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Heartbreaking - and Heartless!


Here's a real story.   A cautionary tale which shows how easily some people in this nation fall through the cracks.  Particularly those who are suffering the most and cannot fend well for themselves.  America - one nation - under deception.

Imagine a couple.  In a house.  A dozen years away from paying off the mortgage.  One of them gets injured on the job and that injury leads to surgeries and pain and inability to work.  The other spouse keeps working.  But to pay the bills (a lot of medical co-pays and other bills), they dip into the home equity.  Social Security (disability) eventually  steps in.  But not for a couple of years.  (Did you realize that even if Social Security deems you disabled, you don't qualify for Medicare till you've been disabled for a full 2 years?  Till then, no guaranteed medical care!)

Back to the story.  Somehow the couple manages, dipping into the home equity to help with expenses.  Till the other spouse, with a history of childhood abuse, gets to a point where all the stress activates PTSD (from the past).  It's hard to work when you have flashbacks.  When you'd rather be dead than alive.  So then the second spouse is unable to work for a while.  Lowered pay due to disability.  But teenagers still need food and clothing.  Home equity has gone up - which miraculously allows for more loans to be taken out.

Eventually the spouse with PTSD returns to work.  But meanwhile the bills have mounted.  No amount of juggling the finances can pay the mortgages now - the regular mortgage and the home equity loans.  Seven years from paying off the house - FORECLOSURE.  Bankruptcy.

A few more years pass.  Financial difficulties continue.  Disabled spouse takes to drink.  Becomes abusive.  Once again, PTSD worsens for the second spouse.  The person becomes unable to function, simply wants to be dead.  Tries suicide a couple of times.  Finally lands in the hospital.  Modern medicine means that many drugs work - but have serious side effects.  Side effects are treated with other drugs - that also have other side effects.  Five drugs later, the person is less depressed and not suicidal.  But side effects are so bad, the person cannot return to work.

Now here's the kicker.  The employer, a health care corporation, provides disability insurance.  And here's how it works.  There's short-term disability and long term disability.  Short-term, you get part of your salary and your medical benefits (for 3 months).  Next comes long term disability  Now what do you think "long term disability" meansFor a health care corporation.  It means 15 months!  After that, you're terminated.  But there's more!  Just 3 months into the long term disability, your medical benefits will disappear - unless you pick up the entire cobra amount!

You got that right:  A health care corporation cuts off medical benefits for a disabled employee!  (unless they can pay for cobra.... maybe from their home equity... if they still had a home... with equity)  And ultimately terminates them.

Let's think this through:  (A)  Stay on your meds.  You'll be alive.  But you can't work due to side-effects.   (B)  Go off your meds.  And you'll want to die.   (C)  Stay on meds long enough and you'll lose your health insurance.  Then how do you pay for meds?  Or your doctor? (D) No meds, you'll want to die again - especially if you contemplate your impossible situation.

This is an impossible situation.

But it is one small example of how our society fails to care for its sick, its disabled, its bankrupt, its soon to be homeless.  Those who have the least ability to fend for themselves.

Did you know that there is a huge backlog of people in this nation who are disabled, but have been unable to receive social security - because the bush bad-ministration simply didn't work for those in this nation who were poor or disabled or suffering?

The human wreckage here is heartbreaking.  But the heartlessness of bushco is beyond belief!  They whine that those of us seeking justice for their misdeeds are meanies.  Gosh, I wish they had to live in the shoes of their victims for a while.  Victim after victim.  One type of victim after the next.



57 Comments

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♪,
I am intimately aware of the Disability path and the problems people have with it. I have helped too many people in the EXACT situation you describe.

Here are the key things when trying to qualify for disability:
1. KEEP A DIARY of your medical problems.
Things like sleep habits, pain levels (1-10)
2. File immediately IT CAN BE DONE ON THE PHONE
3. Once you have filed call an advocate/atty
THAT PRACTICES IN THE COURT WHERE YOUR CASE
WILL BE HEARD.
4. You will get denied at LEAST once.
5. Get a Psych. evaluation (it is more ammo to
use in your qualification)

The sooner you accept the fact that you will get turned down AT LEAST ONCE the easier it becomes.

BTW, EVEN federal student loans are not discharged when the feds decide in your favor.

TOO MANY people get turned down ONE TIME and give up.

Rec'D

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Excellent advice. It's hard for anyone. But even harder for those with psychological disabilities.

