I’m going to start this off by sharing my disbelief at the way health insurance premiums have risen the last few years - way beyond what I believe the costs of providing the care have increased.  We have had collective heart attacks every year at my firm when the increases come in. This trend is going to result in employers being forced to drop coverage because it will exceed their labor costs and probably every other cost.  I think health insurance companies have made bad investments and are using health care premiums to make up for their bad judgments. For this reason I favor single payer but don’t see how such a radical change could be accomplished.  But something needs to be done to rein in these costs.

BTW, my answers.  a. d. a.

I agree with you 100% about single payer. Frankly, I’m disappointed that none of the mainstream candidates advocated it, including Obama, whom I supported.

I have some insight into the inner workings of health care companies from past employment and consulting gigs, and I can tell you that yes, there is a lot of waste. Every company has its own claims administration processes and subscriber database, etc., which costs a lot to maintain. Also, as is evident from records of publicly traded companies, executive compensation can be huge.

However, insurer waste isn’t the only culprit in rising costs. Right now, something like 75% of health care spending goes toward treating chronic diseases, many related to lifestyle choices like smoking, high fat diets, etc. That number will keep going up as the US population ages. There’s no comprehensive program to address this. But we know that every dollar we spend in preventing the development of chronic disease would pay major dividends down the road when we DON’T have to treat someone for chronic disease. A comprehensive disease management program should be a priority.

I have a lot more to say about this, but I’m gonna have to rejoin the discussion later. Life beckons. Catch y’all in awhile, and thanks again, M, for hosting…

I am a paralegal and as such have had several personal injury clients who have fallen afoul of the health care system through no fault of their own.  I will document their stories here.  For the purposes of full disclosure I am English, born and raised there, so I was a product of and a user of the National Health System in Britain which I think is brilliant. 

Case number one.  Not actually a personal injury client but a construction worker who had some other issues.  He worked hard, (as construction workers do) but did not have benefits.  He earned too much money to qualify for medicaid.  One day on the job he had chest pains.  He went to the local ER and they did an EKG etc., they discovered he had THREE blocked arteries.  They scheduled him for an immediate angioplasty.  The cardiologist arrived at the hospital, found out he had no insurance AND DISCHARGED HIM.  He refused to do the surgery if he was not going to get paid.  The client was told to “go to VocRehab perhaps they will approve you in 6 weeks”  He was told to walk around for six weeks with blocked arteries.  This IMHO is immoral. 

How ironic, my confirmation word is “life39”

Second case, a lifetime waitress at Golden Corral (13 years) was in a car wreck, no fault of her own (passenger).  Her right leg was seriously injured, she needed surgery to fix it.  She showed up for the surgery at the hospital and was actually in pre-op when the orthopedic surgeon asked for $3,000 (it might as well have been 3 million) she of course didn’t have it.  They packed her up, and sent her home.  No money, no surgery, despite the fact that without being able to wait on tables she NEVER would have the money.  She now works two days a week (that is all her leg will allow) is trying to find jobs which require sitting, and trying to get by.  The PI settlement was enough to pay off her past due bills (due to policy limits) but not enough to reimburse her for a lost career.  And despite what anyone thinks being a waitress is a perfectly respectable career.

My final story concerns my mother (who of course lives in England).  She is 75, she had her first heart attack at age 25 (when she was having me) one Christmas Day several years ago she was not feeling very well.  Her fiance called the Doctor and within an hour or so the Doctor was at the house.  He checked her out and wrote her a prescription for some medication.  Her fiance then went to the pharmacy and filled the prescription.  Her bill for those services?  Zero.  Do not believe the horror stories that people like Limbaugh et. al. tell about a National Health Care system, they are lies.  My sister pays approximately 7.65% tax rate, (that is TOTAL taxes) I pay that for FICA plus State and Fed and yet we do not get anywhere near the services that the people in Britain get.  IMHO a National Health Plan is the most important thing that Barack can do, it is criminal that the most powerful country on the planet has 47 million people uninsured and people are dying daily because of lack of health care.  It really is criminal.

This IMHO is immoral. 

Mine too!  In fact I would go considerably beyond the word immoral.  Along with the next story.  These things are outrageous and disqualify these people from calling themselves human beings.  Thank you for sharing - I think these are the kinds of things Obama and Daschle need to hear.

