How the Health Care Crisis Hit Home for My Family

No way the GOP wins a fight over health care with stories like this multiplied by the millions. You don’t succeed when you want to cut back and Obama wants to cover more folks.

http://www.political-buzz.com/

Outstanding piece KT. I’m glad it made the cover. You make a lot of good points.
” A paradox of medical costs is that people who can least afford them — the uninsured — end up being charged the most.” It is expensive being poor.
Those without an advocate as skilled as you are in dire straights.
I wish your brother well.

The first irony is that our current situation is not new. While certain elements in our country like to make light of those less fortunate than themselves and pretend they deserve what they get, the truth is significantly more complex and as KT notes significantly more tragic than its been portrayed for going on 15 years now.

The other thing worth noting right off, is that the insurance her brother was buying bears a remarkable similarity to the mortgages many people have bought.
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People profiting mightily on consumer needs couple with misplaced trust.

KT-Thanks for sharing something personal to you with us. I know this is not easy for a traditional reporter like yourself, who loaths to be the story. But your brother’s story is important to me too. No one should be without access to needed health care. Period.
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I can’t fix our health care mess, but if your family needs assistance to help defray costs I will be more than glad to donate and you can count on me.

What a heartbreaking story. Thanks to your brother for his willingness to lay bare his life in a national magazine. Thanks to you for naming names.
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We can hope that the fear that we all have of losing jobs and health coverage will provide the political impetus to get this changed.
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(Stengel is talking about the story on MSNBC right now, along with Nancy snyderman)
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One thing I haven’t seen addressed is the increase in productivity that would surely follow if this burden of fear were lifted from all Americans.
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Please read your story online and let the High Sheriffs know that some of the links into your story (and others, but here we are on yours) are wildly inappropriate to the point of being infuriating:
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That’s when Pat, who is now 54, learned that his kidneys were failing. (See the most common hospital mishaps.)
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I said I’d take care of it, bringing to bear my 15 years of experience covering health policy, sitting through endless congressional hearings on the subject and even moderating a presidential candidates’ forum on the issue. (See pictures of Barack Obama behind the scenes on Inauguration Day.)

KT, I’m so sorry about your brother. I hope you all find some way to get him help, and that he gets better.
I had major spinal surgery last year. My company’s insurance is apparently as good as anybody’s, but even with coverage it was astonishingly difficult to get them to pay. Both my hospital and the artifiical disk manufacturer employ several people who spend all day prevailing upon insurance companies to meet their contractual obligations. I think the hospital finally gave up on collecting the last few thousand dollars.
I don’t know how people without the resources (and persistence) that I have available could ever get things paid for even if they do have coverage.

Thank you, Karen, for the fine article. You’ve performed an important public service if it helps to wake people up.
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Your article could be used as a summary for the movie ‘Sicko’. The same issues are dealt with in the movie, and the conclusion is the same. I highly recommend watching it to anyone who hasn’t. I know Michael Moore is a lightning rod for many on the right, and some of the scenes in the movie (particularly in Cuba) could have been more effective if they hadn’t been so contentious. I hope people can get beyond the messenger and concentrate on the message. It’s important.
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Your brother has our best wishes.

This article should shine a bright spotlight on any political argument that relies on blaming the victim for their troubles. Such arguments are, of course as common as termites and just as harmful. I hope that your article inspires scrutiny on ALL such debates, bnot just those involving medical care.
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Thanks for the article. You’ve provided an invaluable service.

KT, thank you. Ditto the comments above. And isn’t it interesting that your family’s story would have fit right in Michael Moore’s “Sicko,” which focused on how health insurance in America seeks to not pay for treatment. And wqhich key figures in teh msm sought to discredit (see: Gupta, Sanjay)
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Best wishes to your brother and your family in its entirety.
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I hope you don’t mind, but I reposted your blog at my site in the hope of driving more traffic to your story. It is important.

kathy: agreed. am asking the High Sheriffs to fix this. some of those links are just flat-out weird.

wvng: much, much appreciated.

But given “the extraordinary circumstances involved,” the company agreed to pay his claims from last year, when the policy was still in force. (Pat canceled it on Aug. 22, 2008.) Those extraordinary circumstances, I assume, included the fact that the state insurance department was sniffing around.
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one suspects, given how bad Texas’s health care/insurance system is, that it was your position as a national journalist digging into Assurant that played an even bigger role. I have a hard time believing that you were the first person to complain to the insurance commission about these kinds of policies… and I’d be willing to bet that the insurance commission has let Assurant sweep this under the rug for a while.
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” A paradox of medical costs is that people who can least afford them — the uninsured — end up being charged the most.”
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and one strongly suspects that when Assurant did finally decide to pay, that the care providers didn’t charge Assurant what Pat Tumulty was being charged.

pluk: to the best of my knowledge, assurant did not know anything about me or my connection to pat when it made that decision. i waited until after they did to call them and ask for comment. however, the texas insurance department did.
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also, you have a very good point on that second one. the figures that i cite in the story came from the statements that assurant sent us when they started paying the claims. however, it is important to point out that because my brother’s policy had a $2,500 deductible and a 50% copay, he is still on the hook for over half of what is owed, which is thousands of dollars. i won’t really know how much until we sort all this out. but so far, he has only received one check from assurant, for about (if memory serves me right) $13.

Karen, I’m praying for Pat’s peace, comfort, and return to health. I’m also praying for justice. I worked briefly for QualMed/Foundation Health in the ’90s, and know whereof I speak.

It’s not a seamless system. Pat gets confused navigating between Smolens, who prescribes tests and medications, and CareLink, which must approve them. “The fact is, for guys like Pat, it requires a lot more work to do the same sorts of things” that would be a snap if he had insurance, says Smolens, sighing.
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this struck me, because CareLink seems to be operating like your average HMO; in other words, even if Pat had “insurance”, he’d still be having to deal with a difficult to navigate insurance system instead of just getting the care he needs. (I was referred to a specialist by my “primary care physician” a while back; and when the specialist recommended further tests, I had to go back to my primary care physician to get his approval for more tests….)

KT: Thanks for sharing a personal issue and best wishes to your brother. It amazes me that as a nation we have failed so miserably to provide basic care for everyone. I know there are vested interests and conniving politicians who have made medical care a business for profit. My brother in Canada had major throat surgery and extensive care, free prescriptions for a year, home visits – you name it – oh yes free parking when going in for treatment – and he is okay now. When Pres Obama was in Ottawa the Canadian Prime Minister repled to a question on health saying they factored in that cost so health care in not aan added issue for say auto manufacturers.

