Debunking Canadian Health Care Myths

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Rhonda Hackett
Jun 7, 2009 - Denver Post

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What do we pay for, anyway? As a Canadian living in the United States for the past 17 years, I am frequently asked by Americans and Canadians alike to declare one health care system as the better one.

Often I'll avoid answering, regardless of the questioner's nationality. To choose one or the other system usually translates into a heated discussion of each one's merits, pitfalls, and an intense recitation of commonly cited statistical comparisons of the two systems.

Because if the only way we compared the two systems was with statistics, there is a clear victor. It is becoming increasingly more difficult to dispute the fact that Canada spends less money on health care to get better outcomes.

Yet, the debate rages on. Indeed, it has reached a fever pitch since President Barack Obama took office, with Americans either dreading or hoping for the dawn of a single-payer health care system. Opponents of such a system cite Canada as the best example of what not to do, while proponents laud that very same Canadian system as the answer to all of America's health care problems. Frankly, both sides often get things wrong when trotting out Canada to further their respective arguments.

As America comes to grips with the reality that changes are desperately needed within its health care infrastructure, it might prove useful to first debunk some myths about the Canadian system.

* Myth: Taxes in Canada are extremely high, mostly because of national health care.

In actuality, taxes are nearly equal on both sides of the border. Overall, Canada's taxes are slightly higher than those in the U.S. However, Canadians are afforded many benefits for their tax dollars, even beyond health care (e.g., tax credits, family allowance, cheaper higher education), so the end result is a wash. At the end of the day, the average after-tax income of Canadian workers is equal to about 82 percent of their gross pay. In the U.S., that average is 81.9 percent.

* Myth: Canada's health care system is a cumbersome bureaucracy.

The U.S. has the most bureaucratic health care system in the world. More than 31 percent of every dollar spent on health care in the U.S. goes to paperwork, overhead, CEO salaries, profits, etc. The provincial single-payer system in Canada operates with just a 1 percent overhead. Think about it. It is not necessary to spend a huge amount of money to decide who gets care and who doesn't when everybody is covered.

* Myth: The Canadian system is significantly more expensive than that of the U.S.

Ten percent of Canada's GDP is spent on health care for 100 percent of the population. The U.S. spends 17 percent of its GDP but 15 percent of its population has no coverage whatsoever and millions of others have inadequate coverage. In essence, the U.S. system is considerably more expensive than Canada's. Part of the reason for this is uninsured and underinsured people in the U.S. still get sick and eventually seek care. People who cannot afford care wait until advanced stages of an illness to see a doctor and then do so through emergency rooms, which cost considerably more than primary care services.

What the American taxpayer may not realize is that such care costs about $45 billion per year, and someone has to pay it. This is why insurance premiums increase every year for insured patients while co-pays and deductibles also rise rapidly.

* Myth: Canada's government decides who gets health care and when they get it.

While HMOs and other private medical insurers in the U.S. do indeed make such decisions, the only people in Canada to do so are physicians. In Canada, the government has absolutely no say in who gets care or how they get it. Medical decisions are left entirely up to doctors, as they should be.

There are no requirements for pre-authorization whatsoever. If your family doctor says you need an MRI, you get one. In the U.S., if an insurance administrator says you are not getting an MRI, you don't get one no matter what your doctor thinks — unless, of course, you have the money to cover the cost.

* Myth: There are long waits for care, which compromise access to care.There are no waits for urgent or primary care in Canada.

There are reasonable waits for most specialists' care, and much longer waits for elective surgery. Yes, there are those instances where a patient can wait up to a month for radiation therapy for breast cancer or prostate cancer, for example. However, the wait has nothing to do with money per se, but everything to do with the lack of radiation therapists. Despite such waits, however, it is noteworthy that Canada boasts lower incident and mortality rates than the U.S. for all cancers combined, according to the U.S. Cancer Statistics Working Group and the Canadian Cancer Society. Moreover, fewer Canadians (11.3 percent) than Americans (14.4 percent) admit unmet health care needs.

* Myth: Canadians are paying out of pocket to come to the U.S. for medical care.

