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Doomed To Fail -- By Design

If anyone out there is still wondering if ObamaCare's ultimate goal is to destroy the private market for health insurance and force everyone into a public "option" (bad word there -- "option" implies "choice," and there will be no choice here), let's just drive that final nail into that coffin.

Under the terms of ObamaCare, insurers must allot 85% of premiums they receive towards care for the insured. And just to make things more interesting, they have to do that individually, on each and every policy, not overall or by average (they can't add up all their premiums and make certain that 85% of that goes back to customers' care). Which locks them into a 15% maximum profit.

Pretty good, in theory. Hell, most insurance companies make less than a third of that right now, so that's a good deal for them, right?

Suckers.

The theory behind insurance is pooled risk. Some people will "overuse" their insurance, costing more than they pay in premiums. Others will "underuse" it, and they will make up the losses. The reason this is a good bet for the customers is that no one can know for certain which category they'll fall into ahead of time. The insurance companies, through some accounting magic that's just this side of psychic, can calculate just how much the overall costs ought to be and base their premiums on that number.

Now here's how ObamaCare utterly destroys that system that virtually guarantees not only survivability, but profitability.

First up, those who "underuse" their insurance will totally screw up the system. I know a guy who lost his primary care physician a few years ago, and went over a year without a new one. In that year, though, he kept his insurance going. That means for one whole year, he paid his premiums and didn't get a single benefit back. The insurer paid 0% of his premiums towards his health care -- by his (stupid) choice. That simply would not be allowed under ObamaCare -- the insurance company would have to find some way of giving him back his money, or pay a hefty fine.

Second, the 15% is the "ceiling" on profits. There is no floor. As noted, some people "overuse" their benefits, and they actually cost the insurance company more than they pay in premiums. A run of bad luck by the insured could wipe out any and all profits for the entire pool.

Third, the not-more-than-but likely-considerably-less-than-15% has to cover all the costs of the insurance company. All overhead has to come out of that artificially capped but not guaranteed margin. And that one is the real killer.

For example, as former Guest Wizbanger Rob Port noted, the costs of investigating and finding fraudulent claims can't be charged as part of the 85% that must be spent on customers.

Not only will fraud investigation have to come out of the 15%, so will any and all accounting -- including the reams and reams and reams of paperwork (even if electronic) that will be required for the insurers to prove that they are in full compliance with every single rule of ObamaCare.

Such as documenting that every single policy holder individually received at least 85% of their premiums' worth of health care.

And let's not forget the costs of lobbyists to stay on the good side of the Powers That Be that seem hell-bent on destroying the private insurance industry. We've already seen that contributing healthily to the Democrats can buy a certain level of "protection."

I'm currently choosing my health care plan for next year. I have three different plans to choose from (or none, but that's not an option for me and my wonderful health issues), as well as differing levels of vision and dental. And within those plans are variables that don't apply to me, but are there anyway (dependents, for one). And my employer has, within our subsidiary of Very Big Corporation, about 20,000 people. (And we make up about 7% of VBC's total payroll.)

And this year, my company got clever. It took bids from several insurers, and then chose two to provide coverage. So they're competing against each other, with hopes of getting the whole contract next year.

Let's say that under ObamaCare, 12,000 my colleagues buy into the company's health plan, divided evenly among the three plans. (The remainder are covered through spouses, partners, or other family, or get on a "public option" plan. I'm just pulling that number out of my butt here.) That means that the insurance company has to keep 12,000 individual records that they can produce, on demand, to show that every single one of those customers got back at least 85% of what they paid in premiums. They can't just pull out a single spreadsheet and say "here, we took in a million dollars on this plan and spent $900,000 in direct care, so we're good."

This is what you get when you have people micromanaging private businesses when they've never run anything.

There's an old principle that it's always easier to destroy than to create, and it certainly applies here -- it's a hell of a lot easier to destroy the private insurance business (and force people to be dependent on the grand, benevolent, efficient, eminently trustworthy federal government) than to create a more useful and efficient system.

And there's an old saw that one should never ascribe to malice that which can adequately be explained by stupidity (or ignorance, or incompetence -- there are plenty of variants that all boil down to the same thing).

