If you're so far away from civilization that you can't get profitable mail delivery, then you can't get Internet service either. You wouldn't be able to get phone service either if the phone companies weren't required to do it as regulated monopolies.
Pretty much all the people around at the founding of the nation recognized the value of reliable, efficient, post service available for all. It's essential infrastructure. It's one of the reasons why business works in America. 'Based on the Postal Clause in Article One of the United States Constitution, empowering Congress "To establish post offices and post roads", it became the Post Office Department (USPOD) in 1792.
More hypocrisy. The conservatives complain when the federal government moves into something like health care, because it's not in the Constitution. The USPOD is in the Constitution, so they come up with another attack.
Actually, the BBC gave a link to the NEJM article. What have they done with those 5 patients since then?
http://www.nejm.org/doi/full/10.1056/NEJMoa0905370 Willful Modulation of Brain Activity in Disorders of Consciousness Martin M. Monti, Ph.D., Audrey Vanhaudenhuyse, M.Sc., Martin R. Coleman, Ph.D., Melanie Boly, M.D., John D. Pickard, F.R.C.S., F.Med.Sci., Luaba Tshibanda, M.D., Adrian M. Owen, Ph.D., and Steven Laureys, M.D., Ph.D. N Engl J Med 2010; 362:579-589 February 18, 2010 DOI: 10.1056/NEJMoa0905370
Results
Of the 54 patients enrolled in the study, 5 were able to willfully modulate their brain activity. In three of these patients, additional bedside testing revealed some sign of awareness, but in the other two patients, no voluntary behavior could be detected by means of clinical assessment. One patient was able to use our technique to answer yes or no to questions during functional MRI; however, it remained impossible to establish any form of communication at the bedside.
Conclusions
These results show that a small proportion of patients in a vegetative or minimally conscious state have brain activation reflecting some awareness and cognition. Careful clinical examination will result in reclassification of the state of consciousness in some of these patients. This technique may be useful in establishing basic communication with patients who appear to be unresponsive.
Maybe it's my observer bias, but that figure sounds too low to me.
Those reports are only cases that were reported in newspapers. Lots of cases don't get into the newspapers.
Back in the 1960s, newspapers had a taboo on stories about police abuse. That came up during demonstrations against the war in Vietnam, and counter-culture issues generally. I'd go to a non-violent demonstration, get beaten up by the cops, see other people get seriously injured, pick up the newspapers the next morning, and see a report on the demonstration written exclusively from quotes from the cops, with no mention of police violence. There was a newspaper called the East Village Other that used to print photographs of cops beating up demonstrators that the regular newspapers wouldn't print.
One reason for that was that the cops supplied reporters with news about crime, and the reporters didn't want to alienate their sources.
The cops used to beat up black people all the time. It was only when they started beating up privileged white kids that it became an issue.
The big change came in the 1968 Democratic Convention in Chicago, where Mayor Daley decided that the First Amendment didn't apply to people who disagreed with him. The great thing was that a lot of the out-of-town reporters -- the same guys who had been ignoring police brutality up to then -- got their own asses kicked by the cops. It was in all the national newspapers, in Life magazine, on TV. It sort of broke the taboo.
But if you get beaten up by the cops, even if you file a complaint, and you call up a newspaper reporter to tell him about it, the chances of his doing a story about it are pretty low. A lot of these caught-on-video cases didn't make it into the newspapers until the video came out.
Here in New York City, there was lots of police misconduct during political demonstrations -- against the Iraq war, against the Republican Convention, and now Occupy Wall Street. Now a lot of it is caught on video. They even had a high-level office, Anthony Bolognia, get caught on video spraying protesters who were obeying all the laws.
And in my personal contact with cops on the street, I've found a lot of them to be rude, abusive bullies. I approach a cop in with a polite request, and his attitude to me is, "fuck off."
So you get points for looking up the data. Next step -- validating the data. I think the misconduct rate is much higher.
That's right, Bryn Mawr has a good biology program.
But what is it, $55,000 a year? http://www.brynmawr.edu/sfs/cost/cost_index.html That's more than my relative is paying at her big expensive school. They'd have to be very generous to make it affordable.
