Inside the monstrous Obamacare bureaucracy
My column today delves into the Byzantine world of the Democrats’ government-run health care takeover. I filed it before the latest CBO budget analysis assailing the costs of Obamacare — a predictable outcome which simply bolsters my point. I linked the other day to the incredible flow chart created by the GOP team at the Joint Economic Committee. It deserves far and wide dissemination. This will be the future if taxpayers sit by and do nothing. (And check this out: The nutroots did not like the chart. Update: Some people are misunderstanding me and CrabbyCon’s chart. The point is that none of the lefties wanted the chart’s info to get to the viewing public.)
Latest legislative machinations:
On the House side, Ways and Means helped Obamacare clear another hurdle.
The House Ways and Means Committee approved legislation early Friday to overhaul the health care system and expand insurance coverage after a marathon session in which Democrats easily turned back Republican efforts to amend the bill.
The 23-to-18 vote came just hours after the director of the Congressional Budget Office, Douglas W. Elmendorf, shook up the political landscape by suggesting that none of the major health care bills would significantly slow the growth of health spending…Two other House panels, the Energy and Commerce Committee and the Education and Labor Committee, are working on the legislation.
Democrats said the actions in the Senate and in the Ways and Means Committee created momentum for passage of the legislation, President Obama’s top domestic priority. But in both committees, the votes generally followed party lines, indicating the lack of consensus on how to finance coverage for the uninsured.
Kimberley Strassel says on the Senate side, Sen. Charles Grassley is the key.
***
Inside the monstrous Obamacare bureaucracy
by Michelle Malkin
Creators Syndicate
Copyright 2009
If you think government is too big and too costly, wait until Obamacare kicks in. The Congressional Budget Office put the price tag of the House Democrats’ health care takeover plans at $1.5 trillion over 10 years. But the CBO’s fine print included a tell-tale caveat:
“We have not yet estimated the administrative costs to the federal government of implementing the specified policies, nor have we accounted for all of the proposal’s likely effects on spending for other federal programs.”
You don’t need an accounting degree or clairvoyant powers. The administrative costs and spillover spending effects will be astronomical. Look at existing federal programs. In 1966, the Office of Management and Budget put the total taxpayer costs for Medicare at $64 million. In 2011, Medicare costs are expected to balloon to nearly $500 billion. Medicaid cost $770 million in 1966. By 2011, that program will cost taxpayers an estimated $264 billion. The Virginia-based Council for Affordable Health Insurance estimated that the administrative expenses of both programs last decade were 66% higher than those of private sector health insurance companies.
And we ain’t seen nothing yet. House Republicans on the Joint Economic Committee sifted through their opponents’ 1,018-page health care bill and released a dizzying flow chart detailing the Byzantine bureaucracy Obamacare would create. Washington would become the home of at least 31 new federal programs, agencies, and commissions to oversee the government-run health insurance regime.
Because 32 “czars” isn’t enough, the Democrat plan would add another overlord to the Obama administration. The new “Health Choices Commissioner” would helm the new “Health Choices Administration” (Section 141 of the bill) – separate from the already existing Department of Health and Human Services, Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration), the Veterans Health Administration, and the Indian Health Service.
Because the government has done such a boffo job managing the near-bankrupt Social Security and Medicare Trust Funds, the Democrats have proposed creating a “Public Health Investment Fund” and a “Health Insurance Exchange Trust Fund.” The latter would create a “transparent and functional marketplace for individuals and small employers to comparison shop among private and public insurers.”
No matter that state insurance departments already operate such systems. Health care must be “fixed.” The federal cure is redundancy.
The Obamacare bill also creates a new “Bureau of Health Information” (not to be confused with the already existing National Center for Health Statistics) within the department of Health and Human Services. The BHI will be led by a new “Assistant Secretary for Health Information.” The new assistant secretary will coordinate with the recently-created “National Coordinator for Health Information Technology” – who is responsible for monitoring the $19.5 billion in the stimulus law to implement “a nationwide interoperable, privacy-protected health information technology infrastructure.”