You editor was on MSNBC talking about this.

By the way: nothing is more reprehensible than listening to lobbyists and pols sneering at the Europeans about their “socialised” health care system. We truly have idiots in high places.

pluk: it is significantly more complicated than, say, the system under my managed care plan (united). and his kidney doctor said that sometimes, for instance, he can’t get them to perform the kind of tests he wants done, because they do them another way. and a couple of weeks ago, pat got put on hold for two hours trying to get approval for expensive anemia shots, and finally gave up. (which exasperated his doctor, who just ordered him to come in and get one. we still haven’t sorted out who pays for it.) but i agree that this is built into much of managed care.

bitter: yes, and the system that finally saved my brother is in fact single-payer. it is single-payer on the county level, but “socialized medicine” nonetheless.

These short term & emergency health care plans are such a scam. When I worked at DSS companies would come thru all the time & try to sell “cancer plans.” It was sad to see people actually sign up for these plans.

Many people don’t realize that Medicaid will only pay for a limited number of prescriptions per month. (Used to be 3.). If you have serious medical conditions you are likely to be on more than 3 a month. Tried to help a woman once who had severe mental health problems which required meds, as well as high blood pressure & a siezure disorder. She was poor & illiterate. Each month she would decide between treating her mental health or her seizures. I finally found program to help pay for some of her pills, but she could have never done it on her own.

For many Americans, if you recover from a serious illness, you find yourself physically weakened and flat effing broke. It’s a disgrace. When right-wingers pull the “we could end up like Europe!” scare tactic, they don’t understand that that’s just what we want.

KT, I echo the thanks for the personal and important story and also the good wishes for Pat.
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I’m working contract labor right now trying to get a loan to finish school. No insurance and a painful dental issue I have no choice but to stick it out for a year until graduation and then hope I get a job with insurance quickly.
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That’s the choice I have to make in America, live with the freakin’ pain for a year or more, just to finish my education.

THIS is the post that should have almost 400 comments, and I hope it gets there.
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I work in a small business, where there are only two of us who are actually insured (through our husbands’ work). The rest don’t have any sort of preventative care, and very little care even in acute situations. One woman, Wendy, was reaching for boxes and fell. Her knee swelled to twice its normal size. What did she do? Did she go to the doctor? Nope. She hobbled around the bakery on that knee until the swelling eventually subsided–two weeks later. She couldn’t afford either time off or a doctor visit.
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For these women, no health insurance means that 1) they get sick more easily because of lack of preventative care, 2) they stay sick longer because of lack of care during illness/injury and because they can’t take time off of work, 3) they jeoparidize their future health by not taking care of problems before they become chronic, untreatable, or only expensively treatable, and 4) when they eventually, rarely go to the emergency room, they get charged through the nose and end up in incredible debt, which they can never pay off…because they earn less than $10 an hour.
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On a visceral level, I just don’t understand how this system has lasted for so long. Intellectually, of course, I know about lobby groups and conservative fears, but really–look at the human cost here. And we consider ourselves a world leader?
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Thanks, KT. This is, in my eyes, the most important story you could write.

Thanks for the story, KT and best thoughts for your brother, Pat.

But people have to realize that delay and/or denial of care is standard operating procedure and really part of the business model for health insurance companies. They know that if they deny the claim, that a lot of people will give up and they won’t have to pay for the procedure. Simply put health insurance companies don’t make a profit when they pay out claims. They only make profits when you pay your premiums and don’t use healthcare. They use the premiums to invest in the stock market. They are in a world of hurt right now with the stock market going down. Look for the next industry bailout with the new “healthcare reform” bill pending in Congress….

Karen, I am so sorry your family is going through this right now. Thank you so much for writing this story. I’ll be thinking of your brother; good luck to you all.

Thanks, Suzie. Yes, the fact that I was closing this story is probably why I couldn’t get all worked up over Rush Limbaugh.

Teresakopec, I think the number of prescriptions medicaid pays for depends on the state (or perhaps county) Medicaid program.

KT –

Excellent work, as usual. It’s the personal component that makes it absolutely compelling. Distraction from Limbaugh is your reward.
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Pretty decent coverage of your cover story on MSNBC, although Morning Joke couldn’t wait to squawk his rote talking point about “rationing health care.” He’s still willfully oblivious to the current system of wealth-based rationing by unaccountable entities. Talk about class warfare…
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My uneducated guess is that we’re headed soon for a near-universal coverage system based substantially on private insurance – and that it will last until everyone sees how much of the cost of such a system goes to “management expenses.” It’ll take another wave of reform to get to efficient universal coverage without the complex for-profit middle layer.

KT –
Thanks for the story and for not getting worked up over Rush. I hope that, as the debate over health care continues, we see more solid reporting, and more personal stories. In fact, if Time wanted to build on this and provide a place where people could post their own stories, that could be very powerful. I could also see the Twitterverse being harnessed, using “#healthstories” as a tag and linking to blogs about personal health crises and insurance horrors. They are out there!

KT — All insurance has its limitations. I am, if anything, over-covered. I am still working, and for the federal gov’t, so I have their excellent Blue Cross-Blue Shield coverage. But I’ve aged to the point where I also have Medicare. I pay part of the cost of both (Medicare Plan B isn’t free). And I still cough up almost $10,000 a year for uncovered treatments and medication for my wife (also covered by both) and me.

Also, like your brother Pat, I have some kidney failure. It’s not acute — yet — and my kidney guy has it under control, but I’m scared of what happens if it goes sour. Medicare won’t pick up everything — even if I were on the drug plan, I’d hit the donut hole. If the kidney trouble forces me to retire, I’ll either have to give up my Blue Cross coverage or pay a much higher premium for it. It won’t be a financial crisis like Pat’s, but it will put a major dent in my exchequer.

Compared to Pat, I feel very lucky. It is beyond outrageous to pile all that emotional suffering on top of a painful and debilitating disease. And yet, as you note, his story can be multiplied by millions. What kind of country are we that with all our wealth we can’t — no, won’t — provide quality medical care to all citizens? If I ever do retire, maybe I should move to France.

Good luck to Pat and to those of you helping him.

