Every Blue down in Blueville liked Healthcare a lot...

But the Pinch, who lived to the left of Healthcare did NOT!

The Pinch hated Healthcare, the whole Healthcare system!

Just don't ask why, only he had the wisdom.

 

It could be his head was screwed on to the left,

It could be his ears were plugged up and deaf.

But I think the most likely reason of all,

Was that he thought the Blues brains were much much too small.

But whatever the reason, his head or his ears,

At enrollment season, Pinch took glee in their fears.

Staring down from his Tower he took some delight,

As they worked through enrollment and pondered their plight.  

"They're struggling, their choking," he coughed with a sneer.

"The deadline's approaching.  It's practically here!

Then he growled with his tiny heart nervously pumping,

"Each year they get an insurance thumping!"

"With enough pain in Healthcare, they'll eventually see...

The only way to Healthcare is directly through Me!

But every year undeterred, the Blues found their way,

To Healthcare solutions and new ways to pay.

HSAs, HRAs, an alphabet soup,

Consumer Driven Health made the Pinch feel like poop!

 

Then his brain started working, he came up with a thought.

A horrible, dreadful and awful old thought!

"I'll run for office, then they can be bought!"

"I'll promise them Healthcare.  Every man, woman, child.

We'll tell them it's FREE, he said with a smile. 

So he threw on his coat, and dragged along Mrs. Pinch,

With his trusty bullhorn, this would be a cinch.

 

A tight message, Ms. Pinch, and his bullhorn in hand,

He blazed into Blueville with promises grand.

FREE healthcare for all, if you all vote for me,

They lined up with big smiles and voted with glee.

Every Blue man and wife, cast their ballot for Pinch,

He won by a landslide, by more than an inch.

He cleaned out the Cabinet as quick as a flash,

Put them all in a bag and out with the trash.  

Into his new post, he jumped rather nimbly,

And anyone in his way, he rammed up the chimbley.

But while bagging and ramming, he heard a small coo,

He spun quickly around and there stood a Blue.

A wee little Blue, named Sweet Mary Lou.

 

"Is this some sort of micro, terrorist," he thought?

"Or maybe a rodent that needs to be caught?"

Without batting an eye, he asked, "What is it dear?"

"I'm here to take care of you, you have nothing to fear."

Then Mary Lou Blue, this sweet little tart

Looked straight in his eyes, then pulled at his heart.

"All the Blues, here in Blueville love you so much,

They want you to help them, but not be their crutch."

She said, "Dear Mr. Pinch, please don't act as our Mother,

Please stand beside us and be like our brother."

We want you to help us with Healthcare that's true,

There are so many, so many, things you can do.

Insurance companies need to be rid of their greed,

With some of their excess to help those in need.

Reward, those who are healthy with lower cost plans,

And breaks on their taxes, and more tools in their hands.

And what about good people whose health is not great,

But do all they can with what's on their plate?

They could use tools and insurance for sure,

But going broke in the process isn't the cure."

 

Then she paused for a moment and breathed deep some air.

Taken back by such wisdom, Pinch simply stood there.

But she was not through, little Mary Lou Blue,

The little Blue girl who was no more than two,

"Let all the Blue people, Blue employers and you,

Stand together and work all of these healthcare things through.

You see Mr. Pinch, the Blues are all very smart,

 And if you will work with them and for them, they'll all do their part."

 

With that Mary Lou Blue, walked out of the place

Mr. Pinch stood there standing, a strange look on his face.

For awhile Pinch stood there, with no place to go,

But he had an idea and it started to grow.

And what happened then...?

In Blueville they say

That Pinch realized Government healthcare was not the way.

That the Blues down in Blueville were pretty damned smart

And when faced with a challenge did take it to heart.

If all of the Blues worked together he knew,

That healthcare would not be reserved for the few.

So with newfound leadership they developed a plan,

That with carrot and stick brought healthcare to the land.

And when it was done, and the plan was released

He.....HE HIMSELF....

Got himself into shape, and Mrs. Pinch was well pleased.  

Dan Crowell represents the changing face of health and healthcare in America.  Dan is the street superintendent for the city of Lafayette, Indiana.  Now I don't know Dan but I read about him JConline.com, the online edition of the Journal Courier Newspapers of Lafayette and West Lafayette Indiana.

