cfalk
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Medical Insurance Debate

Thu Aug 03, 2006 12:14 am

As cropped up again in another thread, and keeps coming back year after year, a large part of the US population does not have health insurance. Many on the democratic side call for some sort of national health insurance, like in UK, France and Canada. Of course those who live in those places can attest how swell those systems are.

But I am surprised than nobody has suggested to have the population covered entirely by private insurers. It can work. Switzerland requires all inhabitants, by law, to have basic health coverage (which includes drug costs). It is 100% private - the government doesn't pay a cent. There are around 50 insurance companies that offer this and supplementary insurance, and they compete vigorously on price and quality of service. And no insurance company can turn you down for basic coverage at the standard rate. Even if you have AIDS and bad heart, you can get insurance without it costing you a bomb.

So, why can't we use a similar model in the USA?
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AeroWesty
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RE: Medical Insurance Debate

Thu Aug 03, 2006 12:22 am

Quoting Cfalk (Thread starter):
So, why can't we use a similar model in the USA?

There are a few states that have "must enroll" laws for individuals, if I understand correctly (and I'll happily be corrected on this since it's second-hand knowledge). I'm not sure of all the details of it, but a friend who had a college-sponsored health plan in Texas was able to get HMO-style ins. in MA then NY without having to show prior ins. coverage. It's a tad on the expensive side, $600 per month per person currently for her coverage in NY, but at least it was possible to obtain.

What are the premiums like in Switzerland?
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RE: Medical Insurance Debate

Thu Aug 03, 2006 12:23 am

There is a far greater emphasis on end-of-life care in the United States than almost anywhere else. People who are near death, whose chances of survival and quality of life are both zero, nonetheless receive all types of costly medical interventions without limitation. Any effort to provide universal heath care coverage in the United States will require us to accept some limits on these futile interventions. And that, unfortunately, is not going to happen.
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RE: Medical Insurance Debate

Thu Aug 03, 2006 12:32 am

Quoting Cfalk (Thread starter):
Many on the democratic side call for some sort of national health insurance, like in UK, France and Canada. Of course those who live in those places can attest how swell those systems are.

We have socialized healthcare in Sweden, and for me it works fine. Certain services are privatized in some places, but AFAIK, no critical services cost money. Of course, when I went to get my vaccinations before spending 10 weeks in a semi-rural area of Japan, it cost me 200 bucks since I went to a private clinic.

Quoting Cfalk (Thread starter):
But I am surprised than nobody has suggested to have the population covered entirely by private insurers.

How is a single mom with three kids working one job for minimum wage going to afford the premiums?

If everybody was middle class it would probably work out fine. But some people will always be poor, and can not afford medical insurance.

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AeroWesty
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RE: Medical Insurance Debate

Thu Aug 03, 2006 12:38 am

Quoting Doona (Reply 3):
How is a single mom with three kids working one job for minimum wage going to afford the premiums?

 checkmark  I paid out $700 last month for my premium, three prescriptions, and a doctor's visit, since I hadn't reached my annual deductible yet. And I'm just paying for one person.
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IFEMaster
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RE: Medical Insurance Debate

Thu Aug 03, 2006 12:43 am

There's no way I want the US to go to a nationalized health service. The expectation would be high, the service would be appaling. Why? Because it would be underfunded. The 'business' related competition that exists between health services here is what keeps the standards high, and I must say that I'd rather pay more if it means short waiting times and excellent service, than depend on government ineptitude to provide me with long waiting times and substandard service.

As for the single mom arguement; it's a non-starter. If you wanted the government to pay for it, you'd have to pay extra in tax. Either way you're out of pocket. And if it's that much of a problem, get a part time job at Starbucks - every employee working 20 hours or more per week get full PPO health provision.
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RE: Medical Insurance Debate

Thu Aug 03, 2006 1:14 am

Quoting AeroWesty (Reply 1):
was able to get HMO-style ins. in MA then NY without having to show prior ins. coverage. It's a tad on the expensive side, $600 per month per person

Stupid question, what's HMO-style insurance? $600 definitely sounds expensive ... I pay $170/month for insurance in private hospital room, where I have to pay the first $1900 every year on my own, and from that amount onwards the insurance will pay. I've luckily never used them so far.

