Friday, March 02, 2007

Caricature

While working out the other day I saw part of a movie called "John Q." It stars Denzel Washington as a father of a child who needs a heart transplant but can't get one either because they have no insurance or because their HMO has turned the request down. (Like I said, I only saw part of the movie.) In frustration the Denzel character takes a bunch of people hostage in the hospital and threatens to start killing them unless his son is put on the transplant list and approved for the transplant.

Like many movies about medicine or health care, the movie is more caricature than realistic portrayal. The protagonist, even though he's holding hostages at gunpoint and has threatened to kill them, is widely considered to be a good guy, sort of a folk hero, even by some of the hostages. Yeah, right. The hospital administrator is cold and heartless, and doctors in HMO's are accused of denying care to people so they can get bigger bonuses. In reality, HMO's might have some problems, but the vast majority of HMO doctors practice ethically and care for patients like they should.

The real fallacy of the movie, though, is that in real life Denzel's son could have qualified for a program called Children's Special Health Care Services (CSHCS), which would have paid for his transplant. Formerly called the Crippled Children's program - you can see why they changed the name - the program was founded back in the 1930's to pay for medical care for children with chronic conditions that require medical specialty care. Different states may call it different names and run it in different ways, but in our state many, many diagnoses are covered, such as cerebral palsy, leukemia and other malignancies, bronchopulmonary dysplasia, and congenital heart disease. The cost for it varies according to the families' finances. It's free for the very poor but has monthly co-payments for others, according to their ability to pay. Relatively few people know about it, but in real life the hospital's finance department would have helped Denzel's family sign up for it.

Since we're talking about programs with complicated initials for names, I am reminded of SCHIP: States Children's Health Insurance Program. This is a federally funded program that allows families too rich for Medicaid but too poor to buy private insurance to get health insurance for their children at greatly reduced rates. It has been a success the last few years, providing health insurance for millions of children of the working poor. It's not the answer for all the uninsured people in the U.S., but it's a start. Unfortunately, in the latest budget proposal the Bush administration is proposing only $5 billion to cover the program, which is several billion dollars short of what states need to cover it at its current levels.

I finished my workout before the end of the movie. I'm not sure how it ends, but suffice it to say that things weren't looking too promising for the health of the Denzel Washington character. Taking people hostage doesn't pay. Talking to knowledgeable people about different helpful programs, although a lot less exciting and entertaining, does.

23 Comments:

Blogger terri w/2 said...

Ahh . .the program you mentioned "insurance for the working poor". .interesting that a caregiver (usually mom) must quit her job to stay home with a severely disabled child, and she no longer qualifies for even state health insurance. She is not considered "working." So is not part of the "working poor" that qualifies her even though by staying at home and raising her child, she is saving the state taxpayers upwards of $100,000 per year in institutional care costs.

Yes, medical care is covered for our minor children not based on income if they are severely disabled. .however, if they are moderately or mildly disabled, they often are not covered. A BIG ole crack in the social service system. In addition, the various pots of money in our state have severe restrictions. Things like wheelchair accessible homes that are necessary when there is a child in a wheelchair - completely out of pocket. A van to transport the child and their wheelchair - completely out of pocket.

In addition, the monitary loss of losing one of the parents' income. Huge. More huge if a divorce occurs (over 80% of couples with disabled children divorce). .mom no longer has an income, no longer qualifies for health insurance - even among educated women - it is a massive downward spiral into low income. In addition, she loses benefits, retirement, 401-K.

However, if you are a mom that adopts a child who is disabled, the state bends over backward to help - financially and every way possible to make it happen! Foster parents receive loads of help as well. Biological parents -very little.

It's nice that there are a few programs out there for families, but the massive restrictions are not working for many of us. There needs to be incredible legislation that looks at all aspects of family life with a chronically ill or disabled child, not just these little programs that throw pebbles into the pond.

3:32 PM  
Anonymous Helen Harrison said...

The movie "John Q." was, interestingly enough, based on a real case.

But the issue in this real case was not denial of insurance coverage for treatment, but rather a right-to-die situation concerning the overtreatment of a brain damaged child.

In 1989 a 15-month-old boy inhaled a balloon, choked, and was left in a coma and on a ventilator at Chicago's Rush-Presbyterian-St. Luke's Medical Center. When the family was unable to convince the staff to stop treatment, Rudy Linares, the boy's father, went to the hospital and disconnected his son, warding off the medical staff with a gun, until his son died.