This is a hidden scandal in America.

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Sadly, this is all too true. Our daughter was diagnosed last fall with a mental disorder and her insurance would only pay half, while it paid full coverage for medical. Now she's out of work, so there is no insurance, but her husband works, but at $42,000 for a family of four, she doesn't qualify for Medicaid.

She has applied for SS, but as you say, it's a long haul. She was turned down once(the story I hear from most), and now she has a lawyer who is working to get it for her. His payment will come out of her lump sum payment, if and when she gets it. She is finally stabilized with the right combo of meds after many tries, but they're now seriously considering bankruptcy because they're medical/psychiatric bills are calling out to be paid.

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My heart goes out to you and your daughter and her family. We can only hope that down the road there will be a more integrated and compassionate system to care for our fellow citizens in need.

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Very well said Face. Very informative. Good man.

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Grrr. You have hit on a subject quite personal to me. I was diagnosed with a severe chronic degenerative rheumatic disease in 1985, but continue to work. Everyone I come in contact with assumes I am on disability; my neck and spine are totally fused, I am totally blind in one eye, etc., but I can't afford to not work for two years while my case is processed, and also don't know that I could afford to live in my current apartment,(A co-op I bought 12 years ago), if I was on disability, so I continue to slog on, getting deeper into debt.

Unfortunately, I'm at work right now, so I can't write more fully. I will come back and post more later.

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My heart goes out to you. Please do take the time to write more fully. I thank you in advance for doing that.

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Mr. Smith, I hope you hang in there. I always read your posts, comments. Always informed opinions.

I hope you have your good days, or better days from time to time.

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MS1,
I recommend that you call your local Social Security Office and just get the paper work started. When you do that you will start the clock running on the benefits you might be entitled to AND you will "officially" find out your monthly benefit.
It will more than likely, take at least two years to work it's way through the govt. maze and you will be paid that monthly benefit from the date you applied, in a lump sum (the number of months it takes to work through the process multiplied by the monthly benefit).
So if you think that within the next couple of years you are gonna need it, NOW is the time to start the ball rolling.
I HOPE you NEVER need disability but "plan ahead".

I AM NOT AN ATTORNEY OR AN "ADVOCATE" but I will answer any questions you have as best I can. Just let me know.

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Actually if the disability predates the application, they can backdate it for up to a year. Or at least that used to be the case.

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Its a jungle out there. Life is unfair.

These are the old mantras of the repubs.

w never had an ounce of empathy or sympathy and he will go to his grave like that.

dicky c never did either.

Although, I swear, you could see a tear on Pat Buchanan's face when he was relaying all the taxes he has to pay.

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You always lay out the paradoxical aspects so well, dd.

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Grrr, from the puppy also. I have no doubt stories like yours, Thera P, and Mr. Smith's are probably more the norm rather than the exception these days. But I would not just lay the blame on the Bushies. The current Republicans in Congress are equally as heartless, with their attacks on people that don't pay income tax and so they should not receive help from the stimulus.

What they don't mention is that the people have working jobs - but they don't make enough in them to pay income taxes on.

Now there is a Republican group that is geared up to fight healthcare reform, Conservatives for Patients Rights (CPR), headed by Richard Scott. From Politico:

According to a 2000 article in Forbes, Scott was forced to resign as head of what became known as Columbia/HCA after fraud charges against the massive health care company in 1997. He was replaced by Thomas Frist Jr., the original founder of HCA and brother of future Senate Majority Leader Bill Frist (R-Tenn.)
The company eventually paid over $880 million to reach a settlement with the Justice Department in 2002 on the charges.


Are they fighting for healthcare fraud or against reform? Either way ...

Kudos and thanks for a great blog.

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There's plenty of blame to go around. But things got much worse under bushco. And yes, we've got a situation where the repubs just want to drag their heels on anything that provides benefits for those who cannot work, be they former military or people injured on the job or the unemployed, people losing health insurance for whatever reason.

The list of sufferers is so long. And the belief that the wealthy have no responsibility toward fellow citizens is frankly contemptible.

Thanks for your kind words, seashell.

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The 'conservative' mind thinks the mind is something to use to process facts chosen from a list. You turn it off when you get done driving and use the boob tube to keep you on schedule so you fall asleep at 11pm.

Stress, to them, is like the air. It's always been there, since we're all about stuffing our round asses into square seats. Don't be a sissy, just take it.