I actually like the Swiss healthcare system, it seems to work very well and there are (almost) no double standards. You're not supposed to get a better treatment if you pay a higher premium (though it still happens in some places).

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WellHung
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RE: Medical Insurance Debate

Thu Aug 03, 2006 1:16 am

Hold the phone! Michael Moore will answer all your questions sometime next year.
 
AeroWesty
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RE: Medical Insurance Debate

Thu Aug 03, 2006 1:25 am

Quoting ManuCH (Reply 6):
what's HMO-style insurance?

It's where you're locked into one main doctor who approves whether or not you get to see a specialist, and who must consult with the ins. co. for approvals for nearly everything. In some models, the doctors operate within "pods" sharing risk, with their year-end bonus dependant upon how much in services they are able to withhold. In other models, a clinic or hospital will hire physicians on salary and develop treatment protocols with the ins. co.'s.

Traditional insurance will allow you to go to any doctor anywhere for any reason. An in-between version is called "PPO", where the ins. co. will contract with doctors and hospitals for a reduced rate for their members. If the patient uses facilities in the network, their portion of the costs will be less.
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cfalk
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RE: Medical Insurance Debate

Thu Aug 03, 2006 1:33 am

Quoting Doona (Reply 3):
How is a single mom with three kids working one job for minimum wage going to afford the premiums?

Are you saying there are no poor people in Switzerland? NOT!

Quoting AeroWesty (Reply 4):
I paid out $700 last month for my premium, three prescriptions, and a doctor's visit, since I hadn't reached my annual deductible yet. And I'm just paying for one person.

That's extremely high, and it's probably because the US health insurance industry is totally unregulated. Your insurance company is probably making tons of money off of you.

The way Switzerland dealt with the problem was to set a standard package for basic insurance, which include medicines, hospitalization, all doctor-ordered procedures, etc.. Every company has to offer such a package, no more, no less, for a price it would set for everyone between 18 and 65 (Other ages have different prices). That way consumers can easily see if one company is truly cheaper or not.

Is Switzerland, where basically everything is more expensive than in the US (you can pay around $0.50 per single pill of aspirin), Basic Insurance will cost someone like me between $130 to $400 per month, depending on where I live and what company I choose.

If insurance companies can offer this service in a place as expensive as Switzerland and still make money, it can be done in the US as well. All it takes is a little organization and the guts to stand up to the insurance companies. Right now, they are simply not covering those who are most at-risk, and overcharging the rest of you.
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RE: Medical Insurance Debate

Thu Aug 03, 2006 1:34 am

Quoting AeroWesty (Reply 8):
It's where you're locked into one main doctor who approves whether or not you get to see a specialist

There are some Swiss models like that, too - and you get a further discount if you choose that.

How can someone possibly afford to pay $600/month for healthcare insurance? Is it like that for everyone, or do cheaper models exist? I guess the other one you mentioned (that you can go to any doctor anywhere for any reason) is even more expensive than HMO...

-Manuel
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AeroWesty
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RE: Medical Insurance Debate

Thu Aug 03, 2006 1:54 am

Quoting Cfalk (Reply 9):
That's extremely high, and it's probably because the US health insurance industry is totally unregulated. Your insurance company is probably making tons of money off of you.



Quoting ManuCH (Reply 10):
How can someone possibly afford to pay $600/month for healthcare insurance? Is it like that for everyone, or do cheaper models exist?

I have the in-between plan, a PPO model, and my basic premium is $420/mo. I pay $20 for generics, $40 for brand name drugs, and $80 for drugs not on the "formulary" (basically any drug the ins. co. doesn't get a deal on, or is the cheaper of drugs with similar theraputic action).

The doctor bill I just paid was close to $600 before my network discount (a 30-minute consultation with a new pain doctor), and I paid $275 of that, with the doctor writing off the balance according to his contract. I would have paid only 20% of the $275 if my annual deductible had been met.

$700 was off the top of my head, but if you add up $420 + $60 for 3 Rx's + $275, that comes out to $755. I'd say this is somewhere in the middle range of what you can expect around the country to pay for health-related costs.

Without health insurance I would have paid $16 + $42 + $330 + $600, or $988 for the same drugs and services.

