OT: a debate on US health care

joepet · Senior User Joined: 18 Dec 2008 Posts: 377 Location: Japan

Since Don was a gentlemen and did not wish to discuss this in another thread, I have made this a place for such discussion if he wishes. Wink

What I would like to discuss are the relative merits of Japan's system, though largely simplified because, like America, it is complex. Japan doesn't really have "universal health care" as it has "universal health _insurance_" Basic health insurance is always available through the government, and at fairly cheap rates. In fact, _all_ basic health insurance is through the government. For the most part, the insurance pays for 70% of all approved procedures, and reimbursements are available when your family's monthly expenses exceed about $1100. In additional, most companies also belong to "health care clubs" that reduce the maximum burden even further. In my case, I pay about $300 a month in health insurance payments for my family, and after reimbursements, my monthly healthcare expenses do not exceed $500.

Because the government is really the only basic health care insurance in town, they have a tremendous amount of leverage in dictating prices. In fact, every two years the government sets the prices for every single drug and procedure it covers. So all hospitals charge exactly the same rate, and you are free to go to virtually any hospital in the country. My Rituxan cost $3000 before insurance; in America, the rate is at least twice as high.

The drawbacks are that the majority of hospitals and clinics are operating in the red. Especially in the rural areas hospitals are closing frequently, and in the urban areas there are sometimes news stories of people dying in ambulences because seven or eight hospitals denied admittance due to overcapacity. Perhaps if it was socialized medicine, the government could tell doctors to go where they are needed, but that is the price we pay for our pseudo-socialist/pseudo capitalist system. But for NHL, the system worked for me extremely well.

I can't really say bad things about the American system though; their "by the pharmaceuticals, for the pharmaceuticals" system has resulted in the drugs that save the rest of the world, at the expense of thousands of Americans who are denied their benefit. So I say thanks to all Americans, for suffering for the good of the world!
_________________
Age 37 (36 at diagnosis)
Diffuse Large B cell Lymphoma
Stage 1AE (localized in colon)
Began six cycles of R chop 21 3rd Dec 2008
Finished R chop 21 Apr 2009
Complete remission as of May 2009

ChemoMan

Hi Joepet

Was thinking of doing the same myself.

In Australia we have both a government scheme and a private system. It seems to work just fine. Under the government scheme everyone is covered, its universal. It is funded by a small levy that everyone pays. You can also buy into a fund and tailor your coverage to suit yourself, but you still have to pay the medicare levy if you are privately insured. Being private means you can circumvent waiting lists for elective treatments, and you can get treated at private hospitals. All critical treatments are done on a needs basis and there are no waiting lists for these.

We get bombarded here with stories about how bad it is in the States. The last one we saw went for an hour and the centrepiece was a story about a foreign aid group who stopped working in south america and set up a medical facility in a football field so that the locals could get basic medical care, not sure what state it was could have been Alabama, but i cant really remember. There were thousands of people being treated at this clinic getting all sorts of basic care. This was done because the need was so great. It was shocking to us that a country which has a global empire has such an elitist health system that cannot even provide universal care to all of its people. And we were really shocked believe me.

Don mentioned that Lymphoma is expensive, and in way it is, but in Australia the patient does not have to burden the cost. We do not have anyone in this country who is refused treatment because they can't pay, and you won't see any Australians posting to the financial board in this forum. Also private insurance is actually affordable and a lot of people are in various schemes although membership does vary according to government policy at the time. The quickest way for a government to lose power in this country is to be accused of bringing in an American style health system.

our scheme is not perfect and public hospitals are always struggling for cash, but they remain the mainstay and the foundation of our system. Waiting list are long for elective surgery and the category of elective surgery can get a bit rubbery, but all in all we are proud of the system and it works well for us.

Australia has a long history of mateship and looking out for your buddies and I think that is why we are not scared of lending a helping hand to our countrymen. It was born out of our pioneering past and forged into steel at Gallipoli and we are damn proud of it. The health of the nation is important not just the health of your own family and we accept that. Its the reason we live so long Smile

_________________
Age 53
Diffuse Large B cell Lymphoma
Stage 2a
Finished six cycles of R chop 21 26th May 2008
Officially in remission 9th July 2008
Remission confirmed 1st October 2008
Remission confirmed 17 June 2009
http://cancerforums.net/viewtopic.php?t=9620
RULE NUMBER 1.....Don't Panic
RULE NUMBER 2..... NEVER GIVE UP
RULE NUMBER 3..... Don't forget the first 2 rules

Don

Hi, This is a good place to start a thread about Health Care Debate. I just got back from Maryland, being with my Mom who has Small Cell Lung Cancer...I can check my e-mail from her computer, but her antique operating system does not let me send replys.