Most patients who come from Canada to the U.S. for health care are those whose costs are covered by the Canadian governments. If a Canadian goes outside of the country to get services that are deemed medically necessary, not experimental, and are not available at home for whatever reason (e.g., shortage or absence of high tech medical equipment; a longer wait for service than is medically prudent; or lack of physician expertise), the provincial government where you live fully funds your care. Those patients who do come to the U.S. for care and pay out of pocket are those who perceive their care to be more urgent than it likely is.

* Myth: Canada is a socialized health care system in which the government runs hospitals and where doctors work for the government.

Princeton University health economist Uwe Reinhardt says single-payer systems are not "socialized medicine" but "social insurance" systems because doctors work in the private sector while their pay comes from a public source. Most physicians in Canada are self-employed. They are not employees of the government nor are they accountable to the government. Doctors are accountable to their patients only. More than 90 percent of physicians in Canada are paid on a fee-for-service basis. Claims are submitted to a single provincial health care plan for reimbursement, whereas in the U.S., claims are submitted to a multitude of insurance providers. Moreover, Canadian hospitals are controlled by private boards and/or regional health authorities rather than being part of or run by the government.

Myth: There aren't enough doctors in Canada.

From a purely statistical standpoint, there are enough physicians in Canada to meet the health care needs of its people. But most doctors practice in large urban areas, leaving rural areas with bona fide shortages. This situation is no different than that being experienced in the U.S. Simply training and employing more doctors is not likely to have any significant impact on this specific problem. Whatever issues there are with having an adequate number of doctors in any one geographical area, they have nothing to do with the single-payer system.

And these are just some of the myths about the Canadian health care system. While emulating the Canadian system will likely not fix U.S. health care, it probably isn't the big bad "socialist" bogeyman it has been made out to be.

It is not a perfect system, but it has its merits. For people like my 55-year-old Aunt Betty, who has been waiting for 14 months for knee-replacement surgery due to a long history of arthritis, it is the superior system. Her $35,000-plus surgery is finally scheduled for next month. She has been in pain, and her quality of life has been compromised. However, there is a light at the end of the tunnel. Aunt Betty — who lives on a fixed income and could never afford private health insurance, much less the cost of the surgery and requisite follow-up care — will soon sport a new, high-tech knee. Waiting 14 months for the procedure is easy when the alternative is living in pain for the rest of your life.

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Rhonda Hackett of Castle Rock is a clinical psychologist.

Hold Your Applause

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Chris Hedges
June 8, 2009 - TruthDig.com

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Did they play Barack Obama's speech to the Muslim world in the prison corridors of Abu Ghraib, Bagram air base, Guantanamo or the dozens of secret sites where we hold thousands of Muslims around the world? Did it echo off the walls of the crowded morgues filled with the mutilated bodies of the Muslim dead in Baghdad or Kabul? Was it broadcast from the tops of minarets in the villages and towns decimated by U.S. iron fragmentation bombs? Was it heard in the squalid refugee camps of Gaza, where 1.5 million Palestinians live in the world's largest ghetto?

What do words of peace and cooperation mean from us when we torture-yes, we still torture-only Muslims? What do these words mean when we sanction Israel's brutal air assaults on Lebanon and Gaza, assaults that demolished thousands of homes and left hundreds dead and injured? How does it look for Obama to call for democracy and human rights from Egypt, where we lavishly fund and support the despotic regime of Hosni Mubarak, one of the longest-reigning dictators in the Middle East?

We may thrill to Obama's rhetoric, but very few of the 1.3 billion Muslims in the world are as deluded. They grasp that nothing so far has changed for Muslims in the Middle East under the Obama administration. The wars of occupation go on or have been expanded. Israel continues to flout international law, gobbling up more Palestinian land and carrying out egregious war crimes in Gaza. Calcified, repressive regimes in countries such as Egypt and Saudi Arabia are feted in Washington as allies.

The speech at Cairo University, which usually has trucks filled with riot police outside the university gates and a heavy security presence on campus to control the student body, is an example of the facade. Student political groups, as everyone who joined in the standing ovation for the president knew, are prohibited. Faculty deans are chosen by the administration, rather than elected by professors, "as a way to combat Islamist influence on campus," according to the U.S. State Department's latest human rights report. And, as The Washington Post pointed out, students who use the Internet "as an outlet for their political or social views are on notice: One Cairo University student blogger was jailed for two months last summer for 'public agitation,' and another was kicked out of university housing for criticizing the government."