Edit: I should add, the $600 figure is for NY, $420 is for Oregon. Health premiums are calculated by your age, benefits, where you live, and how large your group is, for the most part. NY is high because they have different enrollment standards, whereas in Oregon, I would probably pay more than that for an individual plan. I'm on a "continuation" plan that's priced at about the same as small employers would pay for their employees.

[Edited 2006-08-02 18:59:23]
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cfalk
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RE: Medical Insurance Debate

Thu Aug 03, 2006 1:58 am

Quoting ManuCH (Reply 10):
There are some Swiss models like that, too - and you get a further discount if you choose that.

But it's an option you tick off when you fill out the application form (I used to sell that insurance). You are not obliged to have it. If you do, you'll save maybe $15-20 per month or so.

Quoting ManuCH (Reply 10):
How can someone possibly afford to pay $600/month for healthcare insurance? Is it like that for everyone, or do cheaper models exist?

I agree, it's ridiculous.

Again, the advantage comes from standard product. That way everything is comparable.

For example, in the place where I live, these are the insurance companies that offer the basic package. All these provide EXACTLY the same coverage. The prices are the monthly premiums in Swiss Francs (about 1.25 Francs = $1)

ASSURA 197.00
CSS Light 202.40
MUTUEL ASSURANCES 202.90
ARCOSANA/CSS 212.20
AVANEX/Helsana 212.70
VISANA Light 213.60
SKBH / CMBB 213.80
AUXILIA VOLLÈGES 223.00
SANSAN 223.00
CONCORDIA Light 226.30
PROGRÈS 226.70
CSS 229.90
XUNDHEIT 231.60
VIVACARE n.d. 232.50
GALENOS 243.00
AEROSANA n.d. 244.80
SANITAS 247.80
HERMES HMO 254.00
SUPRA 260.50
HELSANA 263.90
AMB n.d. 265.70
VISANA 267.20
ÖKK 270.50
WINCARE 313.30
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RE: Medical Insurance Debate

Thu Aug 03, 2006 2:38 am

Quoting ManuCH (Reply 10):
Is it like that for everyone, or do cheaper models exist?

Cheaper models exist. I have a PPO via Aetna. I pay $11 per month for it, with a $10 copay if I visit a doctor's office, $20 copay for prescriptions, $35 copay if I visit the ER, $50 copay if I need an ambulance, and deductable of $250 if I need hospital treatment.
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AeroWesty
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RE: Medical Insurance Debate

Thu Aug 03, 2006 2:40 am

Quoting IFEMaster (Reply 13):
I pay $11 per month for it

Who pays the balance of your premium? Your employer?
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KROC
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RE: Medical Insurance Debate

Thu Aug 03, 2006 3:59 am

Quoting AeroWesty (Reply 14):
Who pays the balance of your premium? Your employer?

Must be. I pay about 80 bucks a month for coverage for me and my wife. $15 co-pay. Not sure about the prescriptions, but whenever I have needed them I haven't paid much. $50 deductable for Emergency/Ambulance. I had a surgical procedure where I spent a day in the hospital earlier this year and only had to pay $15 for a co-pay. I know my company offers excellent health plans. A buddy of mine works for Coca-Cola and is paying around $250 a month for coverage for him, his ole lady, and his kid.
 
AeroWesty
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RE: Medical Insurance Debate

Thu Aug 03, 2006 4:07 am

Quoting KROC (Reply 15):
Must be. I pay about 80 bucks a month for coverage for me and my wife.

Just to satisfy my curiosity, because I have a theory that most people don't know how much their employers pay out of pocket for most of their benefits, do you know what your employer pays as their portion? If you do, is it near or north of $300 per person per month?
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RE: Medical Insurance Debate

Thu Aug 03, 2006 4:07 am

Quoting Cfalk (Thread starter):
It is 100% private - the government doesn't pay a cent.

Honest question - what about the person who (legitimately) can't work, and thus can't afford premiums? Is there a social safety net?

I like what you're describing, make it mandatory, but force the insurers to play (fairly). Right now we do just the opposite, if you want insurance you have to play by the insurance co's terms, and lets face it, they are not in it for our well being.
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IFEMaster
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RE: Medical Insurance Debate

Thu Aug 03, 2006 4:31 am

Quoting AeroWesty (Reply 14):

Who pays the balance of your premium? Your employer?