My family is on the financial rocks. One thing I notice is the lack of beer in my fridge. I have little patience for people who use drink to soothe their financial stress, but I understand, sympathize.

But to touch on an important point, healthcare companies are not companies that provide health care. They sell rationing services. Just another place where suits and lawyers outnumber caregivers.

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The corporation actually provides services to patients. But apparently not to its employees. It knows full well what it is withholding.

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Don Henley sang that a man with a suitcase can steal mor money then any man with a gun. Who knew a singer could be so keen to the scene.

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Maddening tale, but sadly a daily occurrence in the land of the free and home of the brave.

This highlights the whole scam of "health" insurance. The whole health insurance industry is predicated on denying as much health care as possible in order to maximize profts. The setup is awesome because when you get denied there's no where for you to go. You are on your own completely and isolated from others. If we had more unions this kind of crap would be put to a halt but that's why the rich made sore to weaken unions as much as possible.

Did anyone see the animated feature "The Incredibles"? I recommend it all around, but the main figure (a retired superhero who no longer heroes)gets fired because he works at a health insurance company and keeps failing to deny coverage to people. There is more truth in that portrayal of the insurance company that you can imagine and it's quite clear who the good guys and bad guys are.

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Yes, just imagine needing a job and having a conscience today. Especially in certain fields....

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Great point ... as per usual ... Oleeb

Confuse 'em ... abuse 'em ... and lose 'em!

Today's thought from the pond . . .

Investor Controlled For Profit Health Care? A Game of Confidence ...

You'll surely get the drift of that one...

~OGD~

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Thanks for linking that, OGD! And a terrific description too!

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I'm pleased to aim . . .

... the arrow at the heart of the matter and keep it simple.

~OGD~

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Oleeb I always think about that Helen Hunt movie with Nicholson. Her son has asthma attacks and she has to rush him to the hospital when he has an attack and it looks like he is going to die. And then rich Nicholson, a total ass....gets Harold Ramus to see the kid and treat properly. And Gramma is so ecstatic.

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When I think of real-life situations like the one you mention from the Helen Hunt movie it makes me crazy when the wealthy and their toadies start getting all crazed about allowing "your health care decisions to be made by some government bureaucrat!" They only mind that it's a government bureaucrat of course. If it's a bureaucrat who works for a greedy private firm then you know you're in good hands! Oy!

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That would be "As Good As It Gets", a movie that collected Oscars for both Nicholson and Hunt (quite right, too).

I must admit, this tale makes me think of another health-care movie - "John Q" (Denzel Washington, Kimberly Elise, Robert Duvall, Anne Heche, Ray Liotta).

I can't tell you how many times I've considered moving to Canada. Sure, their health system has its own set of issues, but the out-of-pocket is so much lower that I could actually afford to get proper care there, rather than winging it here in "the most prosperous nation on Earth".

As a recent blog by miguelitoh2o demonstrated, even the cost of healthcare in Mexico is better than it is here.

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"Boyd, this is a very good movie. And I always have had basic cable and it was so illuminating. And I wonder why it is not commented on more.

Thank you. I love it when someone gets what I am talking about or ranting about.

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Good points Oleeb. 'The Incredibles' was a great movie, definitely not just for kids.

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Here are some disturbing related statistics:
Nearly 50% of bankruptcies in the US are filed due to excessive medical expenses.

Every 30 seconds someone in the US files for bankruptcy due to medical expenses.

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Hello traveler and animal friend -

The people who are filing bankruptcies should have taken more personal responsibility for their health and never let it get so bad in the first place, don'tcha know?

Placing responsibility squarely where it belongs, on the shoulders of the patient, will encourage individuals make to make healthy lifestyle choices. Infusing personal responsibility into health care reform allows us all to maintain our cherished freedom to live our lives without government intrusion.

See. I wasn't kidding. That is directly from our new frauds, 'er whatever, Conservatives for Patient Rights.

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Exactly! Before birth make sure you have the right genes and the right parents and so on. Once born, make sure you stay away from all situations where you might be injured. Then make sure you never go anywhere near any germs. Make sure you're born in a country where the air and water are clean. Be sure it's a land where the food and medicine are pure with no additives and dangerous substances in them. And on and on. But if you do get sick, please stay out of the public view and keep it hidden. Don't bring shame on your family or community. Don't embarrass your employer by having to fire you. Consider the poor folks at the insurance company who need their bonuses - for denying services.

