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Health Care Reform

The Healthcare system in the United States is in desperate need of significant reform. Policy makers should take decisive steps to move today's bureaucracy driven, heavily regulated third-party payment system to a new patient-centered system of consumer choice and real free-market competition.

 

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November 20, 2009
Taxes Proposed to Pay for Health Care Reform
By Curtis S. Dubay
(WebMemo #2706)
The U.S. Senate's proposal for a government-run hostile takeover of the entire U.S. health care system includes a barrage of higher taxes.

 

November 20, 2009
High-Income Surtax: How Not to Pay for Health Care
By Karen A. Campbell, Ph.D.
(WebMemo #2707)
Congress is proposing a surtax on high-income individuals to help pay for health care reform that would burden the economy and slow its recovery from ...

 

November 16, 2009
The Legislative Trigger and the Public Health Care Option
By Stuart M. Butler, Ph.D.
(WebMemo #2700)
While the trigger idea may seem like a reasonable compromise, it is unworkable and would actually slow down or undermine creative solutions to coverage gaps ...

 

November 9, 2009
Government-Run Health Care Even Without the Public Option
By Robert A. Book, Ph.D.
(WebMemo #2686)
The reforms under consideration in Congress would impose such rigid control on private health plans that it amounts to a government-run health care system.

 

November 6, 2009
A Closer Look at the House Democrats' Health Care Bill
By the Staff of the Center for Health Policy Studies and the Staff of the Center for Data Analysis
(WebMemo #2684)
A Closer Look at the House Democrats' Health Care Bill

 

November 6, 2009
Pelosi Health Care Plan: Who Pays the Surtax?
By Rea S. Hederman, Jr., and Guinevere Nell
(WebMemo #2687)
The Pelosi health care plan relies on a large surtax that would gradually encompass all American taxpayers, much like the dreaded Alternative Minimum Tax does. ...

 

November 5, 2009
Union Contracts of Health Care Workers Would Inflate Health Care Costs
By James Sherk
(WebMemo #2681)
Widespread unionization of the health care sector would make a government-run "public plan" much more expensive than currently advertised.

 

November 5, 2009
Doing Health Care Reform Right: The Empowering Patients First Act
By Greg D'Angelo and Robert E. Moffit, Ph.D.
(WebMemo #2682)
The Empowering Patients First Act could accomplish needed reforms while minimizing Washington's role in health care.

 

November 2, 2009
How Many Americans Could End Up on the Public Health Plan? A Look at the Estimates
By Greg D’Angelo
(Backgrounder #2334)
Congress will soon vote on massive health care legislation -- and on the amount of power the federal government will have over the entire U.S. ...

 

November 2, 2009
Health Care Reform and the Threat to the Dollar
By J. D. Foster, Ph.D.
(WebMemo #2674)
Health care reform as currently constructed will either weaken the economy or balloon the deficit while it weakens the economy.

 

October 30, 2009
The Wrong Medicare Advantage Reform: Cutting Benefits, Limiting Choices, and Increasing Costs
By James C. Capretta and Robert A. Book, Ph.D.
(WebMemo #2671)
The Medicare Advantage program reforms currently being considered by Congress would lead toward a system of less choice, less accountability, and eventually lower-quality health care ...

 

October 29, 2009
Tax on High-End Health Insurance Policies Takes the Low Road
By J. D. Foster, Ph.D.
(WebMemo #2667)
The Joint Tax Committee recently shed important new light on the proposed "Cadillac excise tax" contained in the Senate Finance Committee’s health care bill.

 

October 28, 2009
Health Care Reform: Rational Alternatives to the Congressional Leadership Bills
By Greg D’Angelo and Robert E. Moffit, Ph.D
(WebMemo #2666)
Three major bills sponsored by congressional Republicans contain promising conservative approaches to health care reform.

 

October 16, 2009
The End of Federalism: How Obamacare Will Impact States
By heritage.org
(Fact Sheet #42)
The bills before Congress would place an unprecedented amount of power in the hands of the federal government to determine health insurance rules and benefits. ...

 

October 15, 2009
Adding Insult to Injury: The Baucus Health Plan Imposes New Taxes on the Sick
By Robert A. Book, Ph.D., Guinevere L. Nell, and Paul L. Winfree
(WebMemo #2651)
The Baucus health care plan would harm those it should help and help those who need help the least.