KT– thanks for writing this powerful and gut wrenching story. I wish your brother all the best and I hope he eventually recovers without becoming destitute in the process.
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Your brother is fortunate to at least have a sister who can champion his cause and navigate this nightmare. I think about those who are on their own, sick and hopeless trying to fight with greedy insurance companies who avoid reducing their profits at the expense of your care and your sanity.
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There have been a number of comments acknowledging your preference for objectivity in your writing. However, I for one am grateful that you’re willing to share your personal story because through it many others may be able to feel not just know the anguish that those of us who face these issues endure everyday.
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I can only hope that after reading your article, that as a nation we might reconsider the moral hazard when it comes to reducing mortgages in the bankruptcy. It’s clear from the numbers you sighted, that a good portion of these homeowners are facing bankruptcy because of a health hazard that doesn’t quite fit the image of one of Rick Santelli losers.
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I can’t help but read your brother’s story and wonder how much a Governor Bush had to do with the incredibly inadequate concern for the uninsured in Texas. Obviously, Barbara Bush didn’t have to deal with this kind of concern when approaching her heart surgery this week. But perhaps if she had her sons would have promoted a different health care agenda.

Thanks for your story, KT. Unfortunately, a lot of people throughout the country have similar stories to tell. The fundamental question we need to ask, is about the morality of a “for profit” health care system. The rest of the civilized world has figure this out. Unfortunately, people in Washington do not have the courage to do the right thing. While they tinker at the edges people continue to suffer.

@flownover — Morning Joke couldn’t wait to squawk his rote talking point about “rationing health care.”
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Too bad Morning Joke hasn’t figured out that no health care is rationing too.

KT: Great story, and I am grateful for the personal perspective you provided. I very much wish that you were participating in the summit at the White House this morning.

My wife and I are on our last month of COBRA coverage and now have no alternative in sight, and may be forced to do without for a while. I suspect we will not be going to Assurant for a stop-gap.

Best wishes for your brother.

The insurance industry has removed themselves from the world of ethics, morality and honorable behavior. Their job is to avoid payments, to make the red tape difficult to place as many barriers to the payment for care as possible. It is a bottom line decision by their accountants, executives and board of directors. This includes not only health care payments, but property losses, etc. This is the morality of Republicans, to take money from people for services they never intend to pay for and give nothing in return. There is a basic evil afoot in this country where people willfully and deliberately take advantage of those less fortunate for power and profits. If they were small time operators they would be imprisoned for fraud. But they have armies of lawyers, lobbyists to assist them in their fraudulent efforts, so they escape punishment for their deeds.

We are trying to set up a way that people can share their own stories on-line. Will keep you posted. Hopefully, it will be up later today.

Yes, this post deserves lots of (nice) comments.
Didn’t MS invite a lot of new “friends” over to his post by twittering yesterday?

KT, I was just speaking with an academic recently who claimed that the American health care system is great for people who have insurance. Thanks for showing how misguided that thinking is.
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And best wishes for your brother.

KT: I echo those who wish Pat well; and thank you for planning a way for more such stories to be told. My own experience with Sen Frist was disquieting. He was Leader of the Senate with a significant interest in a profitable health business (in spite of his claim to have had nothing to di with that business during his period as leader). But it was impossible to get him interested in reform of the hc system. His standard ploy was to tell us about his latest trip to Africa, surgery and medicines in tow where he provided his services for free. The problems lies right there. Congress always takes care of itself; the sick and poor have no clout; and we worship on the alter of profit. Sadly morality, ethics and just plain fairnass have all taken a back seat.

[...] Magazine publishes Karen Tumulty’s account of “How the Health Care Crisis Hit Home for My Family.” “My editors decided to put this story on the cover not because it is so [...]

KT,
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Our very best thoughts are with you and your family. I believe you’ve just gone through re-locating your parents to be closer to you (and with all of the stress that would bring) while at the same time helping your brother cope with a major illness and medical insurance issues.
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I don’t think I would be handling this as well as you but you have once again defined ‘grace under pressure.’
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Please let us know if we can do anything (concur with Gunny – financial, write letters, whatever) to help your brother. At least there would be one less person in this country reeling from the effects of a broken health-care system. Besides, we selfishly would like you back 110%.

I don’t understand why we have for so long tolerated a system where it is in the companies best interest not to pay.

One would think we could figure out a way to fix this the way the rest of the developed world has, or would that just be too easy? (snark)

Karen Tumulty
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That was a great story and I am sure took a lot out of you recounting your very personal family struggles with health care. I can tell you this much, there are all kinds of health care policies out there that are blatantly fraudulent. And I hope you and your brother consider a class action lawsuit not only against Assurant but also the Texas insurance regulators. This is why it is a horrible idea to open healthcare up to be sold across state lines. Because there is not a uniform code that all states must abide by some insurance regulators are a lot more permissive than others. What would happen is that most insurance companies would move their base of operations to those states that allow this kind of behavior and then sell them to people in all other states. I know a little bit about this having sold some insurance, life and health, myself. Its not just the policy but the person selling it thats the problem. And that agent is governed by the rules of which ever state he works out of. When those agents do not fully disclose everything about the policy they are in fact liable in some states. In other states what has to be spelled out is limited however unless the customer specifically asks about it. Short term health policies are not supposed to ever be sold like that over and over and are supposed to be marketed and sold to a niche clientele like someone between jobs. That whomever sold your brother sold that kind of policy over and over again should be unnacceptable. I know here in florida when a situation arises like that you almost have to get the customer to sign off on a separate document that they know what they are doing is not in their best interest as determined by their agent but they wish to go ahead with it anyway. That extra step usually makes the customer think twice or three times about doing something that they might not fully understand or that might imact them in a very negative fashion in the future.
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On a separate note I wonder if you might be interested in doing a story on the percentage of medical claims that are denied because of “pre existing conditions”. I am willing to bet that its the highest percentage of all claims denied. And here is the problem with that. Most health care providers are supposed to give a person a physical before signing them up. I personally believe that having worked in the field that one thing that should be done is that at the time of offering by the insurance company they should HAVE to explain which preexisting conditions they won’t cover and after the contract is consumated whatever they have not listed has to be paid out should the illness arise. To me this is a no brainer but the problem is insurance companies are in business to make money which means they are in business to sign up clients not to deny them coverage before hand. They want those premiums to come in every month whether they plan on paying out a claim or not. As you said before there is a dark underbelly of health insurance that most people don’t hear about and I think your article will help to start that conversation. Great great story. And of course my prayers are with you and your family that things will work out for your brother.

Thanks for the Facebook link in the update, KT. It’s a start.

“And after you do, go find your health insurance policy and read it, too.”
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Why, what good would that do? Should I try to renegotiate a better one with my insurance company or change to one of my many better choices? Might as well start reading my credit card “contracts” as well.