I've reached the tipping point where I can no longer excuse the flaws of ObamaCare as stupidity or ignorance or incompetence. It's simply too complex to have "spontaneously generated" or "evolved" into its current form -- there has to be an "intelligent design" behind it. Quite frankly, if someone were to be tasked with coming up with a "health insurance financing reform" plan that would lead, stealthily but inevitably, towards destroying the current system, putting all private insurers out of the health insurance business, and the demand of a government-run universal plan, they couldn't have done it any better.

Repealing ObamaCare quite frankly, ain't gonna happen before 2013 at the least. But defunding it -- starving it of the literal rivers of cash it needs to function -- is certainly a possibility, especially if Republicans take back the House (which is where, Constitutionally, all tax and spending bills have to originate).

I'm not that fond of my insurance provider. But I have more trust in them -- especially since I know they'll have to compete to keep the contract next year -- than I do in the federal government to take over and run the health coverage of everyone in the whole country.

And anyone who thinks the government can and will run that more efficiently, fairly, and honestly than private industry is simply too crazy, stupid, or power-lusting to be trusted.

Correction: Apparently, "policy" in this context does not refer to the individual policies issued, but the entire plan -- which mitigates but does not eliminate the headaches that will be caused by this micromanagement on behalf of the feds. Personally, I am relieved that the geniuses behind ObamaCare aren't quite as malignant as I had presumed.


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Comments (27)

I've always wondered who wr... (Below threshold)
BlueNight:

I've always wondered who wrote it in the first place. A 2000 page bill shows up like Athena from the forehead of Zeus, and nobody asks who actually wrote the durn thing.

And it happens again a few months later!

I could understand it if the entire text of the bill was laid out on a campaign website for all to see, before an election, as a promise to the voters, but...

2000 page bill outta nowhere!

Here's that /i you're missi... (Below threshold)
SCSIwuzzy:

Here's that /i you're missing

Italics fixed. Sigh... ... (Below threshold)

Italics fixed. Sigh...

J.

C'mon. Requiring that 85% ... (Below threshold)
RefudiateObama2012:

C'mon. Requiring that 85% of the premium goes to actual medical care DOES NOT equate to 15% profit. What about overhead costs? What about regulatory costs?

Under the new law, health insurance is NOT insurance, it's PREPAID MEDICAL.

Anyone with any knowledge of business accounting understands this.

Given that our current enti... (Below threshold)

Given that our current entitlement system burns up around 70% of its federal budget on bureaucratic costs, I wonder how anxious the Democrats would be to mandate that the GOVERNMENT must also allocate 85% of any health care-related dollars it collects specifically toward medical treatments?

No, I'm not holding my breath either.

"Anyone with any knowled... (Below threshold)
JLawson:

"Anyone with any knowledge of business accounting understands this."

Well, that lets out 90% of Congress... If they can't figure out how to run the country on $2 trillion a year, how the heck do they think they can mandate how insurance companies run?

The more I find out about t... (Below threshold)
Oyster:

The more I find out about this abomination of a bill, the more I hate it. Really, why don't they just go ahead and assign some petty bureaucrat to stand over each of our shoulders at our jobs/kitchen sinks/steering wheels/etc and tell us, "You're not doing that right. Do this. Stand over here. Hold your mouth this way." It's what they want. Quit beating around the bush and lying to us and sneaking and just be honest. They're just petty little dictators.

It has never ceased to amaz... (Below threshold)
George True:

It has never ceased to amaze me how a group of politicians and their leftist policy wonks in DC think they somehow know more about health insurance than.....the insurance companies. As an insurance agent and independent broker for the last 22 years, I have accumulated a lot of knowledge about health insurance. I know a hundred times more about health insurance than anyone who was involved with writing this abomination of a bill. And on occasion when I talk with the people who run the companies whose products I sell, I realize that I don't know a fraction of what THEY know about health insurance. And yet, these self-appointed "experts" in DC somehow think they know more than these folks.

When you mandate that insurance companies incur X amount of losses each year, and when you require those companies to issue full coverage to anyone regardless of pre-existing conditions, you could call the resulting "product" a lot of different things, but it is most assuredly not insurance. Way back when I took classes in order to get my insurance license, the very first concept that was introduced on the very first day was the definition of insurance. Insurance is defined as a contract whereby the insured agrees to incur a small but certain loss (in the form of premium) in order to shift the risk of a potentially devastating loss to the insurance company. The insurance company agrees to take on the risk of that potentially large loss in exchange for the premium. That's it. That's insurance.