Republican Responsibility - See how easy it is?

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Bingo . . .

And may I add?

Republican Responsibility - See how easy it is? Just say no.

~OGD~

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I accept your amendment!

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Truly remarkable Seashell! Which I mean in the sense that one can only abhor the mind that conceives such a society.

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It will be a great day when the government finally moves to a health care system that focuses most of its efforts on disease prevention, rather than disease treatment after it occurs. Of course, nobody in the government has had the balls to do this because that would be bad news for expensive insurance companies.

Here's hoping Obama one-ups them....

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It would be so much easier and cheaper and far more humane to fold every type of health service the government already provides into one umbrella organization. Then let the insurance companies compete with that - if they can! Very soon, very, very soon... we'll have universal single payer health care.

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I hope you're right, but I don't see it coming even under Obama. Like Howard Dean said the other day. The time is now. If we don't do it this time in history we won't get another chance for a long, long time.

He is right.

You are right.

I am right.

But there are too many who can't see their way around an insurance-based system.

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It's so hard to be right and see them go wrong!

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What's even more damnable: As a health-care corporation, it undoubtedly helps fund the lobby that year after year bushwhacks any serious efforts to establish comprehensive national health care. Until we stop throwing away our citizens, we remain a country in search of its soul. Rec'd, TheraP.

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a country in search of its soul

Thanks for that concise definition.

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Thera . . .

Yes ... as per usual you place a human face upon the trouble in our land.

As I told Oleeb upthread:

The investor controlled for profit health care swindlers simply use the old, Confuse 'em ... abuse 'em ... and lose 'em! routine.

I had that scam attempted on me years ago by Metropolitan and an employer. It cost both of them dearly. As faces said up thread I kept copious notes and I had a very astute and powerful attorney through my union at the time. It help that my dear Mother was also a mucky-muck in the Kaiser system at that time.

Not only did Met and the employer eventually do what was right, they settled a civil suit out of court in the high six figure bracket.

But what a bunch of needless crap over a 4 year period of my life!

~OGD!

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"As faces said up thread I kept copious notes and I had a very astute and powerful attorney through my union at the time."

There's the magic bullet--unions. I'm waiting for the day when Americans get back to seeing the enormous value of unions. I may not live long enough, but I can only hope.

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Partially correct ... Ramona

But always keep yourself well informed. Sometimes I fought unions as hard as I fought that disability insurance company.

But I will point out that one of my most gratifying times in my 62 years was volunteering back in 1978 through '84 as a union employee mediator under the umbrella of AFSCME when I was employed at UCLA. The folks in personnel at Murphy Hall would shake their collective heads every time I started schooling them and reciting from memory word for word from what was in their very own policies and procedures. They rarely even had a clue where to look to see where I came up with them. But I was always kind enough to direct them to the source in their monstrous paper filing system.

They were totally unaware that I had been given access to the complete online UC system policies and procedures database at that time located in the computer science department in the UCLA Medical Center. They didn't have computer access in personnel.

By the time I left my employment, through a concerted mediation between AFSCME and other unions and UC under a memorandum of understanding, the entire P&Ps were in the process of being re-drafted at personnel in Murphy Hall in conjunction to UC system-wide and transferred to a complete new online database. It was quite archaic at that time, but as you can see it has really come into the 21st century:

University of California - Human Resources and Benefits
Policies, Employee and Labor Relations

Wow! I sure had a boat load of energy back then. Just thinking about it makes me tired.

But as I pointed out at the beginning, always keep yourself well informed. You can see how important this was to me. It makes for a much more healthy and safe work environment.

~OGD~

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"Placing responsibility squarely where it belongs, on the shoulders of the patient, will encourage individuals to make healthy lifestyle choices ..."

GRRR. Tell that to a person with an incurable disease brought on through no fault of their own, and you're liable to get beaten with a cane to within an inch of your life, and you ought to be ... That sort of thinking goes right back to the old, blame the victim scenario used by people who want to deny rapists and abusers of any liability for hurting their victims; aka, the person who was raped or abused asked for it, they brought it on themselves, they shouldn't have worn that slinky dress, etc., etc. A healthy lifestyle choice to someone with a chronic disease is the equivalent scenario. If only you had been a better person, had eaten more vegatables, or didn't eat potatoes, or ... It's your fault you're sick and you're fault you haven't gotten better. Grrrrrrrrrrrrrr ...