 

October 15, 2009
The Baucus Medicaid Provisions: The Senate’s Massive Welfare Expansion
By Dennis G. Smith
(WebMemo #2652)
Expanding Medicaid is not reform. Adding more people to a flawed system would only compound the problem.

 

October 13, 2009
Preserving Freedom and Federalism: What's at Stake for Americans in the Health Care Debate
By Thomas C. Feeney
(Backgrounder #2327)
"Federalism" is no outdated concept. The founding fathers of the American Republic are the authors of a brilliant design of the distribution of political power ...

 

October 9, 2009
Congress's Health Care Reform Bills: The Unknown Costs
By Greg D'Angelo
(WebMemo #2646)
The CBO should produce a comprehensive assessment of the health care reform proposals--similar to the one produced during the Clinton era--before any legislation moves forward. ...

 

October 7, 2009
Congress Breaks Obama Promise on Government Role in Health Care
By Dennis G. Smith
(WebMemo #2644)
A government "takeover" in the form of greater government control over health care financing and the practice of medicine is inevitable.

 

September 25, 2009
Baucus Plan Increases Out-of-Pocket Costs for Many Families
By Rea S. Hederman, Jr., and Paul L. Winfree
(WebMemo #2628)
The mandates in Senate Finance Chairman Max Baucus's health care reform bill will hurt individuals, families, and businesses.

 

September 25, 2009
The Baucus Individual Health Insurance Mandate: Taxing Low-Income and Moderate-Income Workers
By Robert A. Book, Ph.D., Guinevere Nell, and Paul L. Winfree
(Backgrounder #2325)
The individual mandate in the Baucus health care plan would impose punitively high, regressive taxes on low-income and moderate-income working families. Its penalties and additional ...

 

September 23, 2009
Going Out of Business: How ObamaCare will Hurt American Businesses
By heritage.org
(Fact Sheet #40)
The House and Senate draft proposals for health care reform include employer mandates that require employers to pay higher taxes if they do not offer ...

 

September 21, 2009
Sound Health Care Reform for a Sound Economy: A Response to the CEA Report
By Robert A. Book, Ph.D.
(Backgrounder #2318)
The President's Council of Economic Advis­ers correctly notes that fixing several problems with the American health care system would produce substantial economic benefits. However, the ...

 

September 18, 2009
The Max Tax: Baucus Health Bill Is More of the Same
By heritage.org
(Fact Sheet #37)
A public plan disguised as a co-op, individual and employer mandates, massive federal regulation over insurance and benefits, and massive Medicaid expansion--the Baucus bill has ...

 

September 18, 2009
Reconciliation 101: A "Nuclear" Abuse of Power
By heritage.org
(Fact Sheet #38)
Reconciliation was created to streamline Senate rules to make it easier for lawmakers to achieve the spending and tax levels in the budget resolution. It ...

 

September 17, 2009
The Baucus Health Bill: A First Look
By the Staff of the Center for Health Policy
(WebMemo #2619)
The Baucus bill still contains the most objectionable features of the liberal health policy agenda.

 

September 15, 2009
President Obama's Medical Liability Reform Proposal: No Silver Bullet
By Randolph W. Pate
(WebMemo #2614)
In an apparent concession to Republicans on health care reform,
President Obama broached the topic of medical liability reform Wednesday
night in his health care ...

 

August 28, 2009
Five Major Faults with the Health Care Bills
By Nina Owcharenko
(WebMemo #2599)
Current efforts by Congress to “reform” the health care system are centered on several flawed policy initiatives that will transfer more power and decisions to ...

 

August 28, 2009
Economics of Play-or-Pay Mandates in Health Care Reform Bills
By D. Mark Wilson
(Backgrounder #2312)
The play-or-pay mandates in the health care reform bills, which require employers to offer health insurance to their workers or pay a tax to the ...

 

August 28, 2009
The Trial Lawyers' Earmark: Using Medicare to Finance the Lifestyles of the Rich and Infamous
By Edwin Meese III and Hans A. von Spakovsky
(Legal Memorandum #47)
A proposed amendment to the America's Affordable Health Choices Act of 2009 would have generated abusive Medicare litigation on a massive scale to benefit plaintiffs' ...

