun, bad pun!


Hama wrote:
Hurray for socialism...

Not that highly socialized public health care like we have in Norway isn't without its problems, but from what personal experience my family and friends' family have had, it's pretty decent. Non-critical issues will have you waiting for a while before you get something done, but you generally get well again.

The Exchange

Hama wrote:
Health insurance shouldn't be a perk. It should be a basic human right.

Compassion through thievery.

Sovereign Court

What.


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If it's theft when the gubmint takes your money to pay for healthcare, is it theft when your insurance company takes your money and tries to decline as many claims as possible?


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Hama wrote:
What.

We seem to have encountered a Libertarian. They believe the market repairs all because financial gain totally makes people reasonable and forward thinking, the government should let corporations do what they want because they will then give workers more money for some reason, and that the government is bloated, useless, and shouldn't be trusted with anything.

The Exchange

You can have free medical and pensions. All you need do is require companies to pay a one off billion dollars each to qualify for a hundred year lease of the land they build their corporate headquarters and factories on and they get to function on one percent tax for the next hundred years payable up front as one percent of the issued shares for the next century to the government. All you do then is make sure each citizen gets allocated a million dollars each.


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That is the stupidest idea I've heard out of you in the last five minutes.

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