The expanding imperial projects and tightening screws of repression lurch forward under Obama. We are not trying to end terror or promote democracy. We are ensuring that our corporate state has a steady supply of the cheap oil to which it is addicted. And the scarcer oil becomes, the more aggressive we become. This is the game playing out in the Muslim world.

The Bush White House openly tortured. The Obama White House tortures and pretends not to. Obama may have banned waterboarding, but as Luke Mitchell points out in next month's issue of Harper's magazine, torture, including isolation, sleep and sensory deprivation and force-feeding, continues to be used to break detainees. The president has promised to close Guantanamo, where only 1 percent of the prisoners held offshore by the United States are kept. And the Obama administration has sought to obscure the fate and condition of thousands of Muslims held in black holes around the globe. As Mitchell notes, the Obama White House "has sought to prevent detainees at Bagram prison in Afghanistan from gaining access to courts where they may reveal the circumstances of their imprisonment. It has sought to continue the practice of rendering prisoners to unknown and unknowable locations outside the United States, and sought to keep secret many (though not all) of the
records regarding our treatment of those detainees."

Muslim rage is stoked because we station tens of thousands of American troops on Muslim soil, occupy two Muslim nations, make possible the illegal Israeli occupation of Palestine, support repressive Arab regimes and torture thousands of Muslims in offshore penal colonies where prisoners are stripped of their rights. We now have 22 times as many military personnel in the Muslim world as were deployed during the crusades in the 12th century. The rage comes because we have constructed massive military bases, some the size of small cities, in Iraq, Afghanistan, Saudi Arabia, Turkey and Kuwait, and established basing rights in the Gulf states of Bahrain, Qatar, Oman and the United Arab Emirates. The rage comes because we have expanded our military empire into neighboring Uzbekistan, Pakistan, Kyrgyzstan and Tajikistan. It comes because we station troops and special forces in Egypt, Algeria and Yemen. And this vast network of bases and military outposts looks
suspiciously permanent.

The Muslim world fears, correctly, that we intend to dominate Middle East oil supplies and any Caspian Sea oil infrastructure. And it is interested not in our protestations of good will but in the elemental right of justice and freedom from foreign occupation. We would react, should the situation be reversed, no differently.

The brutal reality of expanding foreign occupation and harsher and harsher forms of control are the tinder of Islamic fundamentalism, insurgences and terrorism. We can blame the violence on a clash of civilizations. We can naively tell ourselves we are envied for our freedoms. We can point to the Koran. But these are fantasies that divert us from facing the central dispute between us and the Muslim world, from facing our own responsibility for the virus of chaos and violence spreading throughout the Middle East. We can have peace when we shut down our bases, stay the hand of the Israelis to create a Palestinian state, and go home, or we can have long, costly and ultimately futile regional war. We cannot have both.

Obama, whose embrace of American imperialism is as naive and destructive as that of George W. Bush, is the newest brand used to peddle the poison of permanent war. We may not see it. But those who bury the dead do.

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Chris Hedges writes a regular column for Truthdig.com. Hedges graduated from Harvard Divinity School and was for nearly two decades a foreign correspondent for The New York Times. He is the author of many books, including: War Is A Force That Gives Us Meaning, What Every Person Should Know About War, and American Fascists: The Christian Right and the War on America. His most recent book, Empire of Illusion: The End of Literacy and the Triumph of Spectacle, will be out in July.

The 'Death Tax' Scam

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America's wealthiest families are pouring millions into slashing the estate tax - and some Democrats are siding with the super-rich

Michael Crowley
May 27, 2009 - Rolling Stone

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On a bright April day in Barack Obama's America, where equality is on the rise and greed is on the run, a Democratic senator from an impoverished Southern state took a brave stand — on behalf of the country's richest families.

On April 1st, Sen. Blanche Lincoln of Arkansas, a state with the nation's third-lowest median income, sponsored a budget amendment that would sharply reduce taxes on the estates of multimillionaires after they die. Estates worth up to $7 million per couple, and $3.5 million for individuals, are already exempt from taxes — meaning that 99.75 percent of all Americans die without paying a dime to Uncle Sam. But Lincoln's proposal would raise the exemption to $10 million — and slash the tax rate on even larger estates from 45 percent to 35 percent. All told, the move would let the children of Wall Street barons, dot-com millionaires and wealthy industrialists pocket more than $90 billion in tax revenues over the next decade.