 

August 26, 2009
The Public Health Insurance Option: Unfair Competition on a Tilting Field
By John S. Hoff
(Backgrounder #2311)
Advocates of a "public option" government insurance plan assure us that it would compete with private insurers on a level playing field. In reality, the ...

 

August 5, 2009
Kerry's Excise Tax on "Gold-Plated" Health Insurance Policies
By Edmund F. Haislmaier
(WebMemo #2578)
Senator John Kerry has suggested a new excise tax on "gold-plated" health insurance policies. But this is not the right way to go.

 

July 30, 2009
Obamacare: Top 10 Reasons It's Wrong for America
By heritage.org
(Fact Sheet #36)
President Obama said: "They're going to have to give up paying for things that don't make them healthier...If there's a blue pill and a red ...

 

July 30, 2009
A Federal Health Insurance Exchange Combined with a Public Plan: The House and Senate Bills
By Robert E. Moffit, Ph.D.
(Backgrounder #2304)
While the national health insurance exchange advocated by President Obama and congressional leaders is sometimes described as a nationwide pool of health insurance providers, its ...

 

July 29, 2009
State Health Reform: The Significance of Utah Health Insurance Reforms
By Edmund F. Haislmaier
(WebMemo #2569)
Utah will soon offer a working model of how states can design and implement a consumer-centered health insurance market that leverages existing resources with minimal ...

 

July 24, 2009
Illusions of Cost Control in Public Health Care Plans
By Robert A. Book
(Backgrounder #2301)
The available evidence does not indicate that a public plan modeled on Medicare could provide health care comparable to that offered by existing private plans, ...

 

July 24, 2009
Executive Summary: Illusions of Cost Control in Public Health Care Plans
By Robert A. Book
(Executive Summary #2301)
The available evidence does not indicate that a public plan modeled on Medicare could provide health care comparable to that offered by existing private plans, ...

 

July 24, 2009
New Taxpayer Subsidies: The Impact of the House and Senate Health Bills
By Dennis G. Smith
(WebMemo #2564)
Under the House and Senate bills, taxpayers are going to pay more for health insurance.

 

July 24, 2009
Compromising the Doctor-Patient Relationship: The Impact of the House Health Care Bill
By John O’Shea, M.D.
(WebMemo #2563)
A growing number of physicians believe that H.R. 3200 is likely to make matters worse.

 

July 23, 2009
House Bill to Hit Small Businesses with Surtax
By Rea S. Hederman, Jr.
(WebMemo #2556)
The large tax increases proposed by House Ways and Means Chairman Charlie Rangel (D-NY) would harm over a million small businesses, making them less likely ...

 

July 23, 2009
Micromanaging Americans' Health Insurance: The Impact of House and Senate Bills
By Edmund F. Haislmaier
(WebMemo #2558)
Both the pending House health care bill and Senate HELP Committee bill include provisions that would, if enacted, result in sweeping, complex, and highly discretionary ...

 

July 23, 2009
Undercutting State Authority: The Impact of the House and Senate Health Bills
By Dennis G. Smith
(WebMemo #2559)
The states are being invited into a shaky bargain that trades dollars for control over the administration of Medicaid.

 

July 23, 2009
Senator Kerry's Tax on Health Insurance Companies Would Hit Everyone with Insurance
By J. D. Foster, Ph.D.
(WebMemo #2561)
Taxing health insurance companies is a bad, backdoor alternative to the more sensible, more transparent policy of capping the exclusion for employer-sponsored health insurance.

 

July 21, 2009
Employer Health Care Mandates: Taxing Low-Income Workers to Pay for Health Care
By James Sherk and Robert A. Book, Ph.D.
(WebMemo #2552)
Congressional rhetoric to the contrary, much of the burden of paying for an employer mandate will fall on ordinary Americans, and lower-income workers will be ...

 

July 15, 2009
Understanding CBO Health Cost Estimates
By Donald B. Marron
(Backgrounder #2298)
Congressional Budget Office analyses often rely on sophisticated economic modeling and are usually framed in ways that match the specific, sometimes arcane, requirements of the ...

 

July 15, 2009
Understanding CBO Health Cost Estimates
By Donald B. Marron
(Executive Summary #2298)
Congressional Budget Office analyses often rely on sophisticated economic modeling and are usually framed in ways that match the specific, sometimes arcane, requirements of the ...