A grand jury declined to indict the father on a murder charge.

8:00 PM  
Anonymous Shawnee said...

I know I am bringing up an older post but it felt "complete" The post entitled "Woof" grabbed my attention. My family and my husband's family wants to be in the room and I don't feel comfortable with that, I just want my husband in there. I kindly sent your post out to our families and now they somewhat understand from a doctors side why they shouldn't be in there and to quit pushing the issue with me. THANK YOU VERY MUCH!

12:19 AM  
Blogger NeoNurseChic said...

Do those programs really pay for things like heart transplants? I could see them paying for some things, but I didn't realize they would pay for a heart transplant or something so major. And also, when a child is covered by a parent's health insurance, if that particular insurance doesn't pay for the child's need, then it seems like the family is up a creek. Do those programs cover children for additional things if the family's insurance won't pay for it? I remember there being this big to-do when my cousins' dad was looking for a new job. This was before HIPAA, and he was denied job after job because his daughters have cystic fibrosis and the company didn't want to have to shell out premiums for 2 kids with a fatal genetic disease. Once they had insurance, they were at the mercy of whatever that particular policy would pay for.

I don't know enough about the programs to truly comment, but I have to say that a lot of times those things seem like great answers, but in reality, it's not so. First off, people who are sick do not have the time or energy to jump through hoop after hoop. When I was in nursing school, I was on Aetna HMO for 2 months, and it was the worst 2 months of my entire life. I was a ping pong ball between my doctor's office, the pharmacy, and the insurance company. And nobody would help me at all. One day, after a nurse at my neuro's office screamed in my face that she could not help me because I had a bad insurance that wouldn't pay for my home oxygen, I left the office in tears and called my mom and told her that I had to sign all my papers over to her because I just couldn't do it anymore. The battles with the insurance company were making me so much more sick! I got all sorts of release forms for my parents to be able to talk to insurance companies, doctors and so on. Still we continued to have problems...

I think a lot of the social programs out there are great, but in order to prove you qualify for them, or simply to apply for them at all, you have to fill out countless forms and try to then solicit your physician to fill out forms and so on. There is a lot of waiting and chasing up with people to make sure they've done what you need. Sometimes docs even charge money to fill out forms - which is fine because they are time consuming, but add that to the bill of someone already having financial problems, and it's just one more stressor to add to the list. And then for some programs, they make it so difficult to qualify or find one thing after another wrong with your application.

I mean - I know this isn't where your topic was headed, but look at disability. People with disabilities are often denied SSD and SSDI simply because they don't have the strength or energy to fight these battles...

People have always said the free clinics are a good alternative for the poor, but those clinics are often in sorry shape themselves. They're understaffed and the waits there are hours long.

I know there are a lot of things out there, but when you've got a kid who is dying (as in John Q) or you're battling major health issues yourself, it's really hard to find the extra energy to do battle for these things. We'd like to think that people are out there to help us get the resources we need available, but the fact of the matter is that those people are few and far between as well - and they are also stretched thin on resources.

It's a sorry state of affairs, sometimes!! When I saw John Q - all I could think about was what sort of person I had become while on an HMO. It wasn't pretty. I was an absolute nervous wreck - and in my case, it wasn't life or death or dealing with heart transplants, so I can't even imagine if I had been even worse off than I was - what would have happened.

Take care!
Carrie :)

1:43 AM  
Blogger Eric said...

Our experience with CCS (California Children's Services) has been great. It's the insurance in CA (you'd never have guessed, right?) for chronically ill kids. They've been FANTASTIC. Granted, it's done by county, and as our county has a smaller # of people depending on it, more services for us are covered, whereas LA county has tons less in the way of services. (Example: in our county, I can buy $15 of food per day that my son is hospitalized, and get reimbursed. Los Angeles county pays $5 per day. My county pays up to $85 per night for housing while my son is hospitalized or traveling to dr appts, Los Angeles doesn't cover housing.)

The social workers at the hospital helped me fill out the various paperwork needed for applying to CCS, Medi-cal, and SSI. They also helped us hook up with a group that does fundraising for children needing trasnplants.

It *does* feel like jumping through hoops going through the yearly renewal process, and I hate the restrictions on income and property (for example, we can only own one car...so if hubby has it at work and there's an emergency with my son, I have to either call an ambulance or hope I have benevolent and available neighbors), but overall the experience has not been unpleasant.