By the way, I also attended my step-brother's funeral who died suddenly due to complications from a colostomy reversal. He had lymphoma, but that was in remission...so, if your lymphoma is in remission...don't neglect the rest of your health!!!!

Now...health care. I am just going to comment on one aspect about it and add more comments later.

USA is a superpower with a large GDP and a high standard of living; but we do not provide Universal Health Care as do other countries. For one thing, it would require tremendous fiscal resources, which we cannot afford right now without huge tax increases, which Americans don't like. We have Social Security and Medicare (Health Insurance for those over 65) and both those programs will be bankrupt in a matter of a few more years. Adding another entitlement program, such as Universal (Single Payer - as in US Government) Health Care, will "do this country in". We will be literally bankrupt...we simply cannot afford it.

In order to save money, we are afraid that any government run, single payer, health plan will have to ration care: limiting treatments, denying care especially for the elderly ("You are too old for this treatment...go home and die."), etc. We see such government intrusion in our lives as untenable and Socialistic.
_________________
Don B
Dec 07 Dx Follicular NHL, Grade I (Indolent)
Stage IIIA - No Symptoms
Watch and Wait - 6 Month Checks
Jan 09 Scan shows Progression - no symptoms
May 18, 09 - Started R-CVP
After Third Round, CT scan showed some tumor shrinkage
July 31,09 - Completed 6 Rounds R-CVP

SingleDad

Don
Good summary of the view point....dead wrong in terms of "afford" - you can't afford NOT to.

You have a bloated predatory system that others on the planet look on with horror.

YOu spend the most per capita by almost double yet your outcomes are poorer and you fail to cover 40 million of your citizens and spend 25% of the whole system on administration.

It's a horror from end to end and to their credit many of your healthcare institutions are well aware of it.

We read stories of bankruptcies and and horrid treatment by private for profit insurance companies and shake our heads and wonder how you tolerate being preyed upon in such a way.

Good resources here
http://www.uhcan.org/

•••••

This is reality - you have a horridly inefficient system that needs radical change

........."Lack of universal health care in the US: morally and fiscally bankrupt

Category: Health care • Health insurance • Priorities
Posted on: April 13, 2009 6:51 AM, by revere

The idea that if the United States joins the rest of developed nations and finally adopts a universal health care system it will bankrupt itself is not based in reality.

The reality is that the US spends a larger proportion of its Gross Domestic Product (GDP) than any other developed nation. By far. Not even close.

CDC has just documented it from data collected by the Organisation for Economic Co-operation and Development (OECD) in its 2008 health data yearbook (statistics and indicators for 30 countries).

>>>>It suggests we are being bankrupted by our lack of a universal health care system:<<<<

more

http://scienceblogs.com/effectmeasure/2009/04/lack_of_universal_health_care.php
_________________
Age 62
Diffuse Large B cell Lymphoma Stage 2/3
CHOP+R started Feb 26th 2009
Completed 6 cycles June 2009
Diary here http://cancerforums.net/viewtopic.php?t=12003
Officially in remission July 9th 2009 Wink

Three rounds of Intrathecal completed July 29th
Radiation as a prophylactic measure.
1st Radiation Sept 9 completed Oct 1.
Cancer free scan Jan 2010 - remission confirmed
In South Africa for three months

joepet · Senior User Joined: 18 Dec 2008 Posts: 377 Location: Japan

My condolences to your family Don on your loss. Did the colostomy have anything to do with the original lymphoma? I am grateful to my doctors for going the extra mile to make a difficult, but correct, diagnosis...a lot of doctors would have treated my lymphoma as colon cancer, simply due to the location of the tumor. If that happened to me, then in the best case, I would probably be worrying about coloscopy reversal issues right about now.

I think that Americans (or perhaps, more accurately, people living in America, since I am American but this issue doesn't affect me directly) are so disillusioned by health care since privatization took place in the 70's, that they are fearful of any change, in the belief that change will only make things even worse. In other words, they are in fear of fear itself.