 

July 1, 2009
The House Health Care Bill: A Blueprint for Federal Control
By Robert E. Moffit, Ph.D.
(WebMemo #2515)
The incentives built into the House bill would guarantee that millions of Americans would lose their private coverage, regardless of their personal preferences.

 

July 1, 2009
Senate "Free Rider" Penalties: Taxing the Poor to Pay for Health Care
By Robert A. Book, Ph.D. and Edmund F. Haislmaier
(WebMemo #2516)
Congress's mad scramble to turn health care buzzwords and bumper stickers into legislation last week careened off in yet another direction.

 

July 1, 2009
How to Design a Tax Cap in Health Care Reform
By Stuart M. Butler, Ph.D.
(WebMemo #2517)
The Obama Administration and congressional Democrats have recently opened the door to a change in the tax treatment of employer-sponsored health benefits as part of ...

 

July 1, 2009
How Reforms to the Tax Treatment of Health Insurance Benefit the Middle Class
By Greg D’Angelo, Rea S. Hederman, Jr., and Paul L. Winfree
(WebMemo #2518)
Health reform proposals recently introduced in Congress--such as the Patients' Choice Act of 2009--seek to replace the current income tax exclusion with a fairer, flatter ...

 

June 30, 2009
Entitlement Reform Is Necessary for Long-Term Fiscal Stability
By Douglas Holtz-Eakin and Gordon Gray
(Backgrounder #2291)
Entitlement spending is projected to exceed 20 percent of GDP by 2060. Furthermore, the U.S. will be spending a crushing 22 percent of GDP to ...

 

June 30, 2009
Executive Summary: Entitlement Reform Is Necessary for Long-Term Fiscal Stability
By Douglas Holtz-Eakin and Gordon Gray
(Executive Summary #2291)
Entitlement spending is projected to exceed 20 percent of GDP by 2060. Furthermore, the U.S. will be spending a crushing 22 percent of GDP to ...

 

June 25, 2009
Health Information Technology: The Case for a Sound Federal Policy
By Tevi Troy, Ph.D.
(Backgrounder #2289)
As part of the stimulus bill, Congress is set to spend $20 billion to encourage doctors and hospitals to adopt electronic health records (EHRs). A ...

 

June 25, 2009
Health Insurance Co-ops: How Congress Could Adopt the Right Design
By Edmund F. Haislmaier
(Backgrounder #2290)
Consumer-owned cooperative, or mutual, health insurers could increase consumer control and choice in health insurance. Member-owned mutual health insurers would return any profits or surplus ...

 

June 24, 2009
Health Care Reform and Economic Growth: A Critique of the CEA Report
By Robert A. Book, Ph.D.
(WebMemo #2502)
The CEA report fails to draw a link between any particular health care reforms and the economic benefits that might theoretically be achieved.

 

June 22, 2009
The Senate Health Care Bills: $1.5 Trillion Sticker Shock
By James C. Capretta
(WebMemo #2498)
The government cannot bend the health care cost curve from Washington without resorting to arbitrary caps and price controls that always lead to a reduction ...

 

June 19, 2009
Obama's Health Care Agenda: How it Will Hurt American Families
By heritage.org
(Fact Sheet #33)
Instead of empowering parents, President Obama's health care plan will chip away at the fundamental rights parents have in key health care decisions for their ...

 

June 18, 2009
Health Care Co-Operatives: Doing It the Right Way
By Edmund F. Haislmaier, Dennis G. Smith, and Nina Owcharenko
(WebMemo #2493)
Some key Senators are considering cooperatives as an alternative to a public health plan. Here are several principles that must be a part of any ...

 

June 15, 2009
Conservative Principles of Health Care Reform: The Road Ahead
By the Honorable Michael B. Enzi
(Heritage Lecture #1124)
Obama health care plan, Expanded health insurance coverage should give every American access to affordable, high-quality health insurance. Patient-focused care provides the highest quality and ...

 

June 12, 2009
Why the Kennedy Health Bill Would Wreck Bipartisan Reform
By Robert E. Moffit, Ph.D., and Stuart M. Butler, Ph.D.
(WebMemo #2481)
The Affordable Health Choices Act is a setback for bipartisan health care reform.