New bureaucracies always have old special interests to appease. The Bureau of Health Information will house its own “Office of Civil Rights” and “Office of Minority Health.” The information czar will be required to collect health statistics in the “primary language” of ethnic minorities – and thus, the need for a new “language demonstration program” to showcase their efforts. Obamacare will also ensure “cultural and linguistics competence training” and establish “a youth public health program to expose and recruit high school students into public health careers.” The government health care juggernaut must be fed and staffed, after all.
Providing more stimulus for taxpayer-funded jobs, the Democrats’ bill would add a new “Senior Advisor for Health Care Fraud” and require the Attorney General to appoint a “Senior Counsel for Health Care Fraud Enforcement.” There’s already a national Health Care Fraud and Abuse Control Program, but who’s counting?
To coordinate all the new bureaucrats, Obamacare would create a new “Health Care Program Integrity Coordinating Council” to “to coordinate strategic planning among federal agencies involved in health care integrity and oversight.”
To make sure all the existing local and state environmental public health agencies don’t feel lonely, the Democrats’ plan creates a new “Coordinated Environmental Public Health Network” to “build upon and coordinate among existing nvironmental and health data collection systems and create state environmental public health networks.”
A new “National Health Care Workforce Commission” will be “tasked with reviewing health care workforce and projected workforce needs.” New funding will be available for a “demonstration program to improve immunization coverage” that would enable government busybodies to send reminders or recalls for patients or providers, or home visits.”
Who’ll be looking out for you? The House bill creates a “public plan ombudsman” and a “special health insurance exchange inspector general” to police spending and guard against waste, fraud, and abuse. Given the sad fate of aggressive watchdogs in the age of Obama, however, these positions will end up like every other new agency, commission, task force, and office created to serve the federal health care beast: black holes.
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This bill is truly a monster. I have emailed my one liberal Senator and Representative, for all the good it will do.
Investor’s Business Daily had a great editorial on how rules on page 16 of the monster bill will eventually outlaw private health insurance.
It’s Not An Option
What other nasty surprises await us?
As well-run and efficient government programs, agencies and commissions are, what could go wrong with 31 more?
This is going to take decades to undo.
That’s why it’s going to cost 2 or 3 times what they say now.
And not only that, those “adminstrators” will include legions of unionized government workers that will do little work and get generous pay and benfits that will no doubt include raises and retirement plans not heard of in the private sector.
Plus they’ll be protected by Dems as were the current gov’t union employees with $135 Billion of the stimulus money.
It’s all sickening.
I wonder, when this becomes a big bust and Americans are drowning in debt, will Obama say he did not have all the facts.
I don’t believe that if this is done, it will ever be un-done.
This is why republicans need to stop it by any and all means necessary. There will be no “fix it later” option.
He’ll be retired and giving speeches and making millions and not giving a damn one way or the other.
What amazes me is that everyone admits it is going to be expensive but continues on with the massive spending and the massive taxing.
Such irresponsibility.
And Biden says we have to spend our way out of bankrupty.
How do these people get elected and re-elected!!!
And he will be covered by the best health plan not available to the peasants.
Just thinking about Obamacare is making me sick…
Someone asked this before.
How can 535 idiots be so out of touch with 300 million of us?
So how can they fix existing medicare for us old geezers without condeming us to die?
Dangerous, indeed evil – whether intentionally evil, or evil-guided and
-directed – , idiocy.
I think that is the point.
pat buchanan’s article today looks at gov’t spending in 1929 to gubmint spending in 2009. 3% of gdp in 1929 to 28% of gdp and rising by the minute today. with state gubmint spending we are looking at 40% of gdp. 4 out of 10 people in the u.s. in effect work for the gubmint. an article yesterday looked at the rise of police and firefighters in the u.s. since the 60’s and today we have policing agencies tripping over themselves and virtually all are mainly revenue collection businesses under the guise of protect and serve. the story yesterday of how the police chief in washington d.c. is so mad about iphones having a speedtrap alert and her revenue has fallen from 1b dollars per year to 29m this past year was hilarious. go count your detectives to your ticket writers in any police force and tell me what they value and do.
I’m afraid I missed it. Which box is for the Department of Redundancy Department?
That’ll fix the problem with Social (in)Security too.
We first saw the flow chart on FBNs Nightly Scoreboard when it was released by the Republicans and it scared the hell out of us. Being a simple servant working for the Department of the Air Force struggling to adhere to ill-conceived regulations and rules designed to hamstring the only functional branch of the Executive Branch of Government on a daily basis. It makes me cringe to see what the same type of useless drones occupying desks in many of the worthless nonfunctional bureaus so many citizens are forced to deal with resulting in less than satisfactory exchanges.