KT, thanks so much for this great article. I pray for Pat and your entire family.

And I echo what Suzie and others have said. This kind of issue and gut wrenching real life stories should be more the focus of the MSM instead of the stupid Rush crap.

SG — It’s funny, during the campaign when the Obama campaign pushed back on McCain’s health plan, pointing to what a disaster it would be to open up the health insurance across state lines the media only paid it scant attention.
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As usual most only took McCain’s word for it:
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“Opening up the health insurance market to more vigorous nationwide competition, as we have done over the last decade in banking, would provide more choices of innovative products less burdened by the worst excesses of state-based regulation,” he wrote in Contingencies magazine.

http://www.cnn.com/2008/POLITICS/10/04/campaign.wrap/index.html

I’d like to point out that the difference between now and the last, Clinton era health plan debacle is that the internet gives us access to *real stories* to drown out Harry and Louise. (Of, course, we still need real reporting to verify them, since not everything on YouTube is the truth.)

joyomama: I have often shook my head in disbelief as I watched all the handwringing about our health care problems. There are diagnoses galore. The Clinton failure seemed to have given insurers and providers cover to go on exploiting the system (see sgw for an inside look). We have a health 9/11; we have great speeches during the campaign and nothing much happens. Somehow Medicare got somewhere during Bush 2.

The health lobbyists rule! That was one strike I had against Daschle. Neither party has behaved well.

KT – Prayers for your brother and thanks for a great story.
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In a 2005 Harvard University study of more than 1,700 bankruptcies across the country, researchers found that medical problems were behind half of them — and three-quarters of those bankrupt people actually had health insurance.
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Such an important point. We keep hearing that the housing market only affects “irresponsible” people and that bankruptcy is caused by people running up their credit cards for plasma TVs.
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Will you be doing follow up stories on the nuts and bolts of the policy debate? You touch on it at the end of this story. Also I wish we’d hear more about the unmentionable third option, socialized medicine. I know the Canadian/European model isn’t perfect, but it sounds a lot better than ours.

KT, I just had time to read your article before I had to leave for my physical therapy appointment. I’m glad that kathy addressed the problem with those horribly inappropriate links. They have annoyed me in other stories, but they seemed so much worse in yours which was so riveting.
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You tweeted at various times how difficult you were finding the story you were working on. Now I certainly see why and let me assure you all the angst was definitely worth it.
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I shall go and look at the Facebook group, but first wanted to add my good wishes and thoughts for your brother. I’m sure this was an added difficulty for your parents as they were faced with the changes in their own life. It is very good you were able to take a bit of time to be there for all of them.
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This is a very important story and I trust it will get a big response.

It would be interesting to see side-by-side comparisons of stories from people with similar health problems but difference insurance situations. My 62-year-old brother who lives in Canada is having hip replacement surgery later this year, and our discussion about it when I visited him was eye-opening. I would be curious to see how his experience compares with a member of Congress, an uninsured under employed person, someone with HMO coverage, Medicaide, etc. etc.

Why do we continue to tolerate this? We boast that we have ‘the best health care system in the world’. For a few of us that’s true. For the rest of us the system ranges from barely adequate to dreadful.
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Each year we see large numbers of our people dieing from a condition that no one is treating and that medical researchers aren’t looking to find a cure for. It can’t be found in any medical books and people in other countries don’t suffer from it. Just Americans. Its called the ‘pre-existing condition’. For many it’s terminal.
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Why do we tolerate this?

KT:
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Brava.
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Absolutely brilliant.
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Thank you so much for proving that a biased press corps is invaluable to the civic health of our nation.
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Of course I’m not speaking of a partisan bias, nor an ideological bias. I mean that a press that is biased toward the welfare of the country, and the interests of its citizens is a formidable force for good in our nation.
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Please communicate my best wishes and prayers to your brother.
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I just read the piece again, and I’m even more impressed than the first time. Excellent, excellent.
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Some journalists might have apprehensions about putting their names on a piece that could get them labeled “the Michael Moore of Time Magazine” by knee-jerk, rightist ideologues in the press. Some journalists might be wary of having their work “fact-checked” by a Sanjay Gupta -type talking head whose sole interest seemed to be the construction of false balance between industry public relations and reality. Some journalists might have neither the courage nor decency nor simple attention span to do such valuable, important work as what you’ve done, Karen.
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Thanks again for doing your job the way that it should be done. You’re a real American.

KT:
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…and I should also add that a press biased toward toward the welfare of the country, and the interests of its citizens will be much more likely produce a product that people will want to pay money for.

joyo: aproposof Canada. Like bitter I think they have a system that caters to 95% of the users. A few years back I was in Ottawa and they were having a lively debate about the special hospital facilities enjoyed by members of parliament, especially Cabinet Ministers who has access to super care at a local military hospital. Even their pols know how to take care of themselves. Still, it is a good system for most citizens.

Here’s what Zach Wamp (R-Tenn-former cocaine addict) has to say about the subject of fixing the health care system: “This is almost class warfare in order for him to be able to say everyone now has health care. Listen, healthcare is a privilege.” Link here.
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Isn’t it interesting that every time something that benefits the poor and middle class is proposed it gets termed ‘class warfare’ by the GOPers?

My best wishes for your brother, Karen. Sounds like this sort of thing could happen to any of us. I look forward to reading your story…

Dear Karen, I am sorry about your brother’s situation, and I hope that everything will work out for your family in the future. I’ve come to consider you the honest journalist of Swampland, even when I might disagree with your interpretation of a given situation. I appreciate your attempt to give us facts, rather than ideology, and I hope you will remain committed to doing so. Good luck to you and yours.

KT: Thank you so much for highlighting the healthcare problems we are all facing. I wish your brother the very best. My wife became seriously ill late in 2007 and came close to dying late last summer. She had lost over 70 pounds and was nothing but skin and bones. We have good health coverage but the co-pays, deductibles and medications spread over 3 calendar years came close to wiping out what was left of our savings after the market plunged. She’s well on the way to recovery now but I know what you and your family went through. It was incredibly brave for you and your brother to share your story. Putting a face on this problem can only help all of us. Again, thank you so much.