 

June 12, 2009
A New Public Health Plan: How Congressional Details Will Impact Doctors and Patients
By Greg D’Angelo
(WebMemo #2482)
Many in Congress are looking to Medicare as a model for a new public health plan, yet millions of Americans would lose the private coverage ...

 

June 11, 2009
A Guide to State Health Care Reform
By The Heritage Foundation
(Special Report #55)
The Heritage Foundation's A Guide to State Health Care Reform is a concise summary of actions needed to achieve patient-centered health reform. Successful health care ...

 

May 21, 2009
The Public Health Care Plan: What Seems to Be the Problem?
By heritage.org
(Fact Sheet #29)
It's impossible to believe that Congress and the Administration could resist setting rules - and interpreting those rules - in favor of their own public ...

 

May 15, 2009
A Principled Path to Rational Health Care Reform
By Nina Owcharenko
(WebMemo #2448)
The health care policies outlined by President Obama during his campaign would centralize control over the health care system in Washington. There is a much ...

 

May 6, 2009
Coverage Issues in Health Reform
By Stuart M. Butler, Ph.D.
(Testimony )
There is broad agreement on the broad goals of health reform.  We all want to achieve significant progress this year towards the vision of an ...

 

May 5, 2009
Why a New Public Plan Will Not Improve American Health Care
By Walton J. Francis
(Backgrounder #2267)
The real reason why a number of policy analysts and politicians favor a public health plan is because they see it as a way to ...

 

May 5, 2009
Executive Summary: Why a New Public Plan Will Not Improve American Health Care
By Walton J. Francis
(Executive Summary #2267)
The real reason why a number of policy analysts and politicians favor a public health plan is because they see it as a way to ...

 

April 3, 2009
Single Payer: Why Government-Run Health Care Will Harm Both Patients and Doctors
By Robert A. Book, Ph.D.
(WebMemo #2381)
The key issue in the emerging national health care debate is the role of the federal government: A concentration of government power over health care ...

 

March 16, 2009
Health Care Reform: Changing the Tax Treatment of Health Insurance
By Greg D'Angelo and Robert E. Moffit, Ph.D.
(WebMemo #2344)
A proposal that gradually phases out the current income tax exclusion while phasing in a more equitable and efficient system is essential to achieving serious ...

 

February 27, 2009
The Obama Health Care Budget: Hopeful Savings and Costly Change
By Robert E. Moffit, Ph.D., Nina Owcharenko, and Dennis Smith
(WebMemo #2314)
President Obama's health care budget proposal is large but surprisingly unimaginative.

 

February 4, 2009
Comparative Effectiveness in Health Care Reform: Lessons from Abroad
By Helen Evans, Ph.D.
(Backgrounder #2239)
President Obama’s proposed Institute for Comparative Effectiveness would mean more government control of private medical decisions. It is clear from the British experience and other ...

 

February 4, 2009
The Stimulus Bill: Why the Senate Must Fix the Health Care Provisions
By Nina Owcharenko
(WebMemo #2267)
Liberals in Congress, under the guise of emergency economic stimulus legislation, are attempting to push forward their radical health care agenda.

 

December 5, 2008
Employer-Based Health Insurance: Why Congress Should Cap Tax Benefits Consistently
By Jason Roffenbender
(Backgrounder #2214)
Too many Americans do not fully understand how the health insurance they receive through their employer is financed. Formal premium payments to health insurance companies ...

 

December 4, 2008
The Concept of a Federal Health Board: Learning from Britain's Experience
By Jeet Guram and Robert E. Moffit, Ph.D.
(WebMemo #2154)
Tom Daschle, President-elect Barack Obama's pick for secretary of health and human services, has recently been advocating the creation of an independent "Federal Health Board." ...

 

December 4, 2008
How a Federal Health Board Will Cancel Private Coverage and Care
By Robert E. Moffit, Ph.D.
(WebMemo #2155)
President-elect Barack Obama,Senator Max Baucus, and former Senator Thomas Daschle (D-SD)—Obama’s choice for Secretary of the U.S. Department of Health and Human Services—have outlined policy ...

 

November 14, 2008
The Baucus Health Reform Plan: A Starting Point for Serious Discussion
By Stuart M. Butler, Ph.D.
(WebMemo #2132)
Senate Finance Chairman Max Baucus (D-MT) has just unveiled a comprehensive health plan. This is a welcome development in that it puts some flesh on ...