How long will you have to stand in line with our fellow plebian dogs at each soulless bureaucratic hurdle (office) for the most basic of healthcare requirements? How sick or old do you have to be before you are a burden on the system and the same soulless bureaucrats running these anything but efficient agencies send them to the wilderness to die? I’m sure abortions on demand will go to the head of the line along with those willing to take the drastic step of assisted suicide to end their suffering to keep these useless eaters off the backs of the every intrusive dictatorship we find ourselves being ruled by.
The 4 idiots representing us in Idaho as part of this renegade Congress have continued to give the big stink eye to their constituents enlarging our tax burden and confirming the worst possible candidates for any cabinet position in Lord Obama’s tyrannical dictatorship. I’m sure they are terrified of what will happen to them should they vote for this, but what impact will 2 votes in each chamber have against the thugocracy we see on a daily basis.
Megan Ryan of Fox News is handing Senator Bernie Sanders I-Vt his ass (I guess the I stands for idiot).
ΜΟΛΩΝ ΛΑΒE (mo-lone lah-veh) Translation: Come and take them!
What I can’t help but notice about the picture is how small the consumers and the providers are relative to the government. Tell you anything?
Chuck Grassley, I don’t trust him.
I’m going to start researching the companies that make rubber stamps, and those “Take a Number for Faster Service” thingys like you see in the deli section. There’s a fortune to be made.
NJ-Aviator: My formula for calculating the actual cost of a government proposal is to double it and then multiply by pi.
I don’t trust any of ‘em. They’re bottom feeders.
Reg.conservative said:
I do not trust any of them, they are thumbing their collective noses at the very contry that gave them everything possible.
They are all Land Carp.
I can imagine waiting for hours in some hot, dank, run-down waiting room, with kids wailing, flies buzzing around, dirty walls, curling-linoleum floors, blinking fluorescent lights, metal chairs with slashed vinyl padding, and a gaggle of who-gives-a-$#!+ staff talking amongst themselves behind the bullet-proof glass partitioned counter, ignoring the sick children and gasping elderly.
If you don’t believe this is how it will be, I guess you’ve never been to a “public” hospital in socialized-medicine Australia.
Just imagine what all this bureaucracy will do to medical advances and innovation. I wouldn’t look to any more breakthroughs with this bureaucracy in place.
FruNobulux, along the same lines of your description, look at the lack of customer service and product quality we have today. I remember years ago when consumers could expect lousy quality from anything produced in Russia – now we expect it and a “we don’t give a damn, we have our money” after the sale.
You shouldn’t trust him. He’s weak.
If Obama follows the usual historical path, all power-mad people take, he’ll declare himself “president for life” in 2012, or 2016. It’s so sad, that there are many people in our dumbed-down, illiterate society that actually support and defend the idea of the government running every aspect of their lives.
That sounds like every govt. office I have ever had the displeasure of having to visit, especially federal offices who ultimately answer to people in far-away D.C. Having dealt with immigration numerous times in the past three years on my wife’s behalf I am convinced there is not a single person that will lift a finger to do something outside their job description or even answer a simple question with clear information. The most they will do is suggest you visit their website to find the appropriate information or form. The only thing they do well is ensure nobody, including small children, enter their buildings without a full body search and scan. (Which will become part of going to the doctor once it is nationalized.)
Get used to hearing the following:
“I can’t help you with that. Have you visited our website to get a list of available forms?”
God was being a pratical joker when he wanted Morons with us. thus, Democrats.
I know I’m just a simple country boy, but something about this math doesn’t work for me.
They are always quoting a number of 36 million Americans without health insurance, but it is going to cost 1.5 TRILLION dollars to insure them. That works out to $4,166,666.67 per person.
What kind of insurance are we buying them? That kind of money could insure my entire family for about 300 years! I must be missing something somewhere.
Dear Ms. Capps,
There are WAY too many problems with NATIONALIZING Health Care.
1. It is patently unfair that the union members, Congress and the President are exempted from being apart of this monstrosity. Either y’all buy into this crap or drop it.