The social workers at the hospital make all the difference--if you get a good one, they'll help pave the way. A bad one can make life miserable for you. --alexis

3:27 AM  
Blogger catherine said...

terri w/2 is right on. just some realistic tax breaks would be nice.

8:53 AM  
Anonymous chris and Vic said...

This is the 2nd story I've heard in 2 weeks about Aetna not covering things that other insurances DO cover. Interestingly, in this area, an investigative journalist with a local TV station got Aetna to pay for what the insurance said was an "experimental" treatment for a person with a rare disease.

In the foster care system in my area, relatives can apply for "kindred care". They get reimbursed to care for a child that they are related to. I don't know how/if it would work for others, in other areas/states, with other social workers.

You can also make your child a ward of the state and be his guardian, with or without retaining the power to make medical or educational decisions. By doing this for a child who is racking up the medical bills, you keep from maxxing out your insurance and having the whole family become uninsurable/un- insured.

I wonder, if your child had a medical home through his ped, if there would be more opportunity for the family/child to get some financial breaks. If your child is on a registry for his/her chronic disease or condition, maybe there would be some chances to get into research studies, where medical care or medicine or durable medical equipment is provided to study participants.

Last, docs accept a certain number or percentage of kids on Medicaid into their practices, and use the losses as a tax deduction--or they used to before the advent of doctor's practices that are attached to some larger healthcare org. Maybe this still goes on in some places---parents will have to ask for "charity care". In this area, Medicaid covers dental work, except that there are very few dentists who accept Medicaid. So I have my son on my dental insurance plan, so that I can find a dentist more easily. (Vic will need oral surgery for a 2nd row of teeth in the lower front, due to his narrow jaw, due to being on a vent for a long period of time and due to the familiar "toaster head" configuration that ex-preemies have just from positioning.)

It seems to me that there ought to be an expert in every ped's office who knows how to work the system to get the bills paid. That person will probably know the applications that must be made, the people who must be contacted, the appeals processes, etc. Look for the name of a judge or a political candidate who is looking for a cause that will make him a hero on the local news. Find that proactive social worker. Contact the local churches. Call back to the NICU, and ask for their help. There may be a corporate lawyer at the hospital who may have some pieces to the puzzle. Yes, it is a lot of energy just to keep going at a basic level--making all your appointments for all the follow-up specialists, where they ask for your insurance info before you even show up to the appt. It always feels unfair---it makes you into a beggar. It eats up your time. Etc.
God bless us, every one.
Chris and Vic

10:43 AM  
Anonymous Katherine said...

I've been on an HMO since I graduated law school and have never been denied any treatment for which I asked. For five years I struggled with bulimia, and my HMO paid not only for inpatient treatment, but they paid for all of my follow up care: weekly visits to a nutritionist, thrice weekly visits to a therapist, weekly sessions of equine assisted therapy (I know, funny), weekly sessions of art therapy. They paid for it all, without question. So, to me, it seems like HMOs kind of get a bad rap. After all, you only hear about the horror stories...not about all the times it works marveously.

11:18 AM  
Anonymous Bryan said...

This is all part of the vast conspiracy to portray everyone in authority as evil. And us as victims. Interesting post.

11:36 AM  
Blogger Laura said...

concerning terri w/2's comment about parents who adopt disabled children yada, yada, yada

::::waving::::

i'm one of "those" parents.

oh yes, my child "qualifies" for medi-cal and he "qualifies" for california children's services, both based on the fact his b.w. was 630 grams, his chronic lung disease and original "working diagnosis" of cerebral pasly (docs emphatically told me he does not have cp after they would put that down to qualify him) and the current "working diagnosis" of mental retardation. he qualifies alright. but there are a couple things one should know: first of all, in this county in california, in order to qualify i must submit every three months proof of my residency, proof of my income and my husband's along with a questionaire...every 3 months. i diligently did this the first two years after son's adoption was final and mailed it off along with my payments to his doctors and hospital bills that our insurance did not cover and for some reason medi-cal or ccs would not pay either....there was ALWAYS a valid reason these weren't covered. it's all good because our insurance is good and the amount we pay doesn't break our backs....kids don't need all those extra toys anyway imho.