My sister pays approximately 7.65% tax rate, (that is TOTAL taxes)

I probably pay 15-20% of my salary for health care premiums (including what our firm picks up because that is salary I would receive if it weren’t going to the HMO).  We have very good family coverage but the cost is totally out of proportion.

I’d like to comment on Litlebritdifrnt’s comment - I lived in the UK as a student in the early 90’s, and I worked and paid taxes there too. The health care system in Edinburgh was easy to access, professional, prompt and absolutely without cost. We got so much more for the taxes we paid there, and the services were top notch.

Mar - the problem is that the Health Care Industry in the US has become just that an Industry, people do not want to become Doctors for the right reasons, they want to become doctors so they can drive a Porche.  You ask anyone in the Health Care System in the UK and they are doing it because it is a “calling” much like teaching.  Here in the US the only reason to go into Health Care is to make a boat load of money.  Ten years ago we represented an Anasthesiologist in a case against the hospital, he was getting paid $33,000.00 A MONTH.  You know what he did for that money?  He sat on his exercise bike and worked out while the Nurse Anesethatist(sp) did the work.  And people wonder why they are charged $10.00 for an asprin in hospitals.  Doctors in this country have forgotten (or never even knew) the hippocratic (sp) oath, it is a business wherein the idea is to make the most amount of money possible with the least amount of effort.

Kimba - exactly, I am sick and tired of the likes of Rush Limabaugh and Sean Hannity badmouthing the UK health system.  It works.  Sure sometimes there are waiting periods but let me tell you I have clients here who have to wait six weeks to get an appointment with an Orthopedic surgeon after they have broken a limb and been seen at the ER.  The bottom line is that they get seen, for nothing, eventually.  THey do not show up at the door and get turned away cause they don’t have the money for the visit or have the money for the co-pay.

I should begin by saying a little bit more about myself. 30 yr old single male. Lived in US and Canada. Work as a computer programmer (eat pizza and drink Coke all day while writing lines and lines of code). Work for a company that used to provide fabulous health benefits (PPO and HMO, with companies such as CIGNA, Blue Cross, Aetna etc). Felt ill and required major medical intervention a couple of times. I am spending time to give answers because, needless to say, health care for most people in the States sucks..for the uber rich it doesn’t suck. I believe Sicko did a pretty good job in attempting to depict the health care problems of this country

1) In my experience the biggest problem with the health system are for profit health providers who look for any reason to avoid paying the health bills. even for well insured people who are covered by their employers. I have experienced it a countless times.

2)I chose doctors based on discussion with family friends, relatives and coworkers. Really they are the best source of information. But I believe that you have to try quite a few doctors before deciding who is best. Rating systems provided by insurance companies are useless as they promote the doctors who save them as much money as possible..ie the more highly graded a doctor is by an insurance company the more they suck. I also go by experience of a doc. I tend to trust a doc who takes the time to talk to me, listen to me and my fears and in the end layout all the options for treatment I can choose from. Sometimes they are not well liked by the hospitals and insurance companies. If the government is serious about improving health care they will have to also look into the idea of rating physicians. This could be done by a quasi governmental agency….maybe like Kaplans Guide to rating colleges with some government oversight..if the military could do it in the way they rate defense companies, then this could be done with doctors too…this agency could find ways to rate doctors in a way that is fair to doctors and patients, and this will make for far more efficient decision making. it may not be a not popular idea among doctors but believe me when I say that I have spent a TON of money visiting really bad doctors who could care less about how I felt and were only concerned about how many patients they could fit in one day. that led to make me bad uninformed decisions and led to wastage of money.

3) I have directly experienced difficulty paying medical bills despite being with a “good” insurance company paid for by my employer. I have had some minor surgeries as well as other infections. Even with PPO, I had to fight to get bills paid. The company would almost never completely pay what they were supposed to. I would have to call numerous times to understand why the bills that they were supposed to pay, or their share of the bill, wasn’t covered. And therein lies the trick. These companies bank on the idea that eventually the patients will get tired of calling the company and will give up. they setup complex phone systems to direct you to a myriad of call center representatives who will direct you to another rep and/or give you complex legal jargon as to why the bill cannot be paid. for someone as myself who is really busy, taking time to call those people only increases the frustration and puts my work in jeopardy. So I cant even imagine what single parents or working families even go through should they be in a similar situation or lose income. And this is with PPO. Don’t even get me started with HMO!!! Almost all docs in my Chicago area pretty much told me they couldnt take me as a patient if I didnt have a PPO..ie they would treat me only if I paid them cash upfront, or check. These companies have adopted the credit card companies strategy. its no different…deny people with any pre-existing condition, and for ones who are covered, snowball them with so many excuses as to why their bills wont be covered that even the companies themselves cant keep track of. Put in so much legal jargon that even lawyers cant figure out what is covered and what isnt. thats what credit cards firms. Bombard granny and grandpa with so much small print that they dont have a choice but to sign without reading if they want credit and then BAM! they get slammed with loan shark interest rates if they miss a payment.