Well yes and no. I own the company, so my company pays the rest. But it's actually a 50% match - when I negotiated the premium to offer to my employees, I got them down to $22 per month. No vision or dental (they are seperate plans).
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AeroWesty
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RE: Medical Insurance Debate

Thu Aug 03, 2006 4:38 am

Quoting IFEMaster (Reply 18):
I got them down to $22 per month.

You have full medical and hospitalization coverage, including office visits, lab, doctor and surgical fees for $22 per month per person?

If you do, please post the phone number of your agent and the insurance carrier, because myself and the rest of the United States would like to join up. That's $300-400 per month below the going rate for employer plans.
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cfalk
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RE: Medical Insurance Debate

Thu Aug 03, 2006 4:49 am

Quoting Searpqx (Reply 17):
Honest question - what about the person who (legitimately) can't work, and thus can't afford premiums? Is there a social safety net?

Yes, if you make very little money, the canton (state), will subsidize your insurance.
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RE: Medical Insurance Debate

Thu Aug 03, 2006 5:53 am

Quoting AeroWesty (Reply 19):
You have full medical and hospitalization coverage, including office visits, lab, doctor and surgical fees for $22 per month per person?

For health, yes...BUT, I use the same provider for worker's comp, vision, dental, LTD, STD, FlexAccount, and a referral kickback for 401k. The subsidy that allows them to offer me $22 per month per person per PPO is more than made up by the premium that my company pays for the other stuff, especially the worker's comp and LTD services. If all my employees signed up for all the benefits, I would imagine the total output is about $380 - $400 per person, not counting any end of year rewards that come back to the company. Net it's closer to the $355-365 mark. If I used my provider for health only, I would be paying through the nose like everyone else.

Bear in mind also that this is a tiered structure aimed at small businesses. Bigger corporations pay more for a more complex, scalable service. Individuals pay more for unsubsidized services.
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AeroWesty
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RE: Medical Insurance Debate

Thu Aug 03, 2006 6:03 am

Quoting IFEMaster (Reply 21):
The subsidy

Thank you. That's more like it.  Wink
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RE: Medical Insurance Debate

Thu Aug 03, 2006 6:06 am

Quoting IFEMaster (Reply 21):
For health, yes...BUT, I use the same provider for worker's comp, vision, dental

Gosh - in South Africa; dental, optical, medical, etc. are usually all included, depending on which benefit option you are. Personally, I pay $142 a month for my medical insurance, which includes unlimited private hospital-and related expenses cover (at cost).

Consultations and day-to-day medical expenses are covered from a "fairly generous" savings account and "gap cover".


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tu204
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RE: Medical Insurance Debate

Thu Aug 03, 2006 6:09 am

In Russia medical insurance is free for all citizens.  Smile
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IFEMaster
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RE: Medical Insurance Debate

Thu Aug 03, 2006 6:26 am

Quoting AeroWesty (Reply 22):
Thank you. That's more like it.

Sorry, I should have been clearer. However, I still think my overall costs are lower than most. Considering that I offer Health, Dental, Vision, LTD, STD, Flex Account, 401k, and have Worker's Comp insurance on the company, my output for ALL of that is $411 per person per month right now. I remember the first tender I had was about $780 per person per month (based on my current number of employees). Negotiating to less than 2/3 of the original price got me a good deal.
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RE: Medical Insurance Debate

Thu Aug 03, 2006 8:22 am

 
cfalk
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RE: Medical Insurance Debate

Thu Aug 03, 2006 2:02 pm

Quoting NWDC10 (Reply 26):
Very good reading. Robert NWDC10

I disagree. From what I can tell, Kerry is talking about health care as some sort of "right". As in you have the "right" to recieve all those expensive treatments.

I disagree. You have a right to be left alone, to live free, and do more or less what you want. Health care is expensive and must be paid for at great cost. It is not a right, it is a priviledge. I do not want the government to get involved in health care. I think it is far, far to involved already. Medicare and Medicaid should be scrapped entirely.

However, as I said, there are ways to have the private sector ensure the people are 100% insured without having the government putting its fat, inefficient, smelly fingers into it. Just set up a few rules, and let it ride.
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JJJ
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RE: Medical Insurance Debate

Thu Aug 03, 2006 5:32 pm

We have free health care systems here, too.

However, a private plan for a young male can go for as low as 60 euro/month inc. dental.