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And then there's the provider's side of it. With good treatment, you can try and stabilize a person, though you may never be able to "cure" them. Doesn't matter! Sometimes the insurance just denies further treatment. It would be like denying insulin to a diabetic. You can't cure the diabetic. But you can stabilize them. For psychological problems, however, there's this idea that the person just isn't trying hard enough. It's so frustrating for both the patient and the provider.

You have my enormous compassion here. Hard enough to be ill. Even worse to have to fight for your right to be treated. And treated with compassion.

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Sorry, spelling is the first thing to go. LOL

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Been there, done that. I'm bipolar and until recent years, there were no medications that worked for me. I was able to get on disability before Bush came along. My case was rejected the first time.

Thanks to the stress involved, I had the good fortune(?) to have an emotional breakdown while I was in the Social Security office talking to a caseworker about my appeal. Freaked them out when they saw my symptoms on full display. They pushed through the approval.

I was young so I didn't own a home, which meant my income and assets were low enough to qualify for Medicaid during the 2 years I had to wait for Medicare to kick in.

Now I'm in a position where I've found new meds that work for me and I'd like to go back to work. I'm afraid to take the risk because an employer's insurance - if I was lucky enough to get a job where it's included (unlikely) - would not cover my pre-existing conditions and mental health coverage is inadequate anyway.

Universal health care would mean that I - and thousands of people like me - would be able to re-enter the work force. It would save money - they're already paying for my health care. But I could give up that Social Security check every month and start paying taxes again.


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Yes. I have neurological problems--epilepsy and narcolepsy. But it sent me into a manic depressive
state. I only filed last year and it will be 20 months to a hearing. Silly. I will have early ss by then. But I got on this health care provided by Minnesota. The shrink gave me Effexor.

I do not know if it is the web or effexor that got me to a consciousness I have not had in two decades. I think it is a combination of both.

We need a universal plan. I just read a blog this week and 10,000 bucks or something was paid for a surgery and the doctor got $700. Something is wrong here.

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I see that too - the rate my providers get reimbursed is very low, esp. for the psychiatrist and therapist. Yet the mental health rate is better than what they get from private insurance.

I haven't kept up with it lately so I don't know if this is still true, but hospitals in Iowa have had a problem because Medicare didn't reimburse them as much as they did hospitals in many other states. Reimbursement was based on costs at the time the rates were set, and at that time, Iowa's costs were lower. It hasn't kept up with the rising costs.

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It's called the 'hidden tax', ddn. And businesses are complaining because they feel they make up the difference in higher insurance premiums, thus also subsidizing the elderly, disabled and/or poor indirectly through the federal govt's Medicare/Medicaid insufficient payments.

In a way, that may help us. Biz in general is unhappy with the state of health affairs and may abandon the Republicans and demand the federal government take over. It's not just the drain on their bottom line, but their inability to be competitive in hiring and in global trade.

And hugs to you and dd.

Also.


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You've described another of the ridiculous aspects of our "system." So much is wrong!

The ironic thing, however, is that many who are able to blog might be doing something else, were it not for this crazy system! In the end the inefficiency of the system may be undone by the very creative individuals, such as you and dd, and many others who blog while disabled! Or the people who do that while unemployed. They've set up a system which never anticipated the web. And now, via the web, people disadvantaged by the system, are able to attack it - on a daily basis!

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Thera P, my therapist keeps telling me the same thing - blog, blog, blog, and nag, nag, nag our congressmen.

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I'd better not comment. I'm...

Not surprised. At all.

(hugs) to yer friends. They are not alone. Which makes it worse in many ways, but can make it better for a moment.

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There is no doubt of that! And we can assure people that we are working hard to make things better.

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I heard some encouraging noises on the news this morning concerning health policy (Bill Plante on CBS).

Granted, nothing is gonna get done today in a 2-3 hour meeting with 120 invited participants, but it was mentioned that Obama has no intention of letting up on this issue. He'll bring it up again and again and again, until there is a health policy in place that serves everyone. He's not gonna let it go. Dog with a bone.

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I love that metaphor! Dog with a bone.

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Act up! Organize a thousand people without health care, some of whom are seriously ill, and start a vigil as close to the White House and Congress as this timid government will allow. Get off our knees.

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TheraP

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