While I feel for KT I have to say it’s too bad members of the press can’t do stories like this unless it involves them. These stories are no fun! Lets talk about who’s up and who’s down! What do the polls say? How much did he spend on that haircut?! All those hours on teevee could have been used to inform, but it’s so much more fun to listen to pundits give us their sense of things isn’t it? Why is this story so important when it happens to someone you care about but not when it happens to the proles? This is the system you and your colleagues have buttressed for decades, you slammed the door and kept out any voices that weren’t center-right, you and your colleagues have derided voices on the left as unserious dirty f@cking hippies and now you tell us you don’t like the result.

Like most journalists, I do my best to operate in a comfort zone of detachment.
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Perhaps more members of the press corps could start to review that methodology –operating in a “zone of detachment” from the realities and concerns of most Americans– and its impact on the bottom line of their host news organizations.

Can Time do an extensive run down of all the proposed solutions to health care? And by extensive, I mean all the center-right proposed health care solutions.

i certainly hope that KT’s brother comes through this circumstance as best as possible.
i do have to say, however, that this is typical of the response of most americans to most serious problems in this country.
as long as those things happen primarily to those folks outside of america’s mainstream – and in america, that usually means people of color and/or poor people – the majority of americans remain utterly blind to the truly disasterous nature of any number of serious problems. as an african-american, i see this pattern repeat itself again and again, as problems that first arise and then fester in our communities, only become real societal problems when they hit the majority white population.
the problems with health care are simply one more example of that pattern. as long as poor people, or people who worked at low-wage jobs that didn’t provide health care, and those “others” were the victims of our broken health care system, well, there really wasn’t a problem, no, not at all. the problems that individuals suffered were usually rationalized as being specific to their own individual, personal case.
it’s only been a real “problem” in the last couple of decades, as more and more white middle class americans have started to deal with issues that were previously the problem of the undesirables.
i’d hope that americans, and yes, even journalists, would not continue to be so myopic about issues of this sort, but would instead try to understand how EVERYONE in our country deserves the same kind and level of care and opportunities.
if only for the selfish understanding that black folks and other marginalized populations are usually like the canaries in the coal mines. while serious problems may start in less advantaged communities, the probability is that those same problems will eventually bleed into the larger population. dealing with them when they first arise and are recognized can only help everyone.

Karen:

This was a powerful, powerful story and I admire you so much for telling it with such skill and humanity. It really brings home the issues involved in the health care debates. You are a godsend Very best wishes to Pat and to you and the rest of your family. And this country.

Thanks for treating this with such humanity, Karen; it makes you an even better journalist.

The lesson that the people going through problems may know more than the experts and pundits is one that should be recognized by more in your profession. It is a badly needed bubble-burster.

I’m wondering:
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Are health care reform proposals –whose goals are simply to put the price of insurance plans like Assurant’s within the financial reach of all Americans– simply subsidizing premiums to health insurance companies who will ultimately fail to pay the full cost of prevention and treatment, while continuing to distort (raise) the true cost of health care?
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Also, would Obama’s campaign plan have helped Karen’s brother in any way, if it had somehow been enacted last year?

Jim Cramer is upset because the Obama administration wants to put price controls on the pharmaceutical industry for drugs purchased by Medicare/Medicaid. The VA already has cost controls.

The pharmaceutical industry will face decreased profits if price controls are passed. Thus Democratic party members are Bolsheviks according to Cramer.

Drugs costs force patients to ration medication or choose between medicine or food.

From the Department of NOT HELPFUL.
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Today, President Obama is hosting a summit to discuss reforming the nation’s health care system with “about 150 elected officials and representatives of groups that have much at stake in the outcome.” In response, Rep. Zach Wamp (R-TN) went on MSNBC to explain his opposition to Obama’s stated goal of comprehensive health care reform, arguing that health care is “a privilege,” not a right:
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WAMP: Listen, health care a privilege. […]
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MSNBC: Well, it’s a privilege? Health care? I mean if you have cancer right now, do you see it as a privilege to get treatment?
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WAMP: I was just about to say, for some people it’s a right. But for everyone, frankly, it’s not necessarily a right.
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Wamp went on to claim that many Americans are uninsured by choice because they “rejected” the insurance plan offered by their employers. Asked to respond to Wamp, Sen. Sherrod Brown (D-OH) remarked “Well my reaction is that it was said by somebody who has a really good health [insurance] plan as a member of the House of Representatives.” “More importantly than that [health care] is a right in this country,” Brown concluded. Watch a compilation at the link:
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http://thinkprogress.org/2009/03/05/wamp-healthcare-privilege/

White House liveblogs its own Health Care Reform event:
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http://healthreform.gov/

It’s amazing how these problems suddenly manifest themselves out of the blue….or did they?

KT – thanks for this. I’ve been meaning to get some lab work and X-rays done, and I think this is the kick in the ass I needed.

I’d like to recommend that Rep. Wamp check into Denver General or Boston City or some other “last chance” public health care facility the next time he gets sick. Real experience is the only teacher that gets through to his ilk.
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If health care were to be considered a “privilege,” by what right is this Wamp creature “privileged”? By money? By family? By merit? What? Presumably this Wamp calls himself a “christian” in order to garner money and votes. What part of scripture would he quote in his defense?

Here’s Obama from the Health Care Breakout summit today.

What part of scripture would he quote in his defense?
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Probably that part of Matthew (I forget chapter and verse) where Jesus tells the invalid to get up and walk…

Looking forward to reading this in the dead-tree Time. Thanks for highlighting it, and best wishes to your brother.

SZ – arrrhhhh!
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He probably would, too, although I would advise him not to do so in my presence.

From the Nickeled and Dimed department: my insurance provider, CareFirst of Maryland, requires a referral from my primary care physician for every visit to a specialist. My primary care physician requires an office visit for every referral, which he attributes to Carefirst’s requirements. Each visit costs me $15 out-of-pocket for a co-pay and whatever is charged to CareFirst (in addition to the valuable time of my physician, which could be better used).
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Recent examples illustrating why this is stupid:
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When I broke my finger while out of my coverage area on a Sunday, I had to schedule an office visit to my PCP before I could see an orthopedist, despite the fact that I had an x-ray and a referral from the emergency room.
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When my optometrist noticed an irregularity on my retina during a routine exam and wanted me to see a ophthalmologist, I still had to schedule an office visit with my PCP to get a “real” referral, despite the fact that the PCP did not even have the equipment needed to view my retina.
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In both cases, my primary care physician said she would gladly trade the income from the unnecessary visit for more time to spend with patients who really needed it.
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The savings from my household alone just on unnecessary office visits for referrals would probably add up to enough to buy insurance for someone else.