but i began to get tired of jumping through this hoop every three months not to mention being told i must abruptly change specialized doctor's for my son because one particular gi specialist is no longer a ccs physician. nevermind she is closer to home. screw the fact she has cared for him since his nicu days and knows his case and him well. she is no longer on their approved list of specialists so i must take my son to a doctor who is a 4 hour drive away from home "if" i want to receive any ccs benefits. it goes on and on.

loads of help?

loads of help?

wtf?

where is it?

oh yeah the one time $10,000 credit we got on a tax return years ago because we adopted a child considered "damaged and unadoptable" kept us from paying taxes but no big whopping check came back. that was a one time credit...not a refund or reward.

oh yeah, the monthly stipend that wouldn't even cover the cost to feed him, clothe him, pay for his child care if he were a "normal child" much less any special medical care he needs. it is in an account in his name which he will get later in life....the way we see it is he can't paossibly live off of it now, it's HIS $ so we invest it for him. he'll need it someday.

6 months ago i informed ccs i would no longer fill out their paperwork with my personal info after they admitted son qualifies regardless of any personal info about me. i also refused the medi-cal. the majority of docs i would take him to do not accept medi-al so why bother? of course the workers are all in a uproar but they don't pay for his care i showed them the box full of bills of claims they denied asking what have they done for him lately.

it galls me that folks who don't live my life make such assumptions about us.

we were never in it for the $$ and we certainly don't get $$.

such assumptions are erroneous and unfair just as the assumptions folks make about families living with micropreemies. don't generalize based on one family you "might" know or that you see or read in th news because you are way off base. live the life before you toss out such "facts". the massive rstrictions apply to my child i did not give birth to just as they would apply to any child i have given birth to or to any other child with the same disabilities or "working diagnoses" of another mom.

i would add yes in the hosipital, a good social worker makes a big difference wading through all this mess...IN the hospital, but in the real world, on your own, living day to day there is no social worker, it is the parents, adoptive, foster and "real" jumping through those hoops together.

11:46 AM  
Blogger terri w/2 said...

Thank you, Laura for the clarification. .

Apparently the services in CA differ greatly from my state - here we have foster care parents who we've heard that are receiving several thousand dollars per month when doing care for children with severe disabilities, in addition to medical coverage for the child. Adoption appears to carry some pretty nice financial support as well. In my state it is a "saints and sinners" mentality - one biological mother I know well was told she could not receive financial support because she did not "choose this" implying that foster and adoptive parents should be rewarded.

It is maddening - caregiving is caregiving, no matter what - we should all be receiving adequate support, as no one can do this alone. We are doing institutional level care, and receiving very little assistance in doing so.

I apologize that I offended you - I should not have assumed outside of my state foster and adoptive families were receiving similar supports.

12:31 PM  
Anonymous Anonymous said...

Seems to me the question here is whether access to health care is a universal right or a commodity to be bought and sold. Why is there such a wide spread assumption that insurance companies should have to pay for everything, without limit?

1:00 PM  
Blogger abby said...

I agree... a decent social worker in a NICU (or I imagine other hospital setting) makes all the difference. Our NICU's social workers were not decent, and never did fill out the paperwork that they promised to fill out for us. Hence, we ended up having to do this ourselves after Hallie was home. So, in the middle of all of our struggles with feeding her, making sure her oxygen was doing its job, taking her to four doctors a week (and paying all of the associated co-pays), I was wrangling with the Medical Assistance program in Pennsylvania. Getting the forms was hard enough. Then we had to track down all of the information to fill them out. Never mind that Hallie automatically qualified as a baby who weighed under 1500 grams when she was born (she was almost a third of that minimum weight!). Then we had to wait. First we heard nothing. I am pretty forceful as an advocate, so I kept calling and kept getting answering machines and no one ever returned our calls. Then we got a rejection letter because Hallie is not disabled. WTF! Under SSI, she is automatically disabled because of her birthweight. Then I appealed, printing out PA's laws and appending them to the form. Then, and only then, did I hear from the county welfare board that there was a "computer error." Right! Anyway, to make a long and ongoing story shorter, we are just now getting enrolled. Her assistance for the copays etc doesn't kick in until mid March. She was born in JUNE. And the county agencies won't backpay beyond December. So when I look at our debt load and ask myself why we have doubled our credit card balances since this summer, I am pretty sure that I have the answer. We are lucky because we do qualify for credit and will eventually be able to pay off this debt (we hope). But the hospital copays for Hallie and her twin who only made it 18 days are still outstanding and I find myself in the unenviable position of having to appeal to the hospital to waive these charges (after all, it was their social workers who lied to us and dropped the ball continually). And I am still not convinced that the county board will ever send us the card for the supplementary insurance in which they have ostensibly enrolled us. So there are more calls to make, more paperwork to submit, etc. And for us parents who are struggling to be able to just find the time to care for our kids who need more than average attention and care, even when they are doing well, well, this is simply too much.