Both cities, faced with ever rising healthcare costs have joined together to save money on health insurance and to promote healthier employees.  One of the keys to their strategy is through employee engagement.  This goes beyond the health risk assessments that most city employees participated in this year, and  includes the formation of a joint city committee comprised of city employees to analyze the data from the risk assessments and then collaboratively determine which health issues to focus on through to promote more healthy lifestyles.

The city managers are looking at other ways to reduce costs and improve overall employee health, and have added HDHPs with HSAs as an insurance option for their employees in 2009.

This brings us back to Dan Crowell.  You see, Dan Crowell, Lafayette's Street Superintendent, is one step ahead of the game and is the city poster boy for what can be.  Dan, over the past couple of years dropped 100 pounds through regular exercise (and I would guess a more healthy diet, but the article didn't say) which he maintains to this day. 

Some folks can get motivated on their own, and others need a little help.  But in order for us to drive our healthcare costs down and our health up, it will take collaborative efforts between employees and employers, between insurance companies and individuals, between the Government and all of us.  Dan and the cities of Lafayette and West Lafayette, get it and are doing their part to become part of the healthcare solution.  A tip of the hat to them.

About the only things I know about Massachusetts have to do with beans (Blazing Saddles), a bunch of whiteys dressed up as Indians (wonder if they were wearing wigs?), and burning witches at the stake (now that's hot).

 Being from the Deep South, my purview of the rest of the country is somewhat narrow, and I suppose for every one of us, there is enough history, news, and politics in our own states to keep up narrowly focused and narrowly minded for a lifetime.  Thank God, I never had to spell Massachusetts in a spelling bee growing up, because that would have for sure thrown me out of the saddle.

Being interested in healthcare, I have been hearing for a couple of years about this movement by the state of Massachusetts to mandate health insurance for all of its citizens.  Besides finding the idea of it generally suspicious, I've really not paid much attention to it.

I stumbled across an article online in The MetroWest Daily News, written by guest columnist Jon Kingsdale.   Being from the South, I had no clue what market this paper served, so I checked the obituaries for the paper and saw such locals as Sudsbury, Falmouth, Framingham, and Rockland, Westborough, and Westchester.  While I didn't know the people or places, I figured out pretty quickly they weren't  from around here.  This was confirmed when I saw many seemed to have died in various branches of the U Mass Hospital system.

I suppose if I were some policy wonk, I'd also recognize the name of Jon Kingsdale, but I didn't and had to look him up too.  But not in the obituaries.  Turns out he is the CEO of the Massachusetts Health Connector.  Didn't know what that was either so I had to look it up too....

Honestly, I don't know how you folks in Massachusetts keep up with all this stuff, but the Health Connector is the state run agency that is in the middle of making sure all the good citizens of that state get health insurance or get fined.  Don't you just love Government?

Anyway, the short story on Massachusetts health policy is that pretty much all adults in the state have to have health insurance in 2009 or face fines.  I'm not sure about kids, but presume they have to have coverage too, but I'm guessing it would be difficult to collect fines from them.  And the fines are not small.  They could exceed $900 per year.

Citizens of Massachusetts can't just have any old insurance coverage, they actually have to have policies that provide them with certain standards of coverage.  As an aside, it is sad that there are policies out there that purport to provide coverage, but that in fact are crap and will do nothing but make an individual health crisis worse in the event it ever had to be used.

So where is the The Gradock Bulletin going with all of this?  We can read policy geniuses comment on this all day long, but our attention spans are too short.  We want your input.

We want to hear some normal people's perspective on this state mandate. Either individuals or employers trying to provide benefits to their employees.

Is it working?  What is it doing to healthcare costs?  Is it being administered efficiently?  Is it better than what was in place before?  Who is getting rich off of it?  Things like that.  

We have put up a discussion forum on the subject at HSAeducator.com in their Forum section and invite real people to share their experiences.  To tell the rest of the world, the real story.

And for all of us outside the great state of Massachuttes, to ask questions about the program.   Why?  Because it or some version of it could be "coming to a theater or drive-in near you."