Harry Reid, the Senate majority leader, was furious at Lincoln's move, calling it "so stunning, so outrageous that some would choose this hour of national crisis to push for an amendment to slash the estate tax for the superwealthy." Yet the tax cut passed with 51 votes — including 10 Democrats.

A few weeks later, during negotiations to reconcile the Senate's budget with the one passed by the House, the tax cut was undone. But the battle over the "death tax," as Republicans have shrewdly labeled it, is just beginning — and it involves one of the best-funded and most effective lobbying operations that Washington has ever seen. It is a movement that conservatives often portray as the work of a grass-roots uprising but in large measure has been propelled by a very small number of extremely rich people. "You have a group of wealthy families that are funding a very sophisticated effort," says Michael Graetz, a law professor at Yale who has studied the movement to repeal the estate tax. Over the past 20 years, those families have exerted their power in ways that can be traced, in a surprisingly direct way, to many of the Democrats who voted for Blanche Lincoln's amendment — and who are hoping for bigger victories this fall.

The families behind the estate-tax repeal — working in concert with right-wing anti-tax ideologues — are attempting to undo a century-old consensus about taxing huge inheritances, one borne of the progressive movement in the late 19th century. The Gilded Age produced such huge concentrations of wealth that even its biggest winners agreed that they should share their fortunes rather than simply pass them along from one generation to another. Among those making the case was Andrew Carnegie, whose steel fortune dominated the nation's economy at the time. "The parent who leaves his son great wealth generally deadens the talents and energies of the son, and tempts him to lead a less useful and less worthy life than he otherwise would," Carnegie wrote, adding on another occasion that he "should as soon leave to my son a curse as the almighty dollar." The estate tax also became a cause of Teddy Roosevelt, who argued that vast fortunes passed between
generations cause "great and genuine detriment to the community at large." Convinced that massive inheritances offended America's egalitarian principles, Congress authorized the first estate tax in 1916.

Fast-forward to the 1990s, when the heir to a fortune begun in Carnegie's time set out to undo the work of his predecessors. Frank Blethen publishes The Seattle Times, which was founded by his great-grandfather in 1896, and runs a family company that also owns newspapers in Maine and elsewhere in Washington state. The 65-year-old Blethen, who drives to work in a $93,000 Porsche and has his newspaper's logo tattooed on his leg, is obsessed with getting rid of the estate tax — a move that would enable his descendants to pocket a family fortune once estimated at $650 million, without paying a penny in taxes. In 1995, Blethen began gathering estate-tax opponents together for annual summits at which they plotted strategy for a relentless campaign to place the issue on Congress' political agenda.

At first, the prospect seemed impossible. "People thought this was out of the question," says Graetz. After all, how could the average congressman fight to save families like the Blethens more money in a single shot than most Americans make in their lifetimes? To shift the political calculus, rich families poured millions into the effort — and created front groups to do the dirty work. According to a joint report by Public Citizen and United for a Fair Economy, at least 18 families are actively working to repeal the estate tax by pumping money into campaign donations, advocacy groups that crank out slanted economic studies and political ads slamming estate-tax supporters. Eighteen members of those families are billionaires who can be found on the Forbes 400 list; by one estimate, their clans stand to save more than $70 billion from a total repeal of the tax.

Many of the families are household names. There is the Mars family, makers of M&Ms and other candy, who would avoid $10 billion in estate taxes. There is the Gallo family, whose winemaker patriarch hoped to save an estimated $500 million from abolishing the tax. There are the Nordstroms, of department-store fame; the Dorrances, makers of Campbell's soup; and the Wegmans, owners of supermarkets by the same name. And there is the Walton family, owners of Walmart, a clan whose worth may exceed $75 billion. Their personal profit from repealing the estate tax would total $30 billion — roughly the gross domestic product of Jordan.

The Progressive Tribe and Improving the World

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Joe Brewer
May 15, 2009 - CommonDreams.org

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The world is in need of some serious change. We all know this. And many people have taken the call personally and seriously. I encourage you to do the same. You can be an engine of creativity. You can be a catalyst for positive change in the world.