She has a lot of good science courses in their standard concentration, including biology and chemistry. The tragedy is that I saw a list of unemployment rates of college graduates with different majors, and biology majors weren't doing too well. There was a time when a biology major would be welcome to teach in high school or even elementary school, and those who wanted to could go into health care, agriculture, etc. or even research. The economy is failing. We're in the middle of a biotechnology revolution, we're finding new drugs to treat major diseases, we need to understand science just to be functioning citizens, and biology majors can't get jobs.
Do you know that tuition in Quebec is $2,200? http://oncampus.macleans.ca/education/2012/09/20/its-official-quebec-tuition-hikes-are-history/ I wonder how much it is for foreign (American) students. As a bonus, you learn French. The French-speaking students killed a tuition hike because they demonstrated against it. The English-speaking students got a tuition hike. I heard a Canadian say that the English-speaking students pay high tuition, and say, "Compared to the US, this is pretty good." The French-speaking speaking students pay high tuition, and say, "Compared to France, this sucks." I wish our students were demonstrating in the streets, although I have to give them credit for Occupy Wall Street. Which the Canadians helped us organize.
Furthermore, even if old medical records are almost always useless, the one-off case where they could be useful might save someone's life. The theoretical benefits exceed the record-keeping costs because, frankly, life is more valuable than space saved by destroying a bunch of papers.
Real example: Suppose you have a chest x-ray and the doctor notices a spot on your lung. It could be cancer. He wants to do a (dangerous) biopsy. As it turns out, there are lots of spots on peoples' lungs. If you have an 8-year-old chest x-ray, you can look it up and see if the spot was there. If it was, and it's not growing, you know it's not cancer and you can skip the biopsy.
Hell, it's useful for a doctor to know what you weighed 8 years ago, and what your height was. Suppose you lost an inch in 8 years. You'd want to find out why.
Actually, cardiologists do treat cancer patients, because many of the cancer treatments cause heart damage.
But to your original point, it is true that hospitals turn away cancer patients. Here's a well-documented example. http://online.wsj.com/article/SB118781024289705455.html Remember, hospitals are required under Medicare rules to accept people in an emergency and stabilize them. They're not required to treat them for chronic conditions.
You say UCSD isn't like Texas? I'm not there, so I don't know for sure. But I do remember a letter to the New England Journal of Medicine. A doctor was addressing the claim that free-standing radiology clinics made x-ray services more accessible. She called up several free-standing clinics, gave them symptoms of a treatable brain tumor, told them that her doctor had suggested that she get a CT scan, and asked them if they would accept her if she couldn't pay. They refused, and suggested that she go to a University of California hospital. The doctor said that that hospital was her own institution, and she knew that their CT scanners were booked solid and weren't available for people who can't pay. (She called the centers again, gave them the name of the insurance plan she actually had, and asked them if she could come in for a (useless) CT scan for a sprained ankle. They offered to schedule her immediately.)
OK, that was a while back, before CTs were overbuilt. The NEJM had a recent article in which they did something similar. They had people call doctors, claim they were on Medicaid, and describe symptoms which would have been life-threatening. Many of the doctors refused to take them.
One last point: The cost of the medical malpractice system is about 2% of the total cost of health care. The malpractice crisis is to a certain extent bullshit propaganda propagated by insurance companies as an excuse to raise their premiums.
So perhaps it's more accurate to say "refusing to provide basic medical care (up to $x in cost) due to inability to pay is immoral." In that respect the U.S. is already there - it is illegal for hospital emergency rooms to turn away patients due to inability to pay.
Not quite. First, it's not illegal. If hospitals choose to get Medicare and Medicaid (as most do), they're required to admit people in an emergency and stabilize them. Then they can kick them out, and often do. A hospital can turn away a patient who is dying of cancer, until she's in an immediate crisis. Then they stabilize the crisis, and kick her out again. http://online.wsj.com/article/SB118781024289705455.html
Second, they can send the patient a bill. If the patient doesn't pay, they send it to collections. There are collection agencies which will hound the patient for decades, seizing their bank accounts and paychecks.
You've failed to mention that both systems will let folks with cancer die. Socialist medicine has proven to fail (Canada), and the steps we've taken towards it in USA have failed
Absolutely false. There have been many studies comparing the health care system in the US and Canada, and they all come to the same conclusion: Health care in Canada is just as good as health care in the US, and sometimes better.