About the only thing we can say with certainty is that the current system is guaranteed to get worse over time, as costs increase, benefits decrease, and Medicare heads towards meltdown. As Michael Moore clumsily but dramatically pointed out, there are several examples of functional health care systems in the world, and honestly, it wouldn't be difficult to design one that would work well for America. The problem is getting such a plan past all of the vested interests, and all of the Republicans and Senators that are getting kickbacks from the pharmaceutical companies to go into law.

Anything more will lead me on a tangent about how the US government structure is outdated and broken beyond repair, which is beyond the scope of this discussion, so I'll stop here for now.
_________________
Age 37 (36 at diagnosis)
Diffuse Large B cell Lymphoma
Stage 1AE (localized in colon)
Began six cycles of R chop 21 3rd Dec 2008
Finished R chop 21 Apr 2009
Complete remission as of May 2009

Don

I like the way this thread is going. There are other forums, unrelated to cancer, that I have stopped participating in because others just begin to insult each other and sling "mud" back and forth; such is NOT debate.

I invite others to join in this forum.

Anyway, I do NOT consider myself an expert on health care administration and I will never be. I rely on information provided by "think tanks" such as the Heritage Foundation or Brookings Institute. You should know that I consider myself very conservative in my political views.

Both sides of the debate provide anecdotal stories to support their points of view and I have similarly read horror stories (again: anecdotal) about the Canadian Health Care System: long waits for basic tests, individuals coming into the United States for care, government dictating what is OK to have and what you can't have, etc, etc.

While you may have figures that show that we would be better off economically going to a Universal (Government run) system, there is another factor to consider. Many of us do not want the US Government becoming involved in that aspect of our lives. We believe that the federal government has overstepped it's bound in too many areas already and there are signs of political "backlashes" developing. If you remember, back in 1994 (I may be off with the dates) our Congress overwhelmingly defeated Bill Clinton's Universal Health Care Bill (that his wife Hillary crafted). The bill was defeated not because of it's cost but because it would give the US Government too much power over our lives. This also was partially responsible for Republicans gaining control over both Houses of Congress and for Bill Clinton to make the statement: "The era of Big Government is over." Republicans didn't do too much better; and George Bush was a Big Government Republican.

Well, it looks like the Era of Big Government is back...and us conservatives are going to try to keep in in check. Perhaps the Health Care Debate is a microcosm of the overall political divide that is developing in the US.

I am going to let these comments stand for a while. I MUST get out of the house and off to Mass. If I miss the early (7:30) Mass, the next one has guitars and bongo drums for music, which to me is like someone scratching their nails on a chalkboard.

Others...please join in...we want to hear your comments.
_________________
Don B
Dec 07 Dx Follicular NHL, Grade I (Indolent)
Stage IIIA - No Symptoms
Watch and Wait - 6 Month Checks
Jan 09 Scan shows Progression - no symptoms
May 18, 09 - Started R-CVP
After Third Round, CT scan showed some tumor shrinkage
July 31,09 - Completed 6 Rounds R-CVP

Don

joepet,

I did not answer your original question about my step-brother's lymphoma.

I am a bit short on facts about his cancer. His side of the family was very "tight-lipped" about his health and after my step-father died in 1993, the communications from his side of the family was minimal. Several months ago, my brother heard through the grapevine that he had colon cancer; I only found out that he had lymphoma when I came to his funeral and his daughter told me. From what I gather, he had some problems with diverticulitis, so bad that they operated and found lymphoma. Apparently, it had damaged his colon to the point of requiring a colostomy. The lymphoma was treated and in remission; but he did not like having a colostomy and had the surgeon, who was reluctant, to reverse it. Then, an infection set in, peritonitis followed then systic shock killed him.

This is the story that I put together after listening to several sources.

Now, I have hijacked this threat to update you on my step-brother.