The job of a health insurance company is not to see that each policy holder receives X amount of health care. it is to assume the financial risk of a catastrophic health related event. In the individual market, there are two entirely justifiable reasons that health insurance companies screen out people with unacceptable pre-existing health conditions. Obviously, one reason is so that the insurance company does not take on so much adverse risk that they themselves become unprofitable or go out of business. The second reason, and one you never hear mentioned by the pinheads in DC, is that it would be fundamentally unfair to the great majority of policyholders who do not overuse the system. If the company takes on too many insureds who are guaranteed to overuse the benefits, it necessarily will greatly increase the premium that must be charged to all of the other insureds. You cannot change this equation. You might as well try to repeal the law of gravity. And yet, the very leftists who always want "fairness" at any cost, don't see the irony that they have caused a monstrous unfairness for the great majority of people by forcing this National Socialist health care bill upon us.

There is no question that the bill was designed to eliminate private health insurance companies by making it impossible for them to make a profit. Generally, even the most lean and mean health insurance companies use 15-17% of premiums for operating costs. That includes paying the rent or mortgage on their building, utilities, paying the salaries of the hundreds or even thousands of people who work for that insurance company, advertising, marketing, and paying commissions to evil profit-driven agents like me. So if the mandated loss ratio is 80% for the individual market (85% for the group market), that means that in the group market, it is guaranteed that the insurance company will absolutely not make a profit, and will probably run at a loss, and a company in the individual market, if they are really, really good, and also at least a little bit lucky, may just break even, or possibly even make up to a 3% profit. In the words of the great philosopher Homer Simpson.....Woo-hoo!!

The only way health insurance companies can survive is to raise premiums dramatically. We are already seeing this, as two of the mandates of Obamacare have already kicked in. Insurance companies must now let adults stay on their parents policies till age 26, and they can no longer deny new coverage to ANY child under the age of 19. So anybody who has a child who has Type I diabetes, or congenital heart defects, or leukemia can now go to any health insurance company and get a policy for next to nothing, and the insurance company is suddenly responsible for paying out hundreds of thousands of dollars on that child's care. The only way for the insurance company to survive that even short term, is to substantially raise premiums on everyone else. In recent years, I have seen many insurance companies simply get out of health insurance, and concentrate on other lines (life, disability, long term care, etc) where they can survive and prosper in the long term. If Obamacare is not ultimately repealed, we will see many more companies exit the market over the next several years. Then the Democrats will say, "We tried to level the playing field, but those EEE-vil insurance companies just wouldn't cooperate. So now we have no choice except the public option".

As much as the Communists, er, I mean Democrats have demonized the insurance companies, it was never the insurance comnaies who were driving prices. It was and always has been the health care providers. The insurance company is just the one paying the bill. The only way to ever bring costs down to where they should be is to have a truly free market in health care, which is something we have not had in a very long time. Consumers should be able to shop around for the best deal on health care, the same way we shop around for the best deal on car insurance, cars, electronics, and everything else we buy.

Several years ago, a friend of mine needed hernia surgery. At the time he was covered under a very good group health plan, and he got the surgery with almost nothing out of pocket for him. But his health plan was billed $15,000. I checked around, and discovered that an uninsured person who was willing (and able) to pay cash up front, could have had it done for between $2500 and $3900. So that was the real price of that surgery, Not $15,000. Very recently, that same friend needed hemorrhoid surgery. He no longer has health insurance, as he no longer gets enough hours each quarter to qualify for the group plan. I looked into some inndividual plans for him, but because he is 60 years old, even high deductible plans were a bit pricey, so he just went without. Anyway, the quoted price for the surgery was almost $10,000. The surgeon and anasthesiologist wanted $1500, and the day surgery center wanted $8000. When he explained that he had no insurance, and that he would pay cash, the surgeon discounted his fee to $500, and the day surgery center dropped their price to $2500. So $3000 was the real price for that particular surgery, not $9500.