Here's one: http://www.openmedicine.ca/article/view/8/1 A systematic review of studies comparing health outcomes in Canada and the United States (Basically it says that the outcomes are the same in both the US and Canada, but the US costs twice as much.)
There's a Wikipedia article comparing the US and Canadian health care systems. They link to dozens of studies, which overwhelmingly come to the same conclusion.
There are also studies comparing the US to other health care systems. They come to the same conclusion too.
There's one exception. When epidemiologists make international comparisons, they have to compare black Americans separately, because their health care is so much worse.
Somebody has to pay for it (before you say "government", where does gov't get its money? That's right, it's your money and my money).
Somehow conservatives think it's a great insight to tell people that their own money goes to pay taxes. Everybody knows that. I'm happy to pay taxes if I get something worthwhile for my money.
The issue is whether you would rather pay $5,000 in taxes, or $10,000 in private insurance premiums, for the same health care. I'd rather pay $5,000. Who would rather pay $10,000? Hands?
Not true. I called the New York State Department of Health about that.
I don't have my notes handy but as I recall, doctors are required to keep a patient's records 7 years after they stop treating him, and hospitals are required to keep their records longer, I think 30 years.
It's a ridiculously short period of time. I think the 7 years comes from the statute of limitations for malpractice. The 7 years is to protect the doctor, not the patient.
The pulmonologist told him he had a spot that "could be cancer," and he had to get a lung biopsy "to be sure."
He had an x-ray several years ago. If he could have gotten it, the radiologist could have compared the 2 x-rays to see whether the spot was there years ago. If it was, and it wasn't growing over several years, then it wasn't cancer.
BTW, lung x-rays always have spots. It sounds to me like the pulmonologist was running a scam, giving a lot of unnecessary and dangerous biopsies.
In general, it's often important to know whether something is new or whether you've always had it.
It amazes me that doctors aren't required to keep medical records for basically the life of the patient. A medical history is the most important part of an examination. Hopefully, with electronic records, it will be cheap enough to keep them forever.
I went to a lecture on Medicare, by a guy who now works for a union and used to work in all sides of the insurance business.
I just looked up my notes.
He said hospitals have a list price which is 12 times Medicaid. Medicaid is the cheapest, and some doctors and hospitals claim to lose money on Medicaid.
The highest prices are for foreigners who come to the US for medical treatment. Usually they can afford it. If they couldn't afford it they would go to Costa Rica.
Insurance companies get discounts.
Individuals also get discounts if they ask for it. Sometimes, they can also get a large portion of the bill, or all of it, written off if they don't have the money. Some hospitals are greedy, though, and will send unpaid bills to collection agencies who are known for being tight-ass.
If you're really poor, you can be eligible for Medicaid, but the income level is so low -- $6,000 a year -- most people wouldn't qualify.
I'm saying that in every human society that has survived, people voluntarily cooperate with each other and care for the less fortunate or less successful.
This is not slavery, this is voluntary cooperation. Cooperation is conserved throughout species, so it's likely to be necessary to survival.
You can read the enormous literature on cooperation in human cultures, by economists, evolutionary biologists, sociologists, and others, in Science magazine or in the peer-reviewed journals of your choice. Or maybe you can catch it on the Discovery channel.
You're gambling your life that you're not only more skilled and productive than your peers, but that you always will be.
If you're wrong -- and many people have been -- you'll end your life broke and living off the charity of others, including the government. If the Republicans and Democrats keep on going the way they're going, that charity will be very stingy.
Maybe you're really that smart. Maybe it's the Dunning-Kruger effect. I can't tell.
Slashdot Mirror
But you haven't demonstrated that bulk mailers lose money. Saying, "it seems obvious to me" is not demonstrating it.
Do you have something that would meet the standards of a reliable source on Wikipedia?
We should also get rid of postal votes and put all polling stations up three flights of stairs
You know of course that that's a health insurance company trick to keep sick people out of their coverage pool.
Why would you (as a Republican) want to bankrupt any government controlled entity?
Because Republicans hate America?
If you're so far away from civilization that you can't get profitable mail delivery, then you can't get Internet service either. You wouldn't be able to get phone service either if the phone companies weren't required to do it as regulated monopolies.
Pretty much all the people around at the founding of the nation recognized the value of reliable, efficient, post service available for all. It's essential infrastructure. It's one of the reasons why business works in America. 'Based on the Postal Clause in Article One of the United States Constitution, empowering Congress "To establish post offices and post roads", it became the Post Office Department (USPOD) in 1792.