4) the insurance package will have to be distributed by a govt system, like Medicare or not for profit private entities. that is the ONLY way to fix health care system.

5)I dont know what my employer pays for health care. But employers are already shouldering far too much of the health care burden. and their employees still suffer because the insurance companies the employer choses knows that no one can do jack to pressure them into paying anything. That said employers can do things like cholesterol test day, or give discount for gym membership or taking public transport and maybe provide some kind of incentive for people to walk to work (if possible). They can find ways to work with the govt to pressure the insurance firms into doing the right thing.

6) Government has to play an active role in prevention. Almost all doctors I go to have done a pretty good job in advocating prevention, like doing prostate checks, advocating lowering cholesterol, exercising, doing regular blood tests etc. Things that will definitely prolong a patients life as well as quality of life. But it shouldn’t stop there. The govt has really taken a bad approach in the way it views prevention. The way our suburbs are built only promotes driving. In most suburbs here in IL, there are no places to walk. you cant walk to the grocery store, you cant walk anywhere. everything has to be done by car. usually the only place you can walk is to McDonalds or KFC because there are so many of them, chances are there is one closest to your house. I initially didnt have a car when I first started working and would take the bus. but as time went on, my manager started slamming me with more work, which would cause me to stay last nights and hence miss the bus. When I protested my manager told me that anyone who works for the company is assumed to have a car and that is the basis why which my company assigns projects. so there you go. You cant even live a half way active life even while going to work.

Govt will also have to look into the way these companies raise chickens and cows and manage industrial feed systems. Much of the meat and food we eat are chock full of pesticides and antibiotics, so really we are just ingesting more poison in our body. even farmed raised fish is nothing but poison. Some way to promote local eating and buying food locally from farmers will have to be encouraged. that way we will be helping the environment by not accepting food shipped from long distance, supporting local economies and eating healthy.

Litlebritdifrnt - yes.

A question: My understanding from some friends in England is that if you want to be seen by a particular doctor, or to be assured a private room, or have surgery on your schedule, you can still buy private insurance. I think this is true, but I’m shy on details. Anyone?

My last input on this (I hope).  There is no reason whatsoever that a civilized society cannot take care of its sick.  As Ghandi said (and I cannot remember the exact quote) but he said something along the lines of “we judge a society by how it takes care of those less fortunate”.  This country is I think almost dead last when it comes to taking care of its sick.  Well perhaps ahead of third world countries but you get my idea.  It is an utter outrage that people are getting sick and dying as a result of no health care, they are getting sick and staying sick because they cannot afford the co-pays.  My husband has a screwed up knee, he has had two surgeries so far, problem is every time he has surgery we incur $2,500 in co-pays, (with his State Employees Health Plan) which of course we cannot pay, which of course goes on his credit report, repeat for three or four years and the best option is bankruptcy.  NO ONE should ever have to declare bankruptcy because of medical bills.  It should not be allowed.

KImba - yes - exactly right - my mom had to have a surgery recently, she was told that she would have to wait about 6 weeks, that would have interferred with her cruise schedule (LOL) so she CHOSE to go private, had it done within a couple of days.  She just paid for it.  There is always the option of going Private, a fact that Limbaugh and Hannity fail to mention.

I’m sorry I don’t have the time right now to read everyone else’s comments but here’s my scoop. My husband just got on Medicare and we are STILL paying over $500 a month for health insurance.
There’s no way he would survive financially if I was on SS too. What he has left over after he pays Medicare barely covers heating costs.
How do single elderly people get by?

This is a tremendously good discussion and the points made about our economy revolving around bad life styles (fast food, not being able to walk more places, etc.) are really valid.  Hard to fix the delivery system if people are sicker than they need to be due to unhealthy food and lifestyles. 