It all starts when you see yourself as part of something bigger. And it helps to have a way to connect to the community you find yourself in. One key element of this is having a name that reflects your tribe - the particular group that you resonate deeply with. In the political world, this is the label that captures your identity. In recent decades our labels have been conflated and, in many cases, attacked viciously as part of public relations campaigns. One casualty of this intensely polarized struggle was the word liberal. That label means something very different today than it did a few years ago.

The newly popular label progressive has taken the political world by storm. The cynical among us treat this as nothing more than a massage of the battered liberal, and yet it is this provocative term that feeds a movement inspiring millions of people -including the supposedly disaffected youth - to rally together for a better world. Why is this word so powerful? It seems like there is more happening than mere wordplay.

Something Deeper is Going On

I am a student of language and thought (In techno-jargon, I study cognitive linguistics.) And I apply this powerful new field of inquiry to the world of political and social change. Insights about the deeper concepts underlying our political labels can help clarify just why the word progressive is so powerful as a motivator of social change. This allows us to gain new perspectives about ourselves, emboldening us to take steps in our own lives to make the world a better place.

An important starting point is knowing that brain function is at the heart of thought. The minds we have are fundamentally shaped by the way our brains operate. A major feature of brain function is that "higher" (i.e. more complex) thought processes are built on "lower" functions that work in combination. For example, in order to make sense of our lives throughout the day, our brains need to be able to construct stories that organize our experience into coherent patterns. This is a very complex process that builds upon something much more basic - the coordination of simple body movements into a choreographed sequence. So when you pick up a glass to drink from, your brain puts together arm extension, opening and closing of fingers, rotation, and many small motions of your head, neck and throat in a dance of complexity that you are scarcely aware of while you are doing it.

It is this ability to choreograph movement that makes storytelling possible. Every story is structured with a beginning, middle, and end that is motivated by some relevant purpose. The same is true for taking a drink of water.

The take-home message from this insight is that much of what your brain is doing on your behalf happens outside conscious awareness. So for movement, also for thought.

Political Labels Tell Stories

What does this have to do with politics? Everything! When you hear the word progressive, many things are happening in your brain that never arrive as conscious thoughts. The part of this having to do with concepts and meaning is what George Lakoff calls a "frame." A frame is the hidden conceptual structure that organizes your thoughts into something meaningful. The Progressive Frame is the pattern of information that arises when you think about the word progressive.

The Progressive Frame is very different from the Liberal Frame. People who haven't studied cognitive linguistics fail to realize this when they assert that the two words are interchangeable. What makes them different? Simply put, they tell different stories. (Actually, there's a lot more going on that I won't go into here.) The Progressive Frame activates a narrative about progress. This narrative has a beginning in some troubled world, then moves through an unspecified series of events to arrive at a better one. The story of progress is about improvement as understood by the storyteller.

By contrast, the Liberal Frame tells a story of liberty. In particular, it is a story about individual freedom against oppression. Historically, this has been applied to issues like self-rule (injustices of monarchy), civil liberties (the right to vote), and equality (empowered citizenship in the face of oppression). The Liberty Story is often told as one of progress from a condition of less freedom to a condition of more freedom. This is when it is most persuasive and inspirational. The power of the Liberal Frame, before it was tainted by an intentional process of radicalization by its opponents, resides in the Progressive Frame that is evoked when telling a story of progress.

The two frames are interconnected, which partly explains the confusion about their political meanings. But it has always been the Progressive Frame that compelled people to join movements. Don't believe me? Ask yourself whether you would ever join a political struggle that DOESN'T involve some kind of progress.

Ironically, the Progressive Frame lies at the heart of Conservative Populism too. The Conservative Frame underlies the powerful label conservative for people seeking to restore what they believe to be traditional values that have eroded away. This is also a story of progress, albeit one that presumes some kind of fall from grace as a pretext to the current situation. The existence of a progress story in conservative thought is what makes possible Obama's appeals to historically conservative citizens. Deep down we all want progress. It is our different notions of what we consider progress to be that leads to so much quarreling.

Declare Your Tribe and Improve the World!

Now that we have greater clarity about the concepts behind important political labels, a landscape of possibilities for actually improving the world appears before us. Political labels matter because of the stories they tell. Furthermore, the stories told by the opposition about our labels can be harmful to us. The word liberal is severely contentious now because it was targeted by a series of smear campaigns in the past (which are ongoing via conservative media outlets like Fox News and talk radio).