This is what has been driving the big increases in health insurance premiums for many years now. The best, and ONLY way to bring down prices is to have consumers in charge of making their own health care choices, just like my friend Mike did recently. Because what screws it all up is having a third-party payor (the insurance company) in between the consumer and the provider. HSA plans work great for this. But the Democrats hate HSA plans, precisely because they put consumers in charge and NOT the government.

The ramming through of Obamacare never had anything to do with fairness, or cost control, or even getting people with pre-existing conditions covered (the insurance industry was already beginning to do that, and at a reasonable price). All the problems they ostensibly wanted to solve could have been solved without the government needing to take over anything. It was always about control, and had little if anything to do with improving health care or lowering costs. If Obamacare is not defunded and ultimately repealed, it will dramatically increase costs for everyone, and it will reduce actual health care to the point that many of us will ultimately die sooner than we needed to.

Jay:Are you sure i... (Below threshold)
engineer:

Jay:

Are you sure it is 85% on each policy? If I pay in $10,000.00 a year in premiums and only have 6 office visits at $150.00 a time, does that mean the insurance company will have to refund me about $9,000.00 to meet the 15% overhead limit? Or will they force me to have an $9,000.00 colonoscopy against my will?

Then next year I break my hip, and have a $35,000.00 hip replacement and rehabilition for my $10,000.00 premium. I guess the insurance company will have to either bill me additional premiums, shaft the hospital by only giving them $8,5000.00 instead of $35,000.00, or simply quit selling insurance.

Then I can get on the free government health plan! And maybe even have my rent and gas paid for....

George True, you are correc... (Below threshold)

George True, you are correct that health care providers routinely bill insurers based on the maximum amount they will pay for a particular procedure, rather than based on the actual cost of the procedure. But part of the reason this is done is because hospitals need a way to make up revenue for patients who cannot afford to pay anything, or who only have Medicare/Medicaid, which in many cases pays far less than the actual costs of medical treatment due to payment caps.

A member of my family works in administration at a local hospital, and has seen the system write off six-figure hospital bills for patients with no insurance or only Medicare/Medicaid.

The whole system is completely out of control and rife with fraud and red tape. Obamacare will only compound the problem because it does virtually nothing to make the existing government health payment systems more cost effective or efficient.

"Underusing" insurance is a... (Below threshold)
John S:

"Underusing" insurance is an interesting term. Insurance is supposed to be underused--that's why it's called insurance. For example, I've been driving 40 years. I've never had an accident nor filed a claim. But I've still paid almost $100,000 for auto insurance over 40 years. And I also paid for health insurance for the past 45 years, and I've seen a doctor twice in that time. Is Obamacare going to send me a half-million dollars so I am even?

Deliberate failure of Obama... (Below threshold)
GarandFan:

Deliberate failure of ObamaCare is a feature, not a bug.

As for 'who wrote that monstrosity'? The same people who are pushing for government-run health care.

"...write off six-fig... (Below threshold)
John S:

"...write off six-figure hospital bills for patients with no insurance or only Medicare/Medicaid."
Except those six-figure bills almost certainly were unadulterated bullshit. A hospital bed should not cost $15,000 a day. I recently had emergency retina reattachment surgery. I was expecting a bill for $30,000 but was shocked to learn the operation was $3,500. Then came follow-ups: every week or so the doctor charged $1,025 to my insurance for "tests." And my insurance company wouldn't pay much of it. So I'm getting $550 bills in out of pocket costs. Then the assholes I worked for fired me for lost time. (Apparently, I was supposed to work with stitches in my eye.) After 16 weeks of unemployment ($280 week), I got a job as a cook making $250 a week. I stopped going to the doctor, I can't afford their bullshit charges. I'm not sure how I'm going to buy the mandatory $2,500 month Obamacare insurance plan after 2014. I'm hoping for a new higher paying job as Guillotine operator.