I said I think single payer is really where we want to end up but does anyone have any thoughts about how we could get from here to there?

Donna it is imoral as far as I am concerned that a country as rich as the US cannot take care of its sick and disabled.

Single payer is the only solution that will make healthcare economical and accessible to all, but it will put a lot of insurance clerks, actuaries, and healthcare executives out of work. The provider side, however, will have an increase in jobs because they will need people to process and serve the extra millions of patients who will be new users to the system.

One additional item: behavioral health, which is too sparsely covered on many benefit plans, needs to be integrated with primary physical health. The reason is that many physical conditions and diseases are rooted in behavioral causes. As an example, when an alcoholic crashes his car and ends up in the ER, that event (the ER costs) is considered part of the physical healthcare system. Yet the underlying cause is the alcoholism.
The same holds true for depression, anxiety, and other behavioral conditions, most of which receive little or no coverage on benefit plans. (Depression leads to addictions, addictions lead to accidents, crime, etc.)

In federal and state systems such as medicaid, the behavioral health and physical health are managed through separate cost pools and paid in different ways, as if there was no relationship between the two.  Research proves they are related. An increase in services in one (behavioral health) will lead to (in the long run) a significant decrease in the costs of the other, the physical healthcare.

It’s really not that complicated. It’s just that the free market system and the agency relationship between patients, insurers, and providers are not compatible. The system creates sub-optimal funding for healthcare services coupled with misaligned incentives.

Which is why we need single payer.

Mar a. d, c.

I have two experiences with regards to healthcare.  The first is being unemployed during the dot com bust for almost 2 years.  I wasn’t able to afford the COBRA payments, so I didn’t have any health insurance during the time.  While I was lucky in that I didn’t have any major illness or injury during that time, it was clear that if I had, bankruptcy would have been the minimum result.

Employment and medical care are completely tied together under our system.  That’s unnecessarily precarious.  Particularly when a large block of workers (e.g., high tech workers in New England and California) have lost their jobs.

My second experience is now being gainfully employed.  My workplace has a self-administered plan that gets high marks with me and my fellow employees.  The billing person at my dentist often makes a point of saying that this is the easiest insurance provider she has worked with.  I pay $30/month with a $10 co-pay for checkups, prescriptions, etc.  While I know that most on the blogs argue for single payer, there also needs to be a way for people like myself who are happy with their existing coverage to maintain that.

insurance clerks, actuaries, and healthcare executives out of work.

Poputonia,, well a single payer system would definitely absorb insurance clerks and actuaries into their employer grid without any problem. I live in Toronto now and Canadians, especially govt agencies like Stat Canada cannot fill enough positions like actuarial and statistical. they regularly go abroad for people with those skills. And as far as health execs go, I mean really Im sure they would find work too in helping the govt manage the process better.

While Im generally in favor of single payer system, I do wanna say that its no bed of roses. Here in Canada, to get an appointment with a specialist takes at 3 months if you are lucky even in a major city like Toronto, whereas in Chicago at most I had to wait 2-3 weeks. A lot of physicians here in Toronto move to States because they can make more money there. I even know of physicians who sneer at Canadians because they hate the idea that govt sets the rates for what doctors can charge per procedure…so if a doctor who thinks he or she is very good and think they deserve more money, they end up going to the States. Now a surgeon here in Canada makes very good money, mind you…almost similar to his/her compatriots in the States, but the idea that govt sets the rates is just abhorrent to them. So if we go with single payer system we will have to fight a powerful lobby of doctors who will demand that govt set no roof/limit on what they charge, which of course the defeats the whole idea of managing costs.

One thing that I have been thinking about is that we could do something like mandated insurance for anyone under 21. That would be a must and Govt could cover their cost. but like Obama suggested, people who like their private insurance can keep it and the govt can negotiate with the insurance company and employer to keep the cost of insurance low. maybe some thing like if they are willing to lower the cost of premiums then the govt can cover some of the medical costs. like say I have surgery and it cost 10,000…if I opt for private insurance then the private insurance company could keep my premium low and in exchange the govt will pay 5000 and the rest will be covered by the company. that could reduce the stress on hospitals with long wait times. People who do not like waiting to get treatment could go to a doctor who accepts private insurance. And we could include the health care model of Germany where cosmetic treatments and other unnecessary procedures like Botox are not covered. Like plastic surgery arising out of want rather than need. And then also the govt can be strict about enforcing and ensuring that alcoholics do not take up the bottle, or that people with serious heart disease problems are not chowing down the Triple Bacon Cheeseburger after a Triple bypass surgery