Speaking of smoking law suit money…

News Flash: PEOPLE GET SICK, whether or not they have health insurance — and where’s the empirical evidence to suggest that broadly available heroic health care prevents ANY catastrophic disease? In the bar association archives?

The STUPID notion of universal adult medical miracle visits does not create any discipline in a society that’s already too fat, drunk, lazy, stupid, and jaded to take care of itself, much less the rest of the global gutter.

Less is more: We need less eager dependence on statist systems that have by & large failed to protect where protection was guaranteed, that have only bloated medical costs, that have reduced the market and scientific excellence to which we were once accustomed, and which has in the media’s hands turned medicine into a vehicle for trial lawyering as the only growth industry in our sick Obama Nation.

Lady, EVERYBODY has sick family members and friends to think about. Sad, but true.

The simple suggestion that Aunt Samantha is somehow going to make all that go away is patently ludicrous, and patently expensive.

Until you can provide evidence that the health slackers will improve themselves to the point of public market fairness, this debate is done.

If anything, cover kids ages 0 to 14, and let the adults fend for themselves.

I really have no interest in paying for the slacker heath insurance overages of some liberal dope that bashes the troops in one breathe, and defends the forces of her instant urban abortion clinics with the next.

I’m sorry.

Once comments have ended will a Washington commenter print up a whole set and send it to the White House Health Co-Ordinator.

Who wants Health Care Reform to fail?
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(from the WaPo Health Care Breakout Summit story)
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Former Columbia/HCA executive Richard L. Scott has launched a nonprofit group called Conservatives for Patients’ Rights, which promises a $20 million multimedia ad campaign warning that the country is hurtling toward socialized medicine. Scott, who was pushed out of Columbia/HCA in the 1990s and now runs a chain of Florida urgent-care clinics, said in an interview that he has put up $5 million of his own money to kick-start the effort, with hopes of building a grass-roots campaign.

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Hey, that name “Richard L. Scott” rings a bell…what is that person known for, again? Why was he “pushed out” of his CEO job at that company?
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(from the Forbes article)
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The company [Columbia/HCA] admitted to systematically overcharging the government by claiming marketing costs as reimbursable, by striking illegal deals with home care agencies, and by filing false data about how hospital space was being used.
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The company increased Medicare billings by exaggerating the seriousness of the illnesses they were treating. It also granted doctors partnerships in company hospitals as a kickback for the doctors referring patients to HCA. In addition, it gave doctors “loans” that were never expected to be paid back, free rent, free office furniture, and free drugs from hospital pharmacies.
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The investigation and the plea is an obvious blow to a company that became a Wall Street darling by promising to bring first-class business practices to the hospital sector, still dominated by not-for-profits. Under former Chief Executive Richard Scott, it bought hospitals by the bucketful and promised to squeeze blood from each one.
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Scott was forced to resign in the wake of the initial fraud charges in 1997. Dr. Thomas Frist Jr., a founder of the original Hospital Corp. of America and the brother of U.S. Sen. Bill Frist, R-Tenn., was brought in to replace him as chairman and CEO.

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Now we know a little bit more about who’s organizing the opposition to Health Care Reform, although not exactly thanks to the Washington Post, who merely mention that there was a “push out” of the fraudster launching an astroturfing campaign, without telling their readers why this concerned citizen had to leave his executive position.
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So who wants Health Care Reform to fail?
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Crooks and liars like Richard L. Scott, that’s who.

Thanks, KT. It’s one of those pieces that shows how journalistic “objectivity” doesn’t mean abstraction.
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I spent a year, on and off, by a bedside in the cancer ward, in a country where, according to the political bloviators, rationed health care has people dying in the street. I honestly don’t know if that treatment would have been available in the US.
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American healthcare culture hovers between two extremes, and at the other extreme is scam insurance, and the kind of quack, infomercial, non-FDA-approved stuff that plays off people’s fears of medical bills and innate distrust of the profession. When Americans automatically second-guess their doctors and insurers’ motives, that’s literally not healthy. Wrangling with bills and insurers and collections agencies is not healthy. And regardless of what Max ‘FEHB’ Baucus says, Americans aren’t so different from people in other developed nations that they embrace the kind of suffering that comes at the hands of the current infrastructure of for-profit healthcare.

You know, there are some mountains along the Af/Pak border where Rep. Wamp and Hula (alter egos, perhaps?) could live exactly according to their principles.

“If health care were to be considered a “privilege,” by what right is this Wamp creature “privileged”? By money? By family? By merit? What?”
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By good Christian virtue, the virtue of the elect, which in turn made him rich and gave him access to the FEHB. For Wamp, it’s just the Calvinistic approach to health, wealth and happiness that Sara Robinson talks about here:
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http://www.ourfuture.org/blog-entry/mythbusting-canadian-health-care-part-i

@pseudonymous — you are right about one thing, Americans are not so different at all. Unfortunately, for thirty years they have been told that government run health care is socialized medicine. Government run health care is bad and they ought not to want it.
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So when Americans are old enough to be eligible for Medicare, which meets the definition of a government run, single-payer, socialized medicine do they reject it? No! It turns out that they love it. In fact, Medicare is so immensely popular most senior don’t realize its a government run program.
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Imagine that, they’ve been so indoctrinated by Republican propaganda that they deny the return address on the envelopes they receive notifying them about their services. The fact that it is discussed when they receive information about their social security benefits doesn’t penetrate. All they know is that government health care is bad and so if they like a system it can’t be government period.
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Of course that is not the same thing as saying that the American people are different so they wouldn’t like a government run system. they just don’t want to know that what it is. “I think a rose by any other name is still as sweet applies here.

I don’t know, Karen. This seems like kind of a petty strategy to get health care reform.

Karen, wonderful job, both as a sister and a reporter. I am on SS disability and have medicare as my only insurance. Quite frankly I could not afford supplemental if it were available to me. However, everything would be considered pre existing so not being able to afford it is the same as not having it. I pay 20% of all medical costs, thankfully it is 20% of what Medicare has negotiated as the cost. I have a part time job in order to keep food on the table, heat in the house, and to keep paying that 20%. Every time I get the hospital paid off…another test or hospitas admittance rears it’s ugly head. I wish your brother well, and want to suggest that since he cannot work full time he might want to apply now for
SS disability. He will get turned down but at least he will have the process started and with a good lawyer and his sister on his side he might just be able to win on appeal and still hold down a full time job. There is a limit to how much you can earn and still draw disability but hey, when you can’t work full time the limit is not really a problem.

exile500 Says:
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“I don’t know, Karen. This seems like kind of a petty strategy to get health care reform.”
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Are you crazy — exp[lain what you mean by this. Even if you don’t agree with health care reform, even if your ideology prevents you from sharing any responsibility for your neighbor, how could y0u be so devoid of human compassion that you could say something so mean spirited.
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If I misunderstood what you were trying to say I’ll take it back, If I haven’t you ought to.

hospitas = hospital

@pseudonymous –
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It’s amazing to me how sturdy the bastard child of Calvinism and Darwinism (which perverts them both, to boot) has proved to be. It’s so deep in the conservative subconscious that they don’t even know it’s there anymore – to them it’s reality.