I have lived and worked in ... (Below threshold)
Myronhalo:

I have lived and worked in South America for over 35 years, having lived more than 7 years in three different countries, and visited most of the others.
Believe me, you don´t want a government like most of the ones down here. You don´t want government health care because if you saw it you would loathe it. It is basically for the poor and extremely primitive. It is better than nothing, but not by much. When something is free, it is usually worthless or has strings attached.
Big, centrally-controlled governments are terribly inefficient (I am an Industrial Engineer which means trying to find the most efficient, cost-effective means to make something). These Spanish off-spring governments take money from everyone, and after running it through a filter with hundreds of thousands of public employees, they give some of it back. Not enough to really provide for someone, but enough to keep them dependent on the government dole.
People hang around the dripping faucet hoping for some water, but they never get enough.It would be much better to turn the faucet completely off than to create false hopes and dependence on something that loses more than 50% of the water in the piping system.
What amazes me to see people so dumb is for Latins who escape the failing governments in their countries and emigrate (either legally or otherwise)to the USA looking for better opportunities, then turn around and vote for or support the kind of government they escaped from. Stupid, stupid, stupid.
A government that "gives you everything free or subsidized" is a government that will make you it´s serfs, destroy all your freedoms and
control every aspect of your life.
I wish I could tell this to all the Latins who are voting for Obama and the Democrat big-government machine.
And the Black people are no different in being led down the path to absolute dependence by the Pied Piper. They don´t show much intelligence or wisdom when they choose that which will ultimately destroy their dignity.

I had the same thought as e... (Below threshold)
john:

I had the same thought as engineer #9. I don't have time to investigate thoroughly right now, but Jay's characterization seems wrong at worst, and incomplete at best.

If you're sourcing from Rob Port's post then I believe you may be misconstruing him. He wrote:

What's more, these insurance commissioners also decided that insurance companies must apply the 85% mandate to each premium individually. Meaning that 85% of the premiums on each individual policy must be spent on medical services, not 85% of all premiums collected.

He claims the 85% applies to each policy, not each individual. A policy can insure 12,000 people. In that case, the 85% target would be aggregated across all of the insureds.

Here's another report that seems to support that:

Under Obamacare, policies that cover large businesses will have to achieve an MLR of 85 percent, while those for small businesses and individuals will have to achieve an MLR of 80 percent.

thehill.com/blogs/congress-blog/healthcare/120067-obamacare-will-significantly-reduce-choice-of-health-plan

"especially if Republica... (Below threshold)
914:

"especially if Republicans take back the House (which is where, Constitutionally, all tax and spending bills have to originate)."


As we have all witnessed. Barry has ways around the constitution. After all, he's a bonafied scholar.

john, I think your characte... (Below threshold)

john, I think your characterization of "policy" is correct; no one could ever set up a system in which 85% of every insured's premium went back to pay medical costs. On the other hand, we often over-estimate the intelligence of Congress ...

Even so, mandating that only 15% of premium revenues can be used for expenses is just insane. As I said earlier, I'd like to see the Federal government forced to pare down its bureaucracies for entitlement programs so that 85% of the Social Security, Medicare, Medicaid, AFDC budgets got paid out in benefits, with only 15% of the budged allowed for administrative expenses. Washington DC would completely come unglued.

Good post. Self-interest i... (Below threshold)
gary gulrud:

Good post. Self-interest is the motivation, one more time.

There is no doubt it cannot... (Below threshold)
Jim Addison:

There is no doubt it cannot work, but believing the Democrats are clever enough to design it thus deliberately belies our experience with them.

"Never ascribe to malice, that which can be explained by incompetence." - Napoleon.

#19But remember Gr... (Below threshold)
Brian The Adequate:

#19

But remember Grey's law:

"A sufficiently advanced incompetence is indistinguishable from malice"

So we are screwed either way.

Such as documenting that... (Below threshold)

Such as documenting that every single policy holder individually received at least 85% of their premiums' worth of health care.

As Michael and John have pointed out, this is an incorrect interpretation.

Jay Tea correctly assumes that the insurance companies would be out of business tomorrow and their stocks would be worthless today if this were the actual regulation. However, he didn't take the simple step to see that the insurance stocks aren't actually trading at 0 today and think again before writing this article.

Even so, mandating that ... (Below threshold)
john:

Even so, mandating that only 15% of premium revenues can be used for expenses is just insane.

Don't forget that insurance companies don't make their money from the margin of premium charged over payouts. They make it from investing the float.

Yoo-hoo, Jay. Where are you... (Below threshold)
john:

Yoo-hoo, Jay. Where are you? Going to do the honest thing and retract this post?

John: Both of your comment... (Below threshold)
George True:

John: Both of your comments are misleading and dishonest.