2. In this time of RECORD BREAKING UNEMPLOYMENT and GOVERNMENT DEFICIT SPENDING, the American Taxpayers CANNOT afford this bill. According to Investors Business Daily, the House version of the HC bill will soon ELIMINATE Private Health Care (except for the Government Workers’ Gucci version, OF COURSE):
“The provision would indeed outlaw individual private coverage. Under the Orwellian header of “Protecting The Choice To Keep Current Coverage,” the “Limitation On New Enrollment” section of the bill clearly states:
“Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day” of the year the legislation becomes law.
So we can all keep our coverage, just as promised — with, of course, exceptions: Those who currently have private individual coverage won’t be able to change it. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers.
From the beginning, opponents of the public option plan have warned that if the government gets into the business of offering subsidized health insurance coverage, the private insurance market will wither. Drawn by a public option that will be 30% to 40% cheaper than their current premiums because taxpayers will be funding it, employers will gladly scrap their private plans and go with Washington’s coverage.
The nonpartisan Lewin Group estimated in April that 120 million or more Americans could lose their group coverage at work and end up in such a program. That would leave private carriers with 50 million or fewer customers. This could cause the market to, as Lewin Vice President John Sheils put it, ‘fizzle out altogether.’”
3. It is too EXPENSIVE. The Congressional Budget Office put the price tag of the House Democrats’ health care takeover plans at $1.5 trillion over 10 years. And this does not account for the ADMINISTRATIVE NIGHTMARE that will be created to deal with the requirements of all the oversight committees and special interest groups. (“We have not yet estimated the administrative costs to the federal government of implementing the specified policies, nor have we accounted for all of the proposal’s likely effects on spending for other federal programs.”)
4. The US Government has done a hideous job at Managing health care for Medicare, Medicaid and Native Americans. Native Americans DIE because lack of properly equipped clinics and understaffed clinics/hospitals. What will make this bill any better? Why don’t y’all fix THOSE monstrosities before you take on this behemoth?
5. Do you really that DOCTORS, after 4 years of college, 4 years of Medical School, 2 year residency in Gen. Med and 2 years in Specialty Field (THAT’S 12 YEARS OF SCHOOL after High School) at a cost of well over $150,000 will settle for making what the government programs will pay? Look at how many doctors opt out of Medicare/Medicaid and the lack of doctors running Tribal programs to get your answer. (Eh – let me help you – the answer is a resounding “NO”.)
6. The Nationalized Health Care system in Britain is so bad, their citizens are going to Switzerland to kill themselves. And Canadians and Mexicans have it so bad, that they come HERE to get medical care. Whatcha got against Canadians and Mexicans that you want to kill them? Oh, I get it, it is the Tom Daschle/Barack Obama plan to lower the population. (Daschle wrote that the elderly need to just get used to diseases and aging. Obama wants to just pass out pain meds until they die. Great plan there. BTW How old are you? Oh, I forgot, you’ll be on the Gucci Government Plan, not in the Peon Taxpayer Medical Queue.)
7. If you take away the Entrepreneurial aspects of our current system, it will eliminate incentives for Drug Companies, Research Scientists and Doctors to Innovate and Improve medicines and medical care for people.
My advice, cancel this bill. It’s too much bureaucracy and not enough real planning.
The secret to good government is less “government”. Those in charge now are old 19th century-style power mongers seeking to build a permanent marxist monopoly. This has nothing to do with “reform” and all to do with seizing permanent and total control of the society. Americans everywhere need to start breaking apart and killing this beast whenever and wherever possible. “Think globally act locally” HAHAHAHA remember that one?
Hear! Hear!
It is amazing that the wisdom of the Founding Fathers is still completely appropriate for today.
The servant has become the master.
Nice piece Michelle. I’m not seeing the fight you’d expect elsewhere though. The main stream media is not truly reporting the facts here so I fear we are doomed to see this disaster come to pass.
I’m watching my country die and feel completely powerless.
It’s a train wreck coming but the engineer and his crew refuse to take the warning. Average citizens like me will watch the crash unable to avert our eyes.
FireBlogger said:
It is close to going “THARN”, watching the headlights coming closer and closer but unable to move.
Now I begin to understand the terrorist mind — no other options against a whacko gov’t gone berserk. Now if I just didn’t have those stupid things called ethics and compassion I could go blow up a building. sigh….