And I'm talking Sanitas, a reputable company.

Quoting Cfalk (Reply 27):
However, as I said, there are ways to have the private sector ensure the people are 100% insured without having the government putting its fat, inefficient, smelly fingers into it

The US spends 13,9% of their GDP on health care (44,4% government / 55,6% private), the UK figures are 7,6% (82,2% / 17,8%). Talk about inefficiency.

http://www.who.int/whr/2004/annex/topic/annex5.xls
 
Doona
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RE: Medical Insurance Debate

Thu Aug 03, 2006 5:41 pm

Quoting Cfalk (Reply 27):
I disagree. You have a right to be left alone, to live free, and do more or less what you want. Health care is expensive and must be paid for at great cost. It is not a right, it is a priviledge. I do not want the government to get involved in health care. I think it is far, far to involved already. Medicare and Medicaid should be scrapped entirely.

It usually serves a goverment's interests to keep it's citizens alive. And being healthy is a basic human right. Most people agree actually seem on that one. What's wrong with providing free health care for people who can't afford it?

Quoting Cfalk (Reply 27):

However, as I said, there are ways to have the private sector ensure the people are 100% insured without having the government putting its fat, inefficient, smelly fingers into it. Just set up a few rules, and let it ride.

See your above post. Regulating such a system is not having the government putting it's fat, inefficient, smelly fingers into it?  duck 

And I'm still sceptical towards letting insurance companies, companies that are out to make a profit, decide if you should get the treatment I need.

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Roger136913
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RE: Medical Insurance Debate

Thu Aug 03, 2006 7:00 pm

Private Insurance per person that I looked into was on average of $550.00 per month, and the insurance was not great.

My Wife has Blue Cross Blue Shield HMO and we pay $225.00 per moth for the family plan (2 of us) she works for the City they pay the balance which is about $800.00 they get a discount with alot of City workers.
 
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RE: Medical Insurance Debate

Thu Aug 03, 2006 10:55 pm

Here in Thailand we pay US$ 85 per person per month for a private medical insurance with inpatient coverage. Basically it means that if we need surgery and stay overnight in the hospital, even for minor surgery, the insurance will pay up. And staying in a private hospital here is about the same as a four-star hotel! It does not cover doctor visits and outpatient medication.

In Spain we used to pay US$ 65 per person per month, and that was for a full private insurance incl. doctor visits, so cheaper and more complete than Thailand. But still, looking at the other amounts mentioned in this thread, I am not complaining...
 
cfalk
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RE: Medical Insurance Debate

Fri Aug 04, 2006 12:02 am

Quoting JJJ (Reply 28):
The US spends 13,9% of their GDP on health care (44,4% government / 55,6% private), the UK figures are 7,6% (82,2% / 17,8%). Talk about inefficiency.

The british government simply underspends. We've all heard of the stories of 6 month waiting lists to get something like a cat scan.

Quoting Doona (Reply 29):
And being healthy is a basic human right.

No, it isn't. You have to either work at it (excercise, eat right etc.), or pay for it (corrective procedures and medical care). Such things are not rights.

Quoting Doona (Reply 29):
See your above post. Regulating such a system is not having the government putting it's fat, inefficient, smelly fingers into it?

I should have been clearer, my apologies. What I am saying is that the government should not have to administrate or pay for health care. It just creates a huge expensive bureaucracy and another political footbal for future political campaigns.

Instead, an intelligent design for basic coverage should be agreed to (the Swiss one might be a good example) and announce a basic structure for national coverage. The basic law should be feasible in 10 pages or less. Once the law is in place, the government should wash its hands of the whole issue, other than a small regulatory police which can investigate compliance issues.
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JJJ
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RE: Medical Insurance Debate

Fri Aug 04, 2006 12:28 am

Quoting Cfalk (Reply 32):
The british government simply underspends. We've all heard of the stories of 6 month waiting lists to get something like a cat scan.

Check Sweden: 8,7% with 85,2%/14,8% and a sterling record or Norway: 8% with 85,5%/14,5%.

The current sorry state of the NHS is largely an outcome of the Thatcherite school of 'let's underfund our public services so that everyone goes private', a single % point would probably set up a great system.

Swiss figures, btw, are at 11%, curiously the same as Germany.

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