More hypocrisy. The conservatives complain when the federal government moves into something like health care, because it's not in the Constitution. The USPOD is in the Constitution, so they come up with another attack.
It can also be demonstrated that the USPS carries these bulk mailers at a per piece loss.
Please demonstrate that.
A tested technology.
Has anyone set up a bibliography template for MS Access?
I was looking for one, but it's impossible to search for "bibliography" on Google.
What's the best way to cut off the back?
Actually, the BBC gave a link to the NEJM article. What have they done with those 5 patients since then?
http://www.nejm.org/doi/full/10.1056/NEJMoa0905370
Willful Modulation of Brain Activity in Disorders of Consciousness
Martin M. Monti, Ph.D., Audrey Vanhaudenhuyse, M.Sc., Martin R. Coleman, Ph.D., Melanie Boly, M.D., John D. Pickard, F.R.C.S., F.Med.Sci., Luaba Tshibanda, M.D., Adrian M. Owen, Ph.D., and Steven Laureys, M.D., Ph.D.
N Engl J Med 2010; 362:579-589
February 18, 2010
DOI: 10.1056/NEJMoa0905370
Results
Of the 54 patients enrolled in the study, 5 were able to willfully modulate their brain activity. In three of these patients, additional bedside testing revealed some sign of awareness, but in the other two patients, no voluntary behavior could be detected by means of clinical assessment. One patient was able to use our technique to answer yes or no to questions during functional MRI; however, it remained impossible to establish any form of communication at the bedside.
Conclusions
These results show that a small proportion of patients in a vegetative or minimally conscious state have brain activation reflecting some awareness and cognition. Careful clinical examination will result in reclassification of the state of consciousness in some of these patients. This technique may be useful in establishing basic communication with patients who appear to be unresponsive.
Maybe it's my observer bias, but that figure sounds too low to me.
Those reports are only cases that were reported in newspapers. Lots of cases don't get into the newspapers.
Back in the 1960s, newspapers had a taboo on stories about police abuse. That came up during demonstrations against the war in Vietnam, and counter-culture issues generally. I'd go to a non-violent demonstration, get beaten up by the cops, see other people get seriously injured, pick up the newspapers the next morning, and see a report on the demonstration written exclusively from quotes from the cops, with no mention of police violence. There was a newspaper called the East Village Other that used to print photographs of cops beating up demonstrators that the regular newspapers wouldn't print.
One reason for that was that the cops supplied reporters with news about crime, and the reporters didn't want to alienate their sources.
The cops used to beat up black people all the time. It was only when they started beating up privileged white kids that it became an issue.
The big change came in the 1968 Democratic Convention in Chicago, where Mayor Daley decided that the First Amendment didn't apply to people who disagreed with him. The great thing was that a lot of the out-of-town reporters -- the same guys who had been ignoring police brutality up to then -- got their own asses kicked by the cops. It was in all the national newspapers, in Life magazine, on TV. It sort of broke the taboo.
But if you get beaten up by the cops, even if you file a complaint, and you call up a newspaper reporter to tell him about it, the chances of his doing a story about it are pretty low. A lot of these caught-on-video cases didn't make it into the newspapers until the video came out.
Here in New York City, there was lots of police misconduct during political demonstrations -- against the Iraq war, against the Republican Convention, and now Occupy Wall Street. Now a lot of it is caught on video. They even had a high-level office, Anthony Bolognia, get caught on video spraying protesters who were obeying all the laws.
And in my personal contact with cops on the street, I've found a lot of them to be rude, abusive bullies. I approach a cop in with a polite request, and his attitude to me is, "fuck off."
So you get points for looking up the data. Next step -- validating the data. I think the misconduct rate is much higher.
Nixon's Secretary of Health, Education and Welfare was Patrick Moynihan, who was a drunken liberal.
That's right, Bryn Mawr has a good biology program.
But what is it, $55,000 a year? http://www.brynmawr.edu/sfs/cost/cost_index.html That's more than my relative is paying at her big expensive school. They'd have to be very generous to make it affordable.