What happens if the government steps in to help families cover the cost of insurance, and they buy the “Assurant” plans, because they see a slick ad on teebee?
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Won’t all of that money have been wasted?

Karen, I think this is a tremendous realization: “I used to think I was something of an authority on health care; I’ve covered its policy and its politics for 15 years. But when my family took its own trip through the frustrating maze that is this country’s health care system, I discovered how much I had to learn.”

I think a lot of us out here in the “blogosphere” feel a great deal of frustration with what you refer to as the “comfort zone of detachment” that it appears a lot of reporters and opinion columnists operate in; it often seems *so* detached from what we’re experiencing as to cause severe cognitive dissonance. It is admirable that you both recognized this, and addressed it. Kudos.

The question is, how can we do this for more reporters in their area of expertise? How can Joe Klein or David Broder or Cokie Roberts or [fill in the blank] gain a similar gut-level understanding? This, I think, is something that it would behoove your colleagues to address.

Ezra Klein notes the banality of progress
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…this is the banality of progress. It is no longer a scoop to report that Obama plans to pass health reform by the end of 2009. There is no surprise when he emphasizes the fiscal necessity of change or the moral urgency of reform. Today’s summit, so far, has provided for few easy headlines. It is just another step on the road to a bill. It’s the process. That may be banal, yes. But when the President of the United States pushing forward on health reform becomes banal, then that, in itself, is news.

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A commenter notes that, at least for herself (and millions of Americans), news of progress is anything but banal:
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Wow. From his mouth to God’s ear. I am just about to lose my health care and I have a chronic condition. I really hope this will happen.
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Posted by: Miriam | March 5, 2009 2:08 PM

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While this story might not be as titillating as Blago, so many people are waiting day after day for the cavalry to even show up on the horizon. Lots of folks are paying close attention.

Universal healthcare is coming. It’ll come before the 2010 elections or right after when there won’t be as much opposition in Washington. If there is any silver lining to this disasterous financial crisis, it’s that people are not only ready for change, they’re demanding it. Most middle class families are only one serious health crisis away from financial disaster. When you think of the millions of people that have lost their jobs and their health coverage and the millions more that have suffered huge drops in their retirement savings, do you think that they’ll vote for the party that is trying to get them and their families health coverage or for the party that wants to rely on the “free market” system?

Karen,

I read your article on the train to work this morning in Melbourne, Australia. I was almost brought to tears by your brother’s plight (I had to show some decorum on the train of course!).

What saddens me most about the situation with health cover in your country is knowing how easy it could be to have a nationalised system like in our country.

In Australia most people pay 1.5% of their income as a Medicare levy. If you earn less than about US$11,000.00 you don’t pay any levy. There are certain categories of exemptions from the levy. This covers everybody. There are obviously some gaps if you go to see a physician but you might have out of pocket expenses of say US$13.00 on a $US40.00 consultation fee. The rest is picked up by Medicare. But you still get to choose your doctor.

The system then treats middle income earners differently. There is a Medicare levy surcharge of an additional 1% of income on people who earn more than US$33,000.00 per year or families that earn more than US$66,000.00 per year. However you can avoid the surchage by buying private hospital insurance. The private health insurance gives you coverage for inpatient care in a private (rather than publicly operated) hospital or possibly an option of a private room in a public hospital. The annual premiums for these sort of policies are usually less than US$1,500.00 per annum per family. And you may have to pay an excess of $250.00 on a hospital stay.

My uncle was diagnosed with colon cancer 5 years ago. He received treatment at the Alfred (public) Hospital in Melbourne, both inpatient and outpatient, over a number of years. He never paid a cent for this treatment including radiology, pathology, histology and hosptial stays. Clearly it works better than the US system.

The difficulty foreigners have with the US system is that it has been so overcomplicated by health insurers and HMOs being given all the power. Had the universal health care system proposed by the Clintons 15 years ago been passed then the country may not be in the financial (and health) predicament it now faces.

I just hope more journalists speak out about this and really get the public motivated. The current administration could pass universal health coverage with the current congress, especially if pressure was placed on the right GOP senators in the right states to avoid a filabuster in the Senate.

That’s the end of my rant. Best wishes to your brother and your family on his treatment and (hopeful) recovery.

Regards

Richard

I am having health insurance issues as well. If I didn’t stay in denial most the time about how fragile “insurance is” for my family, I would go insane.
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Great article Karen. Thanks.

@ stuartzechman:
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Your scenario reflects the sharp end of what happens if Chuck Grassley’s complaint has any impact on legistation — i.e. that a public option will ‘crowd out’ the existing private insurers, which encompasses not just the BCBS and Kaiser Permanentes, but the Assurants and the other bottom-feeders who exploit personal crisis and actual physical suffering for profit.
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If the private sector thinks it can compete with the public sector, then it has nothing to fear. Weird thing is, you’re getting more complaining from congressional veterans who are presumably enjoying their FEHB plans (Grassley became a senator in 1981) and are insulated from the worst excesses of for-profit insurance.

rpjoh-
Thanks for the insight!
Now, do you all consider yourselves “socialists”?
And if so, is that a dirty word?

a public option will ‘crowd out’ the existing private insurers
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It will force existing private insurers to perhaps adopt practices that make them less profitable in order to exist, maybe.
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Did guaranteed Social Security “crowd out” private pension plans, or did we all still get 401k’s?

“A civilization is only as strong as its weakest members”
~
John Dewey, “A Critique of American Civilization,” 1928

Karen thank you for this, I think you covered almost all that is wrong with our health insurance in this story.
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When I saw that Chris Madden was going to start with the Rush story I decided to do something else, but then later saw that you were on and stopped to watch. You were great but I was so upset that he stopped a good segment on health care and and switched back to Rush. I hope that you will have the opportunity to talk about this on some other show.