To give those outside the state an idea of what those in Massachusetts must have in their insurance plans to avoid penalties, below is the list:     

• A comprehensive set of services (e.g., doctors visits, hospital admissions, diagnostic surgery, mental health and prescription drug coverage).
• Doctor visits for preventive care that are not subject to a deductible.
•  A cap on annual deductibles of $2,000 for an individual and $4,000 for a family.
• For plans with up-front deductibles or co-insurance on core services, an annual maximum on out-of-pocket spending of no more than $5,000 for an individual and $10,000 for a family.
• No caps on total benefits for a particular illness or for a single year.
•  No policy that covers only a fixed dollar amount per day or stay in the hospital, with the patient responsible for all other charges.
•  For policies that have a separate prescription drug deductible, it cannot exceed $250 for an individual or $500 for a family.

Folks, we want to know The Good, The Bad, and The Buttugly of healthcare in Massachusetts today.  Click Here to get to the Forum   -  You will have to register when you get there if you are not already.

  One thing everyone agreed on regarding the Obama presidential campaign was  that he picked his messages and stuck to them.  And one of the ones that stuck to me, in fact, with all the media coverage I felt like it was nailed to me with a hammer and sixteen penny nails, was the notion that if you liked the health plan your employer offered you could keep it, but if you didn't you could have the same insurance federal employees enjoy.  And for employers if they didn't provide insurance for their employees, they would have to contribute to a medicare type plan to cover the uninsured.

As I tried to read the tea leaves of Obama's healthcare reform, being the conservative guy that I am and generally distrusting of the U.S. Government, my interpretation of the above campaign message was that it cloaked  of a movement toward government run healthcare.  After all, healthcare in America is a multi-trillion dollar industry, power follows money, and the Government loves power.  Being somewhat cynical, I figure the underlying message of the stated policy was that if the new administration could get some traction around healthcare reform, it would make employee sponsored insurance so untenable for employers they would be forced to pay into the Government sponsored plan, and that would be the end of healthcare as we knew it.

But there is another possibility here, one that a conservative and somewhat cynical blogger hadn't really given much thought to.  There is an article in the November 17^th edition of Business Week entitled Heath Care-Immediate Relief From Rising Costs which made me wonder if rather than putting so much pressure on businesses their only option is to default into the Government plan, the Government might create enough incentives for employers to cover their employees meaning that less of the insurance market and burden would fall to the Government.

Personally, I think we need to tools to rely on ourselves when it comes to healthcare.  The Government needs to be an advocate for us, not control us or our employers.  Consumer Driven Healthcare, and specifically High Deductible Health Plans (HDHPS) and Health  Savings Accounts (HSAs) are tools the Government has given us.  Could they be better?  Absolutely, they are far from perfect.

Ron Klar, a guy way smarter than me when it comes to healthcare, the healthcare debate and fixing the problems related to our Nation's ills, wrote a terrific article just before the election entitled, AmericarePlans: A McCain-Obama Hybrid Proposal posted on Health Affairs, The Policy Journal of the Health Sphere.  Being the last guy on the grape vine, it took awhile for me to intersect with his article. 

I'm not going to regurgitate the article here as it is much better chewed, swallowed and ingested in its original form.

Klar points out, that one of the greatest challenges in any health plan, be it driven McCainanites or Obamians, is coverage for high risk individuals or those with pre-existing conditions.  He then goes on to outline a solution that, as the title of his article suggests is a Hybrid of both the Republican and Democrat healthcare platforms.

The thing I really like about Klar's plan is that he points out (without pointing it out) that we need to be aware that while we have been presented for months with but two options, we should not be bound by either the right or the left, but we should be unbound by our creativity.  We should be unbound by solutions.  We should be unbound from the box which politics so often seems to want to put us into.

It's a thoughtful and hopefully thought provoking read.  Check it out if you can. And if you want to learn more about Health Savings Accounts and High Deductible Health Plans, it's all right here at HSAeducator.com. 

....NOT! 

I saw a humorous YouTube video which led me down an interesting path of reflection and reinforced the extremes in thinking some people have on healthcare in America.   Healthcare is a complicated social issue, and to the best of my knowledge there is only one only perfect solution.  And that's  perfect health.

I've included the video here as it is humorous, but I present it with a large caveat.  Health insurance in America is indeed less than perfect.  It is kind of like owning a used car.  Most of the time it works and gets us where we need to go.  It might have a few accessories like power locks and windows that provide us with some creature comforts, but overall it's just not that pretty.  Sometimes it breaks down and unexpectedly costs us more than we have on hand expect to make it work which can be frustrating but not devastating.  And on rare occasion something major happens and the clunker leaves us high and dry, in the middle of some barren desert, without a chance of survival.