2:11 PM  
Anonymous Anonymous said...

My micropreemie was denied all CCS (LA county) services in CA due to income. Totally unfair, and they knew in my situation with a kid hospitalized I would not have the time to fight that. They were right, and I'm still pissed off about it.

8:24 PM  
Blogger neonataldoc said...

Terri w2, there is no question that it is expensive to be disabled or have a disabled child. And although paretns who adopt such kids may get astate stipend that natural parents don't, I bet they would say there are still expenses that are not covered. I like the idea of being able to pay relatives to care for these kids.

Carrie, in our state CSHCS does pay for heart transplants. Families need to fill out financial information only every one to two years. And if the program makes a decision the family disagrees with, there is a formal appeal process. Abby and anonymous 8:24, you might consider appealing the decisions.

8:03 PM  
Blogger buddhistmama said...

we spent two years trying to get blue cross/blue shield to pay for the coverage we deserved for our twins (who spent 3 months in the NICU).

luckily, my husband is patient (unlike me) and good with numbers (ditto, he's an economist), and a real stickler for details.

what about people who aren't quite that persistent or who don't know their entitlements. or who don't have the time to call up blue cross every week for 2 years. i hate to think how much the insurance companies make off of people too busy or too tired to follow up.

ps. helen harrison, if you are reading this, can you send me the letter on the 'vulnerable child syndrome' you wrote to pediatrics in 1989 that you posted last month? i'd appreciate a copy.

11:12 PM  
Anonymous Anonymous said...

Wow, this post and the many comments make me so grateful to live in Australia! Here, everyone gets access to a high level of publicly funded health care. On top of this, those with the means can purchase private health insurance which covers stays in private hospitals and some less essential medical costs (eg dental, optical devices etc). The biggest benefit to having private health insurance here is that elective/non-urgent surgery happens a lot faster.

The drawback is, we pay far higher income tax in Australia... but it seems to work pretty well for most of the population.

It never ceases to amaze me that the country that spends the largest proportion of GDP on Health care (ie the USA) can have such a phenomenally inequitable distribution of health care. It is unthinkable that anyone should be denied essential healthcare (eg organ transplants) due to lack of personal financial resources.

I guess I am curious about the whole philosophy behind the system of health care distribution in a country like the USA? There must be some kind of advantages? right?

3:55 AM  
Anonymous Chris and Vic said...

Wow, anonymous from Australia! You've asked the million-dollar question when you ask about advantages to our system of healthcare. As it exists right now, it is a can of worms.

The system we have is NOT premised on the belief that healthcare is a right. Healthcare is NOT an entitlement. It is a privilege tied to employment. Employers provide health insurance--at least they DID. Now 40% of employers do not provide that perk. (In other words, a large segment of the population does not believe that healthcare is a right---I went through my master's pgm, in a minority of 2 or 3 people in every class, who believed that healthcare is a right.)

Buying health insurance on your own costs about $6000/yr. People in low-paying jobs cannot do it. Even when their employers provide access to health insurance, some low-paid workers cannot use it because of deductibles and co-pays. (Insurance generally pays 80% of your healthcare bill, and you are responsible for the remainder---but you have to satisfy your yearly deductible first--which varies tremendously. Mine is low at $250/yr. This means that, even with a health insurance policy, YOU must pay the first $250 in costs, and then pay 20% of all other costs. Sometimes there is a cap on this. And sometimes you max out your insurance--someone else mentioned $1,000,000/yr, or $5,000,000/lifetime.)

The advantages of this system may not look very much like advantages. I see the advantages as healthcare is a free-enterprise, or market-driven system. Supply and demand laws govern it. The economic theorists who proposed such systems (Mill?) are probably quite happy with it. I don't think most ordinary folk in America are that happy with it.