Back to the Health Care debate...
_________________
Don B
Dec 07 Dx Follicular NHL, Grade I (Indolent)
Stage IIIA - No Symptoms
Watch and Wait - 6 Month Checks
Jan 09 Scan shows Progression - no symptoms
May 18, 09 - Started R-CVP
After Third Round, CT scan showed some tumor shrinkage
July 31,09 - Completed 6 Rounds R-CVP

ChemoMan

Hi Don

So sorry to hear of your loss. And thanks for the timely warning about not neglecting the other aspects of your health....
_________________
Age 53
Diffuse Large B cell Lymphoma
Stage 2a
Finished six cycles of R chop 21 26th May 2008
Officially in remission 9th July 2008
Remission confirmed 1st October 2008
Remission confirmed 17 June 2009
http://cancerforums.net/viewtopic.php?t=9620
RULE NUMBER 1.....Don't Panic
RULE NUMBER 2..... NEVER GIVE UP
RULE NUMBER 3..... Don't forget the first 2 rules

ChemoMan

Hi

Don I don't really understand why you are so scared of universal health care. True your government is broke, but that is because you now have a socialised banking system and now I hear a socialised car manufacturing system. You can give handouts to the wallstreet bankers and to big industry but your people can go to hell...... I just don't get it. Oh yeah and you spend more on weapons of war than the rest of the world combined...much more. The truth of the matter is your politicians would rather spend money to kill than to cure. Its bizarre when you really sit down and think about it.

Having a pool of 40 million (And growing) without adequate care is downright dangerous. Disease spreads and has no respect for your level of insurance. Forget all that rubbish about waiting lists, its all just hotair. You can run private and public health together that way you get the best of both worlds. We do it here and it works fine. As was pointed out the US has the most expensive system in the world yet your outcomes are amongst the worst. Your all so scared of paying a few extra bucks tax that I fear nothing will get better for you all.

I had treatment in the best Hospital in the state, I was treated by a world renowned professor and had the latest chemo. The out of pocket expenses to me came to $0.00. I did not have to wait in fact as soon as my lymphoma was diagnosed i was offered treatment the next day. For all this I pay 1.5% of my taxable income for the medicare levy. Big deal. I am also in a private insurance but only out of choice. I did not use any of my private insurance to get my treatment and my treatment would have been the same if I didn't have the insurance.

Its about value for money, bang for you buck so to speak. You pay big bucks over there and get crackers...its just beyond my comprehension.

I have thought about this a lot and i came to the conclusion that the different attitudes between Oz and the US is the profound and character setting events in our past. In your case it was the civil war where you all wents nuts and slaughtered each other like there was no tomorrow, and in our case it was Gallipoli where we sacraficed ourselves to slaughter to help our allies. We do that a lot... Its a philospohy over here that we call giving others a fair go.... I think you could all use a bit of the in the States.
_________________
Age 53
Diffuse Large B cell Lymphoma
Stage 2a
Finished six cycles of R chop 21 26th May 2008
Officially in remission 9th July 2008
Remission confirmed 1st October 2008
Remission confirmed 17 June 2009
http://cancerforums.net/viewtopic.php?t=9620
RULE NUMBER 1.....Don't Panic
RULE NUMBER 2..... NEVER GIVE UP
RULE NUMBER 3..... Don't forget the first 2 rules

Don

ChemoMan,
I would like to respond to your last comments first. Your contention that the United States of America has historically been selfish and is thus defunct in national character is not supported by fact. Thousands of Americans gave their lives to defend Europe against the onslaught of Nazi Germany, to name just one example. My father fought in WW II and each time I see pictures of the rows and rows of American grave markers on the shores of Normandy, tears well up in my eyes. We are proud of our history of helping others and I am surprised that you would think negatively of our national character because of this issue, especially since we fought side by side with the Aussies in many battles. Perhaps you have not studied this aspect of our history.

As far as our Civil War, let me give you a short perspective on that because it does lead to the discussion of nationalized health care.

The founders of the United States envisioned strong state governments with a weak central (Federal Government – “Feds”). In fact, the US Constitution only gives the Federal Government 18 powers and then declares: “All powers not given to the Federal Government are reserved for the people and the States.” In other words, if the constitution does not give a power to the Feds, then it belongs to the States. Some examples of Federal powers include: Minting of Money, Providing for the Common Defense (Military), regulation of Interstate Commerce, etc. The list does NOT include Nationalized Health Care. The idea was that it was better for the States to handle some government functions because of the differing regional needs. Since then this intended power structure has been reversed and many of us do NOT think that this is good.