This video, if viewed in a vacuum suggests that health insurance companies are the cause of the problem, spawn of the Devil, the root of all evil (and healthcare problems).  The creators of the video would like us to buy into this premise and then blindly accept their healthcare dogma.

....But the video is funny.  Just take it with block of salt.

After watching the video I followed the link and landed on the Health Care for America Now website.  I felt compelled to read their story, which at an ideal level has some merit (qualitiy, affordable healthcare for all Americans), but at a practical level takes the incredibly arrogant, and naïve position that they are right and anyone who disagrees with them is wrong.  Their truth is a manipulated and contradictory truth at best.

Remember the video?  The one above that makes insurance companies to be the spawn of the Devil, if not the Devil himself?  Health Care For America disdains insurance companies, yet they basically suggest that if you are satisfied with your insurance you can keep it.  That suggests to me that they have either overstated their cause "insurance is not affordable for families...etc." or their true agenda is something else.

This organization states:

"Our government's responsibility is to guarantee quality affordable health care for everyone in America and it must play a central role in regulating, financing, and providing health coverage by establishing:...."

Aha, their agenda....

The thing that really annoys me about this organization is not their desire to improve healthcare for all Americans, but their suggestion that this is a problem for which the bulk of the responsibility for fixing it falls to the Government.  I love it that they are trying to expose social injustice and health issues, but it really frosts my gonads that they fail to suggest that Americans themselves are part of the problem.  That State and The Federal Government are part of the problem.  That healthcare practitioners are part of the problem.  That attorneys are part of the problem.  That big business is part of the problem.  The list goes on, and we nibbled around the edges of this a few days back in our article "The Unscientific Top Ten..."  Yet the face they put on it is one of insurance company greed; part of the problem for sure, but a small part of the problem.

 Government owned, run, and mandated insurance is a slippery slope.  In the end, if the Government is true to form, like that old used care, it will leave us broke and disheartened. 

What frightens me about Health Care For America Now is their proposal rings of the entitlement bell shrouded in the guise of a right.  Unfortunately, rights are entitlements the minds of many.  If healthcare is a right, then it needs to come with an enormous amount of personal responsibility, accountability and some level of sacrifice.  We need to take care of each other.  If we believe  the Government cares a rats about us, I believe we are sorely misguided.

We should treat healthcare must be treated as a privilege for there are people in this world far less fortunate than us who drink dirty water and live in homes with dirt floors and minimal shelter.  Our focus should be on health first and then on healthcare.  For more thoughts on this please read, "Mountains Part Deux."

I think the solutions to our healthcare challenges need to be more collaborative.  I believe organizations like the Healthiest Nation Alliance are healthier at their roots than say Health Care For America. We've shown this video before, but it is worth another look. 

If you have read this far, then you are thinking.  That's good.  Now think a little more about how you can change the world.  Too big?  Then think about how you can change your world or maybe your child's world.  Start with your own health and you will be on your way to better, more affordable healthcare. 

I have an HDHP.  When I go to the Doctor to have them look at the creatures crawling around in my throat, causing me to itch all over, or making my hair fall out in clumps, I am expected to pick up the full tab until I hit my deductible.   I even have a little stash of money, called an HSA to pay for it.  BUT, I don't pay a nickel when the Doctor is done with me.  Not immediately.

The Doctor has to put in a claim to my insurance company, the insurance company tells the Doctor how much they are going to pay, they then tell me how much I am supposed to pay, I then send the Doctor a check, the doctor tells the insurance company they received the check, and then insurance company tells me that the Doctor told them that they received the check.  If this laser-like process of precision breaks down in any way or God forbid, I don't send the check, honestly, I have no clue what happens.

For the past year, I have been writing for the Gradock Bulletin about health savings accounts, high deductible health plans, consumer driven health, healthcare and wellness and pretty much anything else that comes to mind that might be educational, worth a rant and/or is somewhat entertaining.

With that said, I have compiled Gradock's "Top Ten Reasons Why Healthcare Is So Friggin' Expensive!"  This is a very unscientific survey of one, but it points to a the gaggle of reasons that collectively (along with a few others I'm sure) that cause you and me to pay more when we go to the Doctor and put health insurance out of the reach of millions of Americans.