First of all, while Jay was mistaken about insurance companies being mandated to return 85% of premium to each individual insured, it is nevertheless absolutely true that they will be required to incur a loss ratio of 85% (80% for individual plans). In other words, they will now be required to spend an aggregate of 85% of total premiums they collect on health care for their insureds as a group. This amounts to a mandate at best to break even or more likely lose money on their insurance operations. In other words, it was put in the bill with the intent of driving insurance companies out of business, or at least out of the health insurance business. To the people who wrote this bill, and to a lot of the congress critters and senators who voted for it, this was viewed as a feature, not a bug.

Secondly, as someone who has spent 22 years in the insurance business, I can assure you that insurance companies most certainly must make money on the insurance side of the business, or sooner or later, they will be out of business. Yes, they do make additional money by investing the premiums that are not immediately paid out on claims, but so what? Any intelligent business would do this. That in no way means they could routinely make bad underwriting decisions without it bankrupting them eventually.

In recent years, Chrysler Corporation has made more money each year from currency trading than they have made by building cars. So just because they have that additional source of income, does that mean they should become subject to a new law that makes it impossible for them to ever make a profit again from building cars? But that is essentially what the health insurance companies have been saddled with as a result of Obamacare. Again, to the leftists and statists, this is a feature rather than a bug. I don't know how these people think money is made.

I find it hard to take crit... (Below threshold)
john:

I find it hard to take criticism from someone who calls me dishonest without citing a single allegedly dishonest thing I said, and then who claims as truth -- apparently realized by his ability to read minds -- that "it was put in the bill with the intent of driving insurance companies out of business".

John: "Yoo hoo, Jay! When... (Below threshold)
George True:

John: "Yoo hoo, Jay! When are you going to do the honest thing and retract this post?"

By that statement, you seem to be implying that Jay Tea's entire article is wrong or intentionally misleading. The only part that is factually incorrect was his mistaken impression that each policyholder individually had to be given 85% of their premium back in the form of health care reimbursement. In reality, the requirement is that an aggregate of 85% of premium be paid out for benefits. Other than that, EVERYTHING about the article is accurate and factually correct. So your demand that Jay do the "honest" thing and withdraw the article is at best misleading.

"Don't forget that insurance companies don't make their money from the margin of premium charged over payouts. They make it from investing the float."

I am willing to give you the benefit of the doubt and just assume you are simply misinformed about this. As I mentioned before, of course insurance companies make money on their insurance operations. And naturally they invest premiums that are not immediately needed for overhead or for paying claims. But if they make too many bad underwriting decisions that cause too much of a loss ratio (such as an 80% or 85% loss ratio) they will eventually be out of business. Investing the "float", as you say, will not make enough of a difference if their losses on the insurance side of the business are too great. Even the A rated companies will eventually run out of money if they incur a loss ratio of 80-85% for more than a few years. And actually, before that happened, the insurance commissioner of the state they are domiciled in would shut them down because they would no longer be able to meet their reserving requirements.

As far as your charge that I am claiming to be a mind reader.....perhaps I have made the mistake of ascribing to malice that which can be explained by mere incompetence. Perhaps the people who wrote this abortion of a bill are simply so galactically stupid that they truly did not understand that no insurance company can withstand an 85% loss ratio indefinitely. But I doubt it. Even they are not quite that stupid. Over the last several years, I have seen too many video clips of Jan Schakowsky, Hillary Clinton, Alan Grayson, Nancy Pelosi, Henry Waxman, Russ Feingold, and many others coming right out and saying that their intent in creating this bill was to make it so difficult for insurance companies to survive that it would lead inevitably to a public option. They knew what they were doing. But you go right ahead and keep thinking that this was not intentional.

The only part that is fa... (Below threshold)
john:

The only part that is factually incorrect was his mistaken impression that each policyholder individually had to be given 85% of their premium back in the form of health care reimbursement. In reality, the requirement is that an aggregate of 85% of premium be paid out for benefits. Other than that, EVERYTHING about the article is accurate and factually correct.

OK, so EVERYTHING is factually correct... except one of the central themes of his post, that he mentioned multiple times, cited as his real-world example case, and that was the only part of his post that he felt so strongly about he emphasized in bold type.

Fine, I'll concede to you that his byline at the top of the post was factually correct. Other than that, not so much.




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