The Civil War was fought over this principal. The States in the South believed that the Federal Government was overstepping its bounds and they decided to secede (sever their ties with the Federal Government) from the Union. The Feds believed that they could not do this and resisted militarily. Granted, the immoral issue of slavery was central but it was an issue nonetheless. Ironically, the two most famous Southern Generals, Robert E. Lee and Thomas (Stonewall) Jackson, were appalled at the institution of slavery and owned no slaves; but they were adamant about the issue of States rights. Thus, they resigned their commissions in the US Army to fight for the State of Virginia. This war is rigorously studied by students in military academies for its strategy and tactics. Ironically, Irwin Rommel (later Field Marshall Rommel under Adolf Hitler) spent six months in the United States studying the tactics of Lieutenant General Thomas “Stonewall” Jackson, who was known for his aggressive battlefield tactics. It is an interesting era in our history and 90% of the Civil War was fought within an hour’s drive from my house. This war may seem silly to some; but then the constant violence between Catholics and Protestants in Ireland seems silly to us…but not to them.

I concur with you that our government is shelling out money like it is going out of style and giving it to too many unworthy recipients…it does not make sense to me either. I do not like the way the Feds are becoming involved in the operations of our major corporations and taking over our banks. All this sounds like we are becoming a Socialist nation. I do NOT like it and am fighting against it.

We are nearly going bankrupt because of too much spending. Two institutions, Social Security and Medicare (medical insurance for the elderly) are about to become insolvent and will have to rely on the US Government to stay afloat. Taking the steps to correct their deficiencies has proved to be politically impossible. Benefits from these programs were promised to Americans and we were assured that they would always be self supporting. Their insolvency will be a financial disaster for the US economy…and now Obama is pushing for a National Health Care System. This is another entitlement program with open ended funding requirements.

Why do we (conservatives) fear a National Health Care System?
1. We absolutely can’t afford it.
2. It will give the Feds too much power over our Health Care choices.

We could probably work out a plan for National Health Care that would be acceptable to all sides, but it will take time. This Administration is insisting that it be done by August, despite numerous other pressing challenges; AND considering that Obama is pushing for this while at the same time nationalizing banks and taking over Corporations causes many of us think it is another Federal power grab which will lead to untenable consequences.

Yes, we need some adjustments to our Health Care System, but creating a federal behemoth in six months is reckless.
_________________
Don B
Dec 07 Dx Follicular NHL, Grade I (Indolent)
Stage IIIA - No Symptoms
Watch and Wait - 6 Month Checks
Jan 09 Scan shows Progression - no symptoms
May 18, 09 - Started R-CVP
After Third Round, CT scan showed some tumor shrinkage
July 31,09 - Completed 6 Rounds R-CVP

Don

Here is a good video clip about how our Founding Fathers envisioned the US Government to work. It is long, but worth watching:

http://www.wimp.com/thegovernment/

Keep the debate going.
_________________
Don B
Dec 07 Dx Follicular NHL, Grade I (Indolent)
Stage IIIA - No Symptoms
Watch and Wait - 6 Month Checks
Jan 09 Scan shows Progression - no symptoms
May 18, 09 - Started R-CVP
After Third Round, CT scan showed some tumor shrinkage
July 31,09 - Completed 6 Rounds R-CVP

ChemoMan

Hi Don

If I gave the impression that the US is defunct in national character then forgive me it was not my intention. I understand the sacrifice the US made in WW2 and you understand our sacrifice we made to your country and our allies in WW1, WW2, Korea, Vietnam, The Gulf, Iraq and Afghanistan. We have stood shoulder to shoulder with the US in every major conflict since WW2, and I think we are the only country to do that. But that's us. What I tried to understand was the different national character, but in all probability I have misunderstood yours. But I do believe that those defining moments in our past, In your case the civil war and in ours gallipolli set the tone for the future and has made a difference to public policy, in our case for the better.

The health of the nation is paramount as I mentioned before disease has no respect for income levels, insurance levels or which neighborhood you live in, to have such a large pool of people within your borders without adequate health care is, to my way of thinking, downright dangerous.

It would not take much to fix things up and I am sure that it could be done in your case without any tax increase, but I fear no one there can make the decision to cut expenditure where it needs to be cut, to many snouts in the trough and not enough politicians with any sense of decency, but hey we have similar situation here as far as politician go. I hope I am wrong, but from where I sit I can't really see the light at the end of that tunnel.

Speaking of politics did you know it derives from 2 words ?