She has a lot of good science courses in their standard concentration, including biology and chemistry. The tragedy is that I saw a list of unemployment rates of college graduates with different majors, and biology majors weren't doing too well. There was a time when a biology major would be welcome to teach in high school or even elementary school, and those who wanted to could go into health care, agriculture, etc. or even research. The economy is failing. We're in the middle of a biotechnology revolution, we're finding new drugs to treat major diseases, we need to understand science just to be functioning citizens, and biology majors can't get jobs.
Do you know that tuition in Quebec is $2,200? http://oncampus.macleans.ca/education/2012/09/20/its-official-quebec-tuition-hikes-are-history/ I wonder how much it is for foreign (American) students. As a bonus, you learn French. The French-speaking students killed a tuition hike because they demonstrated against it. The English-speaking students got a tuition hike. I heard a Canadian say that the English-speaking students pay high tuition, and say, "Compared to the US, this is pretty good." The French-speaking speaking students pay high tuition, and say, "Compared to France, this sucks." I wish our students were demonstrating in the streets, although I have to give them credit for Occupy Wall Street. Which the Canadians helped us organize.
Furthermore, even if old medical records are almost always useless, the one-off case where they could be useful might save someone's life. The theoretical benefits exceed the record-keeping costs because, frankly, life is more valuable than space saved by destroying a bunch of papers.
Those were the words I was looking for.
Real example: Suppose you have a chest x-ray and the doctor notices a spot on your lung. It could be cancer. He wants to do a (dangerous) biopsy. As it turns out, there are lots of spots on peoples' lungs. If you have an 8-year-old chest x-ray, you can look it up and see if the spot was there. If it was, and it's not growing, you know it's not cancer and you can skip the biopsy.
Hell, it's useful for a doctor to know what you weighed 8 years ago, and what your height was. Suppose you lost an inch in 8 years. You'd want to find out why.
It's true. In New York State, the retention requirements for medical records are 7 years. It's ridiculous.
Actually, cardiologists do treat cancer patients, because many of the cancer treatments cause heart damage.
But to your original point, it is true that hospitals turn away cancer patients. Here's a well-documented example. http://online.wsj.com/article/SB118781024289705455.html Remember, hospitals are required under Medicare rules to accept people in an emergency and stabilize them. They're not required to treat them for chronic conditions.
You say UCSD isn't like Texas? I'm not there, so I don't know for sure. But I do remember a letter to the New England Journal of Medicine. A doctor was addressing the claim that free-standing radiology clinics made x-ray services more accessible. She called up several free-standing clinics, gave them symptoms of a treatable brain tumor, told them that her doctor had suggested that she get a CT scan, and asked them if they would accept her if she couldn't pay. They refused, and suggested that she go to a University of California hospital. The doctor said that that hospital was her own institution, and she knew that their CT scanners were booked solid and weren't available for people who can't pay. (She called the centers again, gave them the name of the insurance plan she actually had, and asked them if she could come in for a (useless) CT scan for a sprained ankle. They offered to schedule her immediately.)
OK, that was a while back, before CTs were overbuilt. The NEJM had a recent article in which they did something similar. They had people call doctors, claim they were on Medicaid, and describe symptoms which would have been life-threatening. Many of the doctors refused to take them.
One last point: The cost of the medical malpractice system is about 2% of the total cost of health care. The malpractice crisis is to a certain extent bullshit propaganda propagated by insurance companies as an excuse to raise their premiums.
So perhaps it's more accurate to say "refusing to provide basic medical care (up to $x in cost) due to inability to pay is immoral." In that respect the U.S. is already there - it is illegal for hospital emergency rooms to turn away patients due to inability to pay.
Not quite. First, it's not illegal. If hospitals choose to get Medicare and Medicaid (as most do), they're required to admit people in an emergency and stabilize them. Then they can kick them out, and often do. A hospital can turn away a patient who is dying of cancer, until she's in an immediate crisis. Then they stabilize the crisis, and kick her out again. http://online.wsj.com/article/SB118781024289705455.html
Second, they can send the patient a bill. If the patient doesn't pay, they send it to collections. There are collection agencies which will hound the patient for decades, seizing their bank accounts and paychecks.
You've failed to mention that both systems will let folks with cancer die. Socialist medicine has proven to fail (Canada), and the steps we've taken towards it in USA have failed
Absolutely false. There have been many studies comparing the health care system in the US and Canada, and they all come to the same conclusion: Health care in Canada is just as good as health care in the US, and sometimes better.