btw, my answer to the questionnaire is

1) a
2) a
3) a

Answering survey questions first:
A, D, A

First, I am self-employed (freelance writer), so have provided my own health insurance for many years, off and on. I had a job with insurance at a newspaper from 2003-2006, paid COBRA after that, and now am on an individual Blue Cross plan. Fortunately (knocking wood), I’ve had few major health crises, though I did carry only a major medical and hospitalization plan for a bit that didn’t cover outpatient orthopedics when I fell and broke a bone in my hand (right one, and I’m right-handed, natch) a few years ago. Go my job with bennies after that, and won’t go back to that kind of “hit by a bus” low-level coverage if I can help it.

So when people talk about other people not wanting to have health insurance, it makes me angry. I am fortunate to be able to afford it, but I am not a charity case. I work, I just don’t work for anyone who picks up my insurance tab, so the people I work for save money with me. Any insurance reform measures that don’t ease the burden for the self-employed, freelance, or small-business owners in the market aren’t doing the job, IMO. (This is assuming we are talking about insurance REFORM, not adopting a government-run single payer program, which would of course be my preference.)

My other issue relates to having had three close family members (both parents and a sister) who have had cancer. My dad died of lung cancer (NOT related to smoking—probably radon exposure, though no one is entirely sure), my mom died this year of colon cancer, and my sister is fighting advanced ovarian. My mother had a colonoscopy three years before her diagnosis, but they obviously missed the early signs given how advanced it was when it was detected. I plan on getting one every two years, and if I have to pay for it myself, I fucking will. Ovarian—I am seeing my sister’s gynecological oncologist now for monitoring, and he points out that even regular transvaginal ultrasounds and CA-125 tests that they conduct in the at-risk ovarian cancer clinic at Northwestern don’t detect many early cancers. So I definitely think we need better screening for all kinds of cancer. My mom and sister had genetic screening for colon, and BRCA1 and BRCA2, respectively, that came back negative, yet cancer is obviously high in my family for unknown or genetically undetectable reasons. I would love to have a prophylactic hysterectomy to remove my dread of ovarian (and it is HIGH), but I’m not sure as of now that my insurance would cover it, since my sister’s genetic test came back negative and it is hence doubtful that I carry the gene.

Finally—hospice and palliative end-of-life care. My parents were fortunate to be able to afford private insurance on top of Medicare. What that meant for my father in particular is that he could get his pain meds covered with his cancer treatment before he went into home hospice. The pain patches and liquid morphine (which didn’t do much good, since it was in his bones by then) cost a small fortune otherwise. So there are loads of people out there who only get good consistent pain relief when they qualify for hospice. “Hey, I only have six months or less to live, but maybe I won’t be screaming in agony so much.” Unreal. We asked the nurse on duty the night my dad died at home if we could donate the unused morphine and patches to some service that helps uninsured/underinsured terminal patients. But hey—War on Drugs! Controlled substances so we had to cut up the patches and flush the morphine. Ridiculous, cruel, unnecessary. I think the way we treat the weakest sickest members of our society at the end of their lives says a lot about who we are.

And finally: better wages and working conditions for non-MD healthcare workers. If we valued the people who take care of other people as much as we value the people who shuffle pretend money around on Wall Street, maybe we’d have a kinder society.

Sorry this is long, but buttons were pushed!

Kerry,

Sorry to read what your folks had to go through. it looks like they truly suffered. Sometimes I think I focus on my misfortunes a bit too much, considering that there are other people out there enduring far too much pain and suffering as opposed to myself.

Totally agree with you on valuing non MD health care workers. these are the people who literally clean our shit when we have lost the capability to clean after ourselves and yet we sneer at them for the ‘lowly’ work that they do

people do not want to become Doctors for the right reasons, they want to become doctors so they can drive a Porche.