Joe Bftsplk

We have a Labor government, but we certainly aren’t socialists! I think you would describe our current government as being socially progressive and economically conservative.

Then again there has been a tradition in Australia of providing government based insurance for health, unemployment and personal injuries arising out of both workplace and motor vehicle injuries. Taxes supplement unemployment benefits, the Medicare levy supplements health insurance and premiums paid to State government bodies pay for the workcover and motor accident schemes.

The problem is certainly compounded by the fact that there has not been a tradition of government support and (US) conservatives have convinced the populus that “liberal” and “socialist” are dirty words. Given that the Federal government wants to “socialise” Citigroup, AIG and probably Detroit you would think it wouldn’t be a stretch to “socialise” health insurance.

Three things I forgot to mention in relation to (the utopian!) private health here:

1. It is highly regulated and the private health insurers are required to submit requests to the Commonwealth health minister for increases in premiums. These increases are generally approved but only to the extent that they enable the insurers to keep operating at a profit as opposed to a massive windfall.

2. The private health insurers can only deny coverage for pre-existing conditions for up to 12 months, so if you get ill you can take out private health cover and use the public system while the waiting period operates. If you have a potentially life threatening injury this isn’t a problem because you will still be treated while you wait for your gold plated private hospital bed to appear. It is only a problem if you require non-urgent surgery (say a knee reconstruction or replacement).

3. My family only has private health insurance for two reasons: firstly, to avoid paying the Medicare levy surcharge which would be more than our hospital cover; and secondly, so that we pay the minimum premium for life as the previous government brought in a system that made it cheaper for younger people to buy private health insurance after an amnesty period. If you are over 31 and don’t have private cover you now have to pay an additional 2% premium for each year you are above 31 years of age.

The John Dewey quote that jcapan quoted above is apt. The problem is that for the longest time the weakest members of your society have been the (primarily GOP) members of congress that have allowed this system to continue in its current form without having any regard to the “People of the United States”.

rpjoh,
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I was fortunate enough to live and work in Melbourne, Australia for about 10 months in 2000. My sons and I were part of an HMO in the states and when we went over there we were assured that my company had coverage for us. While we were there (I have a chronic heart condition and my sons needed sports physicals for their schools) we discovered that if we did have coverage, no one knew how to obtain re-imbursement.
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Then I realized that the amount of our medical bills was so unbelievably sensible, reasonable, and fair that we stopped spending hours trying to fill out the forms and just started paying the bills directly. The quality of health care was very good and I’ll be forever grateful to have lived in a country as wonderful as yours.
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Also, the money I didn’t spend on medical bills was plowed directly back into your economy (and I have the art, linens (from the market under the bridge near Flinder’s station), food/travel receipts, and amazing memories to prove it.)
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Afterwards, I came back to this country and discovered at the age of 38 that I might have colon cancer. I fought with our HMO to get the tests I needed and was fortunate to have it discovered and treated early enough – but only because my father had it as well (when he was 65.) If he hadn’t been diagnosed with it as well, I wouldn’t have gotten the tests and my sons would have been orphans by the age of 20.
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It makes for a very good argument that preventive care and reasonable medical costs can save so much more than money in the long run.
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I’m also so sorry for the fires that swept through there earlier – such a beautiful and lovely country.

[...] got sick. Just about anyone could be one diagnosis away from catastrophe. My editors decided to put this story on the cover not because it is so extraordinary, but because it is so common, and becoming more so [...]

[...] Tumulty at the White House Health Summit. Tumulty, who just published a personal account about the disadvantages of purchasing health insurance in the individual market, attended a break-out session with America’s Health Insurance Plans CEO Karen Ignagni. [...]

Karen,
.
My heart goes out to you, your brother, your family, and all the other folks dealing with this issue. It is crazy that we don’t have guaranteed health care for all.
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Businesses are suffering too–how can they compete with other companies that aren’t 100 percent responsible for all medical costs, as it is in the US?
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Regular working families are all at risk to losing their financial well-being if a serious medical problem comes along.

Your brother is tremendously lucky to have a loving and capable sister who went out and did the groundwork for him. I know of similar cases where people weren’t so lucky.

This is a great story and timely. Pat is lucky that he had informed and resourceful relatives to help him. Others are not so fortunate. I feel great empathy for Pat and your family and wish him and all of you well…but Karen…this is everyman’s story and it has been happening for years. Why must we Americans wait until a crisis hits home before we understand that the healthcare crisis is not just about those “undeserving masses” seeking public assistance. It is time for the US to join the rest of the civilized, industrial democracies and establish a healthcare system for for our citizens. A single payer system…MEDICARE for all…not just for those the insurance industry can’t make a profit on!

[...] more likely to have Medicaid coverage and therefore not be affected by this. Drum writes (quoting Tumalty in the first paragraph, and having his assessment in the second also picked up by Andrew Sullivan): [...]

Karen, the way that your brother has been treated is absolutely appalling, and it makes me sad and angry in equal measures that this sort of thing can be allowed to happen.
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In Australia, we seem to have the complete opposite relationship with our Government with regards to healthcare – we have something akin to universal coverage (as described by rpjoh in far more detail than I ever could!) and it would be electoral suicide for either of our major parties to try to take it away (to the extent that our former Prime Minister, who headed one of the most business-friendly governments in our history, really could only tinker around the edges with healthcare). Our pharmaceutical benefits scheme also goes a long way to making sure that people aren’t left hugely out of pocket by expensive medications.
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Our system is certainly not perfect – the standard of care that patients receive in the public system is always an issue – but to actually risk being denied treatment because you can’t afford to pay for it is utterly abhorrent. Our Government recognises that it owes a duty to its citizens to protect their health and wellbeing. Stories such as your brother’s will hopefully help to remind your Government of this, too.

KT: Great story. Your family is in our thoughts and prayers.
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I’ve got 2 data points:
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1) I lived in Germany for 5 years in the late ’90′s. No complaints. Great service. Choose your own doctor. No forms – a chip card accesses your database. Even got a couple of house calls! Having young children, it was wonderful not having to worry about health care.
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2) We had to get private insurance a few years back after a job change. Then my son broke his arm and I required heart surgery in the same year: 5-digit out-of-pocket expenses. We made the final payment just last month. This is keep-you-up-at-night stress.
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It’s time for change; thanks for the excellent reporting.

[...] pills? Don’t you think you’re all being a little ridiculous? And there are people with much, much worse problems than that. Forget a pair of balls- grow a freakin’ [...]