1, poly ... meaning many and
2, Ticks .....meaning a bloodsucking parasite !
_________________
Age 53
Diffuse Large B cell Lymphoma
Stage 2a
Finished six cycles of R chop 21 26th May 2008
Officially in remission 9th July 2008
Remission confirmed 1st October 2008
Remission confirmed 17 June 2009
http://cancerforums.net/viewtopic.php?t=9620
RULE NUMBER 1.....Don't Panic
RULE NUMBER 2..... NEVER GIVE UP
RULE NUMBER 3..... Don't forget the first 2 rules

Don

Not being a historian, I could not say whether the Civil War was the era that defined the ethos of America; I know that it is interesting from a military history perspective...I have read many books about it; but also of WWII. I like military history.

The political atmosphere in the US is very charged right now. I have NEVER seen a more hostile divide and I am 61. Obama ran as a moderate, but as soon as he got in office, he has pushed far left policies and ideals. In today's paper, two major automakers (GM and Chrysler) announced bankrupcy plans and the person making the announcement in both cases was Obama himself. Things are NOT the way they should over here!!! We think that we are seeing the end of Capitalism and the beginnings of Socialism. I am more frightened over the future of this country than I am of my lymphoma...Seriously!

The mainstream news outlets are TOTALLY in the tank for Obama. They will not report on anything that is negative about him and they totally distort and denigrate any opposing viewpoints. As a result, one cable channel has no less that 5 - hour long commentary shows devoted entirely to opposition of the Obama Administration. I have NEVER seen anything like it.

Obama is pushing for a total government control of health care (what he says and what he means are two different things), and wants a bill by August. Like I said before, we could do some things to ensure that Health Care is more available to those without it...including some sort of government "safety-net", but the details need to be worked out. I would like to see a bi-partisan commission set up to study the problem (Clinton tried this before, but is was NOT bi-partisan and the negotiations were secret - and it was overwhelmingly rejected). It may take a year or so, but rushing into this will prove disasterous (look at our Social Security and Medicare). Once a government entitlement program is established it will NEVER be un-established, no matter what the economic consequences...we CANNOT rush into this.

That is my latest comment. This seems to be a debate between two people. I would like to see others join in...as long as it remains civil and there is NO denigrating others. There is another political web page (not Health related) that I have posted on; but the other posts are nothing more than "mud-slinging". When I mentioned this, another blogger said that they just blog there for entertainment; if I wanted a serious debate to go elsewhere.

Another health question: I have not found a veternary forum, but could anyone tell me why Labrador Retrievers get such bad gas??? My wife thinks my lab was bred with a skunk.
_________________
Don B
Dec 07 Dx Follicular NHL, Grade I (Indolent)
Stage IIIA - No Symptoms
Watch and Wait - 6 Month Checks
Jan 09 Scan shows Progression - no symptoms
May 18, 09 - Started R-CVP
After Third Round, CT scan showed some tumor shrinkage
July 31,09 - Completed 6 Rounds R-CVP

joepet · Senior User Joined: 18 Dec 2008 Posts: 377 Location: Japan

I wonder if it is possible to cross post this to other forums? The topic is certainly not lymphoma specific, so it might be of interest in the other areas as well.
_________________
Age 37 (36 at diagnosis)
Diffuse Large B cell Lymphoma
Stage 1AE (localized in colon)
Began six cycles of R chop 21 3rd Dec 2008
Finished R chop 21 Apr 2009
Complete remission as of May 2009

ChemoMan

Hi Don

Its funny but you sound like the liberals did for the 8 years of the GW era....same complaints exactly

Thats the thing about our democracy....when your side loses it supposed to taste like a S..t sandwhich...thems the breaks but thats the system we have and we just have to live with it.

I have noted in my 52 trips around that it doesn't really matter who is in they all dance to the same puppetmasters.... superficially things look different but the fundementals remain the same.

C'est la vie
_________________
Age 53
Diffuse Large B cell Lymphoma
Stage 2a
Finished six cycles of R chop 21 26th May 2008
Officially in remission 9th July 2008
Remission confirmed 1st October 2008
Remission confirmed 17 June 2009
http://cancerforums.net/viewtopic.php?t=9620
RULE NUMBER 1.....Don't Panic
RULE NUMBER 2..... NEVER GIVE UP
RULE NUMBER 3..... Don't forget the first 2 rules

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