At the same time, we can use the power of progress to unite people. This is the great potential of knowing your frames... you can apply them clearly and powerfully when you know how they work. (Or you can habitually activate them without knowing they are there!) The essential idea is that everyone wants progress. So the label progressive has potential as a unifying force that brings together people who are tired of the push and pull of liberal versus conservative.

Tribes Will Transform the World

Why chose a label? Because it identifies you as part of a tribe. Seth Godin, the marketing guru who popularized the concept of an idea virus, makes a compelling argument that it is tribes, not money or factories, that will change the world. This TED Talk makes the case:

http://www.ted.com/index.php/talks/lang/eng/seth_godin_on_the_tribes_we_lead.html

We all want to make the world a better place. By implication, we are all out to get the status quo. In spite of this the status quo has proven to be quite resilient. What's going on here? I would argue that two key obstacles stand in our way.

First, most people don't understand what is happening below the surface of their awareness - making it easy to sow distrust through manipulative practices (a problem I'm exploring solutions for). This can be addressed by expanding citizen education about the workings of our minds - what I call revealing the Great Political Blind Spot.

Second, we remain divided and disorganized as world-changers. The secret behind social change is Godin's observation about tribes. Margaret Mead famously declared that it is always a small group of like-minded people who change the world. Emphasis should be squarely placed on the small group part of her observation. Like-minded people can unite with existing communications technologies in ways that couldn't have been dreamed of a few short years ago. We have outlets like the blogosphere, YouTube, facebook, and Twitter at our fingertips to organize and get the word out about our activities.

Now is the time to get organized. I encourage you to watch Godin's talk and take his closing remarks seriously. He boldly calls upon the audience to start a movement within 24 hours. All you need is to reach a critical threshold of people, each of whom is engaged in other existing networks that they can reach out to and spread ideas around.

This isn't as hard as it seems. First you have to believe that you can make a difference. Second, start thinking about things you'd like to see improved. Third, look for people who share one of your passions who also want to make progress on the same issue. For example, you might really be into cycling and want to see parents spending more time with their kids. Put the two together and you've got a recipe for Bike-A-Child as a catchy theme for a Saturday afternoon. Cyclist moms and dads can have some fun and teach their kids the importance of good exercise at the same time.

For too long politics has been about preserving our differences. I think its time to change the name of the game. Politics in the 21st Century is going to be built with affinity groups - people who come together around shared interests. Social change is going to arise from a thousand little groundswells of people making a difference in their peer networks. A thousand ripples combined can quickly become a sea change!

Rather than letting elite communications teams (marketing and PR firms) define the labels of our politics, let's claim them for ourselves. We can be progressives because we want to see real progress toward a better world. This may not lead to a vision shared by the masses, but it does allow for communities to grow around visions of our own.

Of course, the concerned reader will quickly point out that one person's vision can be another's nightmare. True enough. But until the visions come from within us, instead of from message architects in the mass media, the only progress to be made will be further entrenchment in the status quo. We've seen where this leads... the largest wealth inequalities in human history and intensely corrupt economic and political systems.

I say, "No more!"

The issue I'm concerned about is manipulation of the populace. If you don't have a movement of your own to start (or even if you do), feel free to get involved in mine. In the days ahead, I want to lay a foundation for new practices in the political and social change arenas based on insights about the mind. This is not something one person can do on his (or her!) own. It is going to take thousands of us coming together and establishing a different set of social norms for political engagement.

If we work together as a progressive tribe, we really can improve the world.

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Joe Brewer is founder and director of Cognitive Policy Works, an educational and research center devoted to the application of cognitive and behavioral sciences to politics.  He is a former fellow of the Rockridge Institute, a think tank founded by George Lakoff to analyze political discourse for the progressive movement.

Zen Moment of the Day

Cattle: Mother Nature's worst nightmare, apparently. Studies show that through their burps, cows emit between 200 and 400 pounds of methane gases each year, one of the most dangerous heat-trapping emission with ties to global warming, second only to carbon dioxide.

In an effort on behalf of the cows to go green, farmers in Vermont are altering cattle feed to reduce methane emissions as part of an experiment conducted by yogurt company Stonyfield Farms. In mid-May, when results were last recorded, one herd showed an 18-percent drop in methane output. Milk production has stayed the same, and the cows' coats are reportedly shinier and their breaths sweeter to boot.

- The Daily Beast