I totally share that sentiment. I think its sad what has become of this profession here in the States, but also around the world. If you read my comments above, I kinda allude to what you too are getting at. Now the kids in medical school go mostly for the money. Compassion is nil amongst them. While doctors deserve far better salary than the average workers for the amount of study they have to go thru and the sacrifice they make, I still don’t seem to understand why most of them deserve yearly salaries of $200,000 in case of PCP’s. A lot of them just don’t seem to care for their patients. When I was sick, it took me at least 15 try’s before I could find a doctor who could truly address my health issues. I have heard of stories of missed cancers, missed sicknesses. I was reading a study that said most doctors miss very obvious signs of HIV infections and dismiss them as flu and other medical conditions. That the medical board doesnt have mandatory guidelines about HIV testing for every adult and teenager bothers me.

I saw Litlebritdifrnt’s comments above and the UK healthcare system being discussed, so thought I’d chime in as briefly as I can.

Nothing much to add on the UK’s National Health Service except that it does get overstretched, some stupid tinkering with it over the past couple of decades has led to bloated management inefficiencies (which could be remedied if the political will were there, so resources could be targeted more directly to patient care), the government has a great vested interest in promoting preventive healthcare initiatives (which do feel a bit nanny-statish at times, it’s true), but in general it’s a system people feel a deep sense of ownership towards, and the alternatives would be far more costly, not just financially but socially.

My wife is American and we’ve had two experiences of her parents having cancer in the US.

One of the hardest parts for my wife when looking after her terminally ill dad (who was eligible for Veterans’ health care as well as a number of other policies he’d bought into) was trying to figure out the different care packages he had. Some covered certain aspects but not others.

The bureaucracy they had to negotiate was unbelievable, and the last thing a family facing this sort of situation needs. How less assertive people or those who don’t have good verbal skills are meant to figure it all out, I’ve no idea. Even as it was, the lack of professional coordination meant that aspects of his terminal care weren’t as good as they could and should have been.

I realize my dad-in-law was fortunate compared to many in that he was able to afford good-quality health cover. But in among the bureaucracy, it felt like there was a layer missing - a need for an advocate/coordinator who could pull the available cover together and take a load off the family so they could get on with coping with the physical and emotional situation.

Recently, my mother-in-law (now widowed) had a brush with cancer. Again, she was lucky enough to have decent cover, but again my wife was left to fill in that advocate/coordinator role and recommend to her the best way forward with her health plan. So far, so good.

No matter what solutions the new administration comes up with, I think this issue needs to be considered as part of the package.

Yetanotherfreakingbrit (great name, BTW!), you are absolutely right. If a patient doesn’t have a family member or friend who can be their ad hoc advocate, both while getting treatment (I can’t tell you how many times we had to remind nurses and physicians of when my mom was supposed to have meds while in hospital—and I’m not ragging on nurses, just pointing out that the system is stretched and it basically ASSUMES that patients will have someone around to fetch water, help them to the bathroom, etc.) and while dealing with the insurance bureaucracy, they are in a pickle.

Think how much most of us hate having to deal with contracts and fine print when we’re feeling good. Now imagine dealing with that on your own when you’re ill, freaked out, frightened, and facing a catastrophic or terminal illness, with no one to go over things with you and reassure you and to really be on your side. Add in the terror of thinking you’ll do something wrong or miss something along the line in a document and get your insurance terminated and that makes it even worse.

Kerry, I’m so sorry about your parents and your sister’s illness.  We have a good friend fighting ovarian and it is tough all around.  If we are ultimately going to end up with some kind of system that just expands what we already have to get everyone covered I think both the cost and the advocate approach you suggested are really important.  We have Kaiser now, which is an HMO, but several years ago had a PPO policy.  I had to be hospitalized for about 3 days with an abdominal infection and the resulting paperwork I had to fight through afterwards to get everything sorted out and paid almost put me back there!  It came down to just needing to pay co-pays to everyone who had ever even set foot in my hospital room but the time and effort involved was huge.  I can’t imagine what we’d have gone through for a major illness.

The pay scale for nurses and other technicians is another important point you raised.  There is a big shortage of nurses in this country and it’s not surprising.  It’s hard work, requires a lot of dedication and compassion and is rewarded by inadequate pay and being treated like servants by the doctors.

I want to emphasize that my parents and my sister both had the best healthcare possible, thanks to their insurance. Cancer is horrible and debilitating under the best of circumstances. I can’t imagine how much harder all of this would have been if we’d also had to fight with insurance companies or felt that treatment was being withheld because of inadequate insurance. No one should have to go through that scenario.

my answers:
a a, b and c
a dn b