Chart:
Reminds me of the org and process flow charts what used to run along the walls and around corners of a bloated company I once worked for. That company has slimmed down considerably…to a toothpick and getting smaller.
Dexter et al.:
OT, WRT Maj Stefan Cook:
http://michellemalkin.com/2009/07/16/socialized-health-care-and-the-death-of-choice/comment-page-4/#comment-747513
Let’s keep using that thread so as not to flood this one.
There really is no way to stop this thing from happening.
And there really is no way under our current system to get rid of it (or a few of the other things that have already been brought down upon us). Votes might change congress. They might change the president. Votes will now, however, change the slimeballs that get elected.
It will take a dictatorship, run by an iron fist conservative, willing to go to violent extremes to undo something like this healthcare disaster. Because only a dictator can have the kind of power it takes to simply say “this is no longer valid”. Our current system now would never be able to do that, or if it could, it would literally take generations of people to do it (100 years or so might work).
We need to face the fact that no matter what happens, from this point on, there are going to be a *lot* of innocent people who die. Whether it be under the Obamacare system, or through all out war against the beast.
old goat said:
I have a mind to get a can of bright red spray paint and in the dead of night paint a nice red V on every roadsign with that Stim Money Logo– hell maybe even progress from there.
this is why We The People need to stop it and then run the morons who came up with this out of town on a rail..
I think if this monstrosity ever does come to pass that bloated flow-chart will look simple compared to how it will work in to reality.
Of course, the black market version will be very simple.
The problem with even the idea of healthcare legislation is the divide between expectations and what we’ll get. Unfortunately, we really need to decide what the lowest level of acceptable care for every single person should be – what is our “right” when dealing with healthcare?
Instead, the panderers will promise a Congressional level plan for everyone, which is better than even billionaires can get today. What gets passed will limit what healthcare non-Congressionals can get to below what people with no paycheck and no insurance can get today for free.
Again, Obama wants to rush this to a vote before anyone even reads it or thinks about alternatives. Why not use the August recess as time for the bills to be read, considered and weighed with constituents while Congress is home with all that free time?
You don’t have to convince me, they don’t read it because they don’t care to read it. Utimately, they don’t care what’s in it. The result will be what they are after. Actions speak louder than words. Others can argue all day long whether it’s typical that they read this stuff. Or that it’s new that they don’t read it or that they should or shouldn’t. If this passes – this argument is mute.
Fireblogger–they’re busy, whaddya want?? Michael Jackson died, didn’t you hear?! Also, sometime ago, his hair caught on fire! See the video!
stillontheroad: ‘my heart has joined the thousand for my friend stopped running today.’
Is it just me, or are you also tired of living in fear of whatever stupid bill next comes out of Congess? Fear of things that we know are in the bills and of things that are hidden because there isn’t full disclosure.
I am tired of that LSOS Sotomayer not being upfront about her racist views.
Overthrow congress in the next election. Throw out everyone – any party. Pass over only those who speak out in the wells of congress like Richard the Lionhearted. (Boehner is one example).
Vote in new members who are republicans (numbers, stupid) and who will completely overhaul congress. Turn conservative Democrats if there are any. Our only hope, now, is the states and congress.
I know there are a lot if important things going on but you gotta admit… that video was pretty funny.
James Felix–my husband watches it every time they play it. It cracks him up.
LIBERALISM KILLS!!!!!!
I learned a long time ago to not fear. I do not turn it into anger either. Both rob you of the ability to think clearly and act because if you cannot do that,the thing you are fighting against will win.
Read the bill? Consideration? Weighed with constituents?
It’s not THEIR healthcare plan – it’s yours and mine.
Reality of the situation is there are those who are exclusively being insulated from the disaster that awaits the rest of us – Executive, Legislative, Judicial and Unions.
Plus, being unemployed, I’m sure that business is currently in a holding pattern to determine what exactly this and other programs will be costing them in the near- and over the long-term. Which leaves the unemployed little to no wiggle-room to find another good job anytime soon.
I’ve been through a few economic downturns in my time, I’ve never experienced anything like this before.
Which is why, even if passed, Government Health Care won’t work, and will hasten the complete economic collapse of the country. Probably in less than a decade.