10.) We can't figure out how to spell "healthcare."

The fact that sometimes it is spelled as two words (health care) and sometimes as one scratches at the surface of inefficiency (it takes more keystrokes and kills more trees when spelled as two words)

9.) The right hand don't know what the left hand is doing:

See paragraph #2 above

8.) Americans are fat slobs:

Which makes us loveable and friendly, but contributes to chronic illness like heart disease, hypertension, and diabetes which cost us billions if not trillions of dollars a year in healthcare costs.

7.) State Mandates:

Did you know that your state may require insurance companies to cover certain illnesses no matter whether you are at risk of it or not, whether you are healthy or not, whether you care about the illness or not.  So for example, if you are a single male living in Arkansas or any of the other 20 states that require maternity coverage, you are paying, in your premium for someone else to have a kid.  Or if you live in Connecticut or any of 9 other states you get to pay for wigs.  Or if you are a non-smoker living in Maryland, you are paying for some lung burning smoker's, smoking cessation treatment when you pay your insurance premium.

6.) The uninsured and non-critically ill in hospital emergency rooms:

Emergency rooms, by their name and nature are set up to deal with emergencies, not the coughs of the illegals and uninsured, or the weekend colds of the insured.  This mindset may be compromising emergency rooms, and certainly is driving the cost of healthcare up for all of us.

5.) Regs on Meds:

My insurance company will not pay for, nor will they allow for money I spend on meds that come from Canada to count against my deductible.  Now some of this is to protect me from witch doctors, voo doo priestessesire and shady drug companies whipping up toxic drugs in oil drums on the streets of some third world country, and I understand that.  But part of this is driven by drug companies desire to tamp down competition.

4.) Three Card Monte Mindset:

Or in other words lack of transparency in healthcare.  Healthcare is set up so that we do not know what procedures, tests, and treatments cost, leaving us to guess where the most cost effective care is to be found.  And it is almost impossible to find the best doctors at the best prices in this environment.  There is some progress being made in this area with the establishment of minute clinics and services like outofpocket.com that are exposing the cost of healthcare which can help create more competition and ultimately drive costs down.

3.) "The Doctor's Handwriting" and malpractice law suits:

If the Pharmacist can't read the Doctor's hand writing and mis-dispenses meds or has to spend more time figuring out what the thing says, then we are talking time and money.  Or if the Nurse in the hospital gives the wrong dose or the wrong medicine to a patient, that can be a bad day.  Do you know that if a drunken, illegal alien with not a nickel to his name rolls into the hospital with his arm half cut off and doesn't like the way the attending surgeon sewed it back on, he can sue the surgeon?  Now I believe the guy has a right to sewing but not suing, unless there is horrific and obvious gross negligence.    

2.) Cleanliness is next to godliness:

Now I'm not a germaphobe but do realize how much stephastrepasyphacoctolis gets spread around because folks don't practice basic hygiene.  That lands folks in clinics all the time with preventable illness and, yes, drives the cost of healthcare up.

1.) What about executive compensation?

We can't let that one slide.  I'm all for people making money and if they make armored cars full of it that's fine it they are truly responsible for creating most of the value.  But I do have a tough time with guys who get paid huge sums of cash for what sometimes ends up to be short term value, or get paid huge sums of money when they screw up and get fired.  Hey, I could screw up any big publically traded company for way less than these guys get paid.  And what kind of money are they making?  Well I took a look at the AFLCIO database on executive comp and here are a few examples:  In 2007 the CEO of Abbot Labs was paid $33 million in total comp; the CEO of Aetna got $23 million total comp; the CEO of Merck got paid $20MM in total comp; the CEO of Humana got $10 million in total comp: the CEO of UHC got $13 million in total comp and the CEO of Cigna got $26 million in total comp.

These were the ten I was able to rattle off without too much difficulty and I know there are many more.  Feel free to comment on this article with additional reasons.  Maybe we can compile it and share it an another article or post it on this site's forum.

From 1861-1865, during the War Between the States, a wounded soldier laying in a field hospital bleeding to death from a horrific injury to his arm or leg would have it amputated in a few of seconds (repeat seconds) with a draconian surgical saw, with little antiseptic, and sometimes even with no anesthesia.  These were life or death moments and neither time nor tools existed to properly address the issues medically.  Split second decisions were made and  executed in attempt to save lives.   Hard to imagine in this day and time but in its time and under the circumstances these procedures probably represented "best practices" under the situation.