Here's one: http://www.openmedicine.ca/article/view/8/1 A systematic review of studies comparing health outcomes in Canada and the United States (Basically it says that the outcomes are the same in both the US and Canada, but the US costs twice as much.)
There's a Wikipedia article comparing the US and Canadian health care systems. They link to dozens of studies, which overwhelmingly come to the same conclusion.
There are also studies comparing the US to other health care systems. They come to the same conclusion too.
There's one exception. When epidemiologists make international comparisons, they have to compare black Americans separately, because their health care is so much worse.
Somebody has to pay for it (before you say "government", where does gov't get its money? That's right, it's your money and my money).
Somehow conservatives think it's a great insight to tell people that their own money goes to pay taxes. Everybody knows that. I'm happy to pay taxes if I get something worthwhile for my money.
The issue is whether you would rather pay $5,000 in taxes, or $10,000 in private insurance premiums, for the same health care. I'd rather pay $5,000. Who would rather pay $10,000? Hands?
Not true. I called the New York State Department of Health about that.
I don't have my notes handy but as I recall, doctors are required to keep a patient's records 7 years after they stop treating him, and hospitals are required to keep their records longer, I think 30 years.
It's a ridiculously short period of time. I think the 7 years comes from the statute of limitations for malpractice. The 7 years is to protect the doctor, not the patient.
First you'd have to get your records from your doctor -- and keep them up to date, every visit.
My doctor's office charged me $1 a page. They charged $15 for a CD of my x-ray.
If you have a chronic disease, your medical records can get very detailed.
Things get lost. Homes get burned down or flooded.
The doctor is a professional, and one of his required skills is to keep records. He hires consultants to make sure his records are kept properly.
I'm an amateur. If I wind up in the hospital unconscious, how can I tell anybody where my records are?
If you give people the responsibility of keeping their own medical records, those records are going to get lost.
That's why it's the doctor's responsibility to keep records.
Friend of mine got an X-ray.
The pulmonologist told him he had a spot that "could be cancer," and he had to get a lung biopsy "to be sure."
He had an x-ray several years ago. If he could have gotten it, the radiologist could have compared the 2 x-rays to see whether the spot was there years ago. If it was, and it wasn't growing over several years, then it wasn't cancer.
BTW, lung x-rays always have spots. It sounds to me like the pulmonologist was running a scam, giving a lot of unnecessary and dangerous biopsies.
In general, it's often important to know whether something is new or whether you've always had it.
It amazes me that doctors aren't required to keep medical records for basically the life of the patient. A medical history is the most important part of an examination. Hopefully, with electronic records, it will be cheap enough to keep them forever.
I went to a lecture on Medicare, by a guy who now works for a union and used to work in all sides of the insurance business.
I just looked up my notes.
He said hospitals have a list price which is 12 times Medicaid. Medicaid is the cheapest, and some doctors and hospitals claim to lose money on Medicaid.
The highest prices are for foreigners who come to the US for medical treatment. Usually they can afford it. If they couldn't afford it they would go to Costa Rica.
Insurance companies get discounts.
Individuals also get discounts if they ask for it. Sometimes, they can also get a large portion of the bill, or all of it, written off if they don't have the money. Some hospitals are greedy, though, and will send unpaid bills to collection agencies who are known for being tight-ass.
If you're really poor, you can be eligible for Medicaid, but the income level is so low -- $6,000 a year -- most people wouldn't qualify.
maybe hire him a hooker.
Or get a volunteer.
I'm saying that in every human society that has survived, people voluntarily cooperate with each other and care for the less fortunate or less successful.
This is not slavery, this is voluntary cooperation. Cooperation is conserved throughout species, so it's likely to be necessary to survival.
You can read the enormous literature on cooperation in human cultures, by economists, evolutionary biologists, sociologists, and others, in Science magazine or in the peer-reviewed journals of your choice. Or maybe you can catch it on the Discovery channel.
You're gambling your life that you're not only more skilled and productive than your peers, but that you always will be.
If you're wrong -- and many people have been -- you'll end your life broke and living off the charity of others, including the government. If the Republicans and Democrats keep on going the way they're going, that charity will be very stingy.
Maybe you're really that smart. Maybe it's the Dunning-Kruger effect. I can't tell.