 

October 24, 2008
The Obama Health Care Plan: A Closer Look at Cost and Coverage
By Greg D'Angelo and Paul Winfree
(WebMemo #2114)
Barack Obama's health care plan would reduce the number of insured, but it would not control costs in any significant way. In fact, it would ...

 

October 24, 2008
The McCain Health Care Plan: A Closer Look at Cost and Coverage
By Greg D'Angelo and Paul Winfree
(WebMemo #2115)
John McCain’s health care plan would reduce the number of uninsured and help control costs, yet it would, as currently designed, require considerable increases in ...

 

August 14, 2008
Government as "Competitor": The Latest Prescription for Government Control of Health Care
By Robert E. Moffit, Ph.D.
(WebMemo #2024)
Proponents of government competition in a "national health insurance exchange" claim that it would enhance personal choice and health plan competition. That is highly unlikely. ...

 

March 13, 2008
Lawmakers Should Approach Wyden–Bennett Health Bill with Caution
By Nina Owcharenko
(WebMemo #1849)
Although it proposes needed tax reforms, S. 334 would also replace the current health system with one that is heavily regulated by the federal government. ...

 

February 6, 2008
Benefits of the President's Proposed Standard Deduction for Health Insurance
By J.D. Foster, Ph.D.
(WebMemo #1799)
Correcting the tax treatment of private health insurance would strengthen the consumer-driven market forces that should discipline health care prices.

 

December 13, 2007
Health Insurance Reform: What Families Should Know
By Connie Marshner
(WebMemo #1739)
Citizens can help to achieve conservative reforms by learning about the best policies to advance their personal freedom.

 

October 1, 2007
SCHIP Plus a Tax Credit: A Compromise Health Insurance Plan for Kids
By Stuart M. Butler, Ph.D. and Nina Owcharenko
(WebMemo #1652)
Congress should fashion a bipartisan compromise that aims to expand coverage for the uninsured while preserving coverage for families that already have it.

 

September 24, 2007
SCHIP: Crafting a Better Compromise to Cover Kids
By Nina Owcharenko and Stuart Butler
(WebMemo #1635)
House and Senate leaders should negotiate a more balanced compromise that aims to expand access to private health coverage for uninsured children.

 

September 20, 2007
Why Families Should Be Concerned about SCHIP
By Connie Marshner
(WebMemo #1630)
Congress should keep SCHIP focused on uninsured children from low-income families and broaden the options available to middle-income families whose children are uninsured.

 

July 26, 2007
State Health Care Reform: The Benefits and Limits of "Reinsurance"
By Edmund F. Haislmaier
(WebMemo #1568)
When most people refer to “reinsurance” in health care, what they really mean is the related concept of risk transfer or risk-pooling arrangements. Although such ...

 

June 13, 2007
Competition: A Prescription for Health Care Transformation
By The Honorable Tom Coburn, M.D., Joseph Antos, Ph.D., and Grace-Marie Turner
(Heritage Lecture #1030)
America is going to have either a government-run health care system in which politicians and bureaucrats make the key decisions or a consumer-driven system in ...

 

March 8, 2007
After Walter Reed: How to Fix Military Medicine
By Daniel H. Johnson, Jr., M.D.
(WebMemo #1388)
Introduce competition into military health care to prevent tragedies like the one at Walter Reed from ever recurring.

 

January 22, 2007
Making Health Care Affordable: Bush's Bold Health Tax Reform Plan
By Stuart M. Butler and Nina Owcharenko
(WebMemo #1316)
A sound basis for a serious discussion on how the tax treatment of health care should be reformed, consistent with good tax policy.

 

October 20, 2006
Building on the Successes of Health Savings Accounts
By Greg D'Angelo and Robert E. Moffit, Ph.D.
(WebMemo #1239)
How to improve HSAs and make all health insurance more affordable and better tailored to consumers.

 

October 5, 2006
The Rationale for a Statewide Health Insurance Exchange
By Robert E. Moffit, Ph.D.
(WebMemo #1230)
Statewide health insurance exchanges give individuals and families the opportunity to secure the health plans of their choice without losing tax benefits.

 

March 5, 1992
A Policy Maker's Guide to The Health Care Crisis
By Stuart M. Butler, Ph.D
(WebMemo )
A Policy Maker's Guide to The Health Care Crisis

 

 
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