There have been movements, and there still are movements afoot to come up with an equitable universal healthcare plan. So far, only a few individual states have pulled it off. I personally think it should be left to individual states to work out their own programs, but the proposals, especially in election years, revolve around the federal gov't coming up with a plan that will be judged as workable and equitable to everyone in this vast nation. I do not believe in a single-payor system, myself. I like Maine's Dirigo plan, which you don't hear too much about. Dirigo has hospitals pledged to avoid any building for certain periods of time, so that they can predictably keep their costs down. Employers who own small companies in Maine were the first to have things worked out for them and their employees. Those were the people who could NOT provide health insurance for their employees, due to their small size/profit margins.
California and Massachussets are working things out, too---though those are far from perfect solutions. New York, I think, has some elements of provision of care for the poor/working poor.

There is a fair amount of medical bankruptcy. I believe that medical mistake lawsuits are partly a response to the crummy economics of healthcare. We have had to come up with laws that prevent hospitals from turning away acutely ill people from emergency departments who do not have insurance. There is also "charity care," by some docs and healthcare orgs, to try to meet the needs of sick people.

There ARE 2 entitlement pgms--Medicare for the elderly and Medicaid for the disabled and elderly. These are 2 cumbersome systems for providers to access. It is typical for a hospital or other healthcare provider to wait 18 months for payment from these 2 government entitlement pgms. They must code the problems according to hoyle and jump through other hoops to get paid. And then Medicare pays 35 cents on the dollar, and in my state, Medicaid only pays 13-14 cents on the dollar. However, if you don't play the game, your hospital or provider service will lose a lot of business--the poor and elderly will not be able to get services from you, and there are a lot of poor and elderly in need of services.

Yes there is a private healthcare industry. For example, a home health agency that is Medicare/Medicaid certified charges $8/hr for a home health aide. A private agency charges $13-20, in this area. On the east and west coasts (I am in the mid-west), costs are very different, that is, higher.
Chris and Vic

1:06 PM  
Anonymous Anonymous said...

I do have to admit that our healthcare system is flawed but I would much prefer it as opposed to socialized medicine.

I attended college in Canada where they have socialized medicine and so many of the people I spoke with felt like cattle receiving substandard medical care.I never heard anyone say anything good about their medical system. I remember two instances in the news there where young and otherwise healthy pregnant women died en route to a hospital because they could not get in to see their docs who could have prevented their fate with early medical intervention.

When we get sick here, we can usually see a doctor within a reasonable amount of time, within a day or so in most cases, if not that same day. There, it takes at least 3 weeks to see a doc. Imagine being elderly, with a bad case of the flu, that creates an opportunity for death. Have you ever seen the bumper stickers that read "End Overpopulation...Support Socialized Medicine" There is a valid reason for those.

My last point that I would like to mention is that NO ONE gets refused from an emergency room regardless of insurance status, ability to pay, or even if they are a US citizen.
EVERYONE here, regardless of their situation, can receive treatment.

2:53 PM  
Anonymous Helen Harrison said...

To Anonymous (2:53 PM) who said
"I attended college in Canada where they have socialized medicine and so many of the people I spoke with felt like cattle receiving substandard medical care."

Many of us in the US feel the same way, but we are paying many times more than Canadians for the "privelege."

I recently went to an ER in Washington,DC, that had just treated our esteemed Vice President.

I had a 14 hour medical wait in a situation I would liken to a circle in hell. Imagine a Jet Blue fight trapped on a runway for 14 hours -- no food, no water, no working bathrooms.

I was eventually hospitalized at this same hospital with a woman from Moldava here on an exchange program who'd just had an appendectomy. She told me that her treatment, in this major American hospital, was worse than any she had encountered in her "socialist medicine" homeland.

To buddhist mama:

My email is Helen1144@aol.com

Email me and I will send you the letter on "the vulnerable child". Thanks so much for your interest!

11:29 PM  
Anonymous Anonymous said...

To Helen,

I agree wholeheartedly that our system is flawed, I never said it was perfect. However, I was just saying that the grass is not always greener on the other side like many think seem to think it is.

8:57 AM  
Anonymous Anonymous said...

Helen,

I'm originally from the same neck of the woods as the exchange student that you met, and let me tell you something: there is no way in hell that the hospital that you've been treated at is worse than a free hospital in Moldova. You have no clue what an average free hospital in Moldova looks like, and I hope you never get to find out.

11:04 PM  
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