The good news is, this will wipe out the trustafarians and most of the urban elites; leaving the rural folk who know how to grow their own food and the military.
Every new beginning comes from some other beginning’s end. This may be ours.
Linked on Drudge…mandatory reading.
We must vote out ALL incumbents, even the Republicans…and when they ask why, we can truthfully say, “you didn’t fight hard enough, scream enough, yell enough, or love your country enough!” If the last thing we have left is our vote, let’s use it wisely, or we will be doomed to a future of debt and misery. I’m not going to let that happen.
True
Dems always say Reps don’t propose alternative solutions. I have an alternative to this nightmare.
If there are 40 million uninsured (I know, that number is probably way too high) why don’t we simply buy each one a priavte insurance plan. If my math is correct, we could spend as much as $37,500 per uninsured for the $1.5 Trillion that would go into ObamaDon’tCare. And we wouldn’t have any administrative costs for the CBO to worry about.
Of course, if it turns out we can do it for less….
I’d agree – but I’m not convinced legally cast votes matter anymore.
When I look into the Healthcare fiasco to see what really drives this thing, it is about power and Dems wanting to help the little guy because that is where they see the votes.
Both Hillary and Obama have those Chicago/Alinsky roots so that is a big motivator and Obama has his racist motives.
This health care plan is all about providing health care for free to poor people and those with limited means. Dems see these people getting bad care or no care while rich people get all kinds of care, tests, medicines, etc. They see this as unfair and want to change it. It is about the evil rich not about insuring the uninsured. The “evil rich” moniker is part of the poor people vote strategy
Unfortunately, changing it means bringing up the health care for the poor and bringing down the health care for the rich. It is not about bringing up the poors standard to the rich. That can not happen because of $. So this plan while ostensibly improving care for the poor will make the care for the rich worse. And I don’t think rich in this sense means $250,000 or more.
That flowchart looks like a blueprint for a Rube Goldberg contraption.
Just the kind of contraption that illustrates government bureaucracies so well.
Ultimately, its because they want the power over us that is in OBAMACARE as well as to make sure they and their cohorts are amply rewarded financially.
T-Bone, Call me cynical but I think Obama and the other collectivists give a rat’s rear-end about the health of the poor. They are solely concerned with their power. If they can get more power by making false promises to the useful idiots in the USA, then they will do it.
Anyone that wants a close up Government run healthcare in the US should visit an Indian Reservation. They’ve had Obamacare for decades.
You beat me to it!
First thing that crossed my mind!
If this passes I would love to see a seriously coordinated effort to refuse to pay taxes. I’m not joking. This is ridiculous. They can’t do this without our money. If enough people just stopped paying taxes, what would they do? These monstrosities are, in a word, evil.
Had to edit it a bit.
The socialists will end up helping nobody but themselves.
This is a vote-buying power grab, pure and simple.
Exactly.
From Betsy McCaughey’s NYPost article, “Broken Promises of Obamacare.”
You come up with the best ideas! I think a concerted effort in this area is waaayy over due.
least of our worries since soon the radical muslims will be chopping the heads off af all who disagree with them.
They will come after you with, ultimately, the gun.
Yep.
Holy Cow!!!! I have not heard of that one. You have got to be kidding!?!?!? Please be kidding. Damn! That section alone should lose them the vote of every adult out there. It won’t. But it should. That is simply outrageous.
Link to Betsy McCaughey article on Obamacare.
fixed it for ya.
Tell everyone you know what you’ve learned about the provisions in this disaster of a healthcare plan. I’m scared and I want them to be scared, too. Scared enough to scream at these congresscritters.
STARVETHEBEAST.net
You got it, Liberty. How do you starve the beast?
Refuse to be eaten. Enough people in this, and BIG BRO has nothing they can do.
THEY HAVE TO HAVE COMPLIANT PRODUCERS.
Hmmmm. Just read the linked article about this plan. Disheartening, to say the least. We will be true wards of the state if this goes through. Tack on Cap & Trade and higher taxes, and I think this will be a country that no longer matches my beliefs.
I guess I’ll stick around until the 2010 elections and fight for change. But if the electorate chooses to continue down this road, then it will be time to go Galt BIGTIME!
The way is clear. It is only a question of individual commitment.