We have all have heard Senator Obama refer to John McCain as one who will preside over the country's, programs, policies and programs with a "hatchet."  He has stated that his competitor, will address the issues with a "scalpel."  In a perfect world, I would favor Mr. Obama's approach.  You can be sure, if I were to find myself bleeding to death from a potentially mortal wound I'd want be to be transported to the finest medical facility in the country, taken to the most organized, state-of-the-art and sanitary operating theater,  and attended to by the smartest most educated and experienced surgical team led by  the best surgeon on earth with a  steady hand and sharp scalpel.  Of course, in my perfect world, I'd want the best possible health insurance on the planet to pay for it.

Unfortunately, sometimes the bleeding and dying bodies pile up so quickly that to approach the problem with the laser-like precision is not only naive but wholly impractical.  As sad as it is, I think  our U.S. Government's bloated and Super Bowl-like spending policies, its self  centered corruption, and its inability to get things done; can be changed more quickly and effectively with a hatchet rather than the scalpel.

While I have come to respect  John McCain on many levels, I am not his biggest fan by any means.   And he may not be the greatest "surgeon in the world" and he may not yield  "the sharpest scalpel."  However, he has demonstrated time and time again that he is willing to put his country and countrymen before his own personal best interest.   I believe, when it comes to health, health care, health savings accounts, government stagnation, the economy, out of control spending, my personal freedom, corporate and government reform, protection of the environment, and the many other difficult and painful issues, we as individuals and as Americans face, there is really only one choice for me.  I'm not stoked about the hatchet approach, but I do believe McCain has a sharp hatchet, a steady hand, and the willingness to use it on himself if he had to help save the rest of us.

.......it's actually harder.

Remember a few years ago when this outfit called the X Prize Foundation paid $10 million for the first privately funded manned space flight?  Quite a contest.  Quite a feat.

Well yesterday, WellPoint and the X Prize Foundation announced a new competition offering $10 million for solutions that can impact positive change in health care cost and quality.

Nice prize.  Tall order.  But just damned cool.

Now if you are itching to sign up and want to know the details (read the rules-no doubt some lawyer is having fun with those), you'll have to wait until early 2009.

Just think for a moment.  Imagine if you will.  Here is a contest that embodies CDH not GDH.  Consumer Directed Health as opposed to Government Directed Health.  It recognizes that we are smart enough, creative enough, and have the ingenuity to tackle and solve some of the largest issues that confront us today.  We don't have to sit back and pray to Government for the answers.  I like that.

So there's all kind of buzz on the internet today regarding the Doug Holtz-Eakin's conference call on McCain's health plan over the weekend.  Basically, he wanted to set the record straight, or at least defend the McCain plan from the general assault that Mr. Barack Obama and Co. mounted against McCain's health care policy.  If you are like me, you're probably asking, "what is a Doug Holtz-Eakin and what does he know about anything?"

Holtz-Eakin is Sr. Policy Advisor to Mr. McCain, so I suppose that means he knows more about McCain's and Obama's health care initiatives than the average Joe.  On the call he suggested among other things that Obama's recent ad campaigns were "cynical and deceitful."  To read an entertaining overview of Holtz-Eakin's de-bunking of Obama's effort, please click here and enjoy.

Once you read the overview, you might be left wondering, how in the world is McCain going to pay for that tax credit he's proposing as part of his plan.  Good question and worth an answer.  The estimated price tag is somewhere north of a tr-tr-tr-trillion dollars (12 zeros if you are curious) over the next ten years and McCain, Holtz-Eakin and company believe it can be found in extracting efficiencies from Medicare and Medicaid.  They believe the plan can be cost neutral from savings elsewhere.

Now I commend McCain-Holtz-Eakin on creating efficiency.  Bravo I say, but we are all (well I assume we are all) a bit cynical about our Government's ability to create efficiency. 

One thing's for sure on this political issue.  Mr. McCain and Mr. Obama are, for the most part, on different ends of the spectrum on how they would address this big giant purple people eater called health care.  And suffice it to say, health care, regardless of which candidate is ultimately elected, is going to be a tough nut to crack.