Category Archives: Health

New cancer screening recommendations suck

I’m not even going to try to link this to living life laid off.  It’s my blog, and I’m going to use the space to vent.

Maybe if the new recommendations for the frequency of mammograms and pap smears hadn’t come on the heels of the Stupak Amendment, or if I weren’t a feminist or if I weren’t a black female, I wouldn’t feel like women, and especially black women, were under attack, but that is the order of things, and that’s my feeling.  Limit women’s access to abortion, have them cut back on the frequency of tests that could save their lives and send the over all message that they should pay less attention to their own bodies.

The message is archaic and ridiculous, and its juxtaposition against the health care debate is highly suspect.  A report on Good Morning America Friday morning said that insurance companies have already received a barrage of calls from women concerned that their insurance providers will no longer pay for the tests they’ve been used to getting annually.  For now, insurance companies have said they will follow the old guidelines and keep covering the tests every year.  But what about a year or two from now?  The cost of health care keeps going up in the U.S., and if you’ve ever had a pre-existing condition or been dropped from your insurance coverage after you get sick, you know insurance companies are looking for ways to cut costs.  But if prevention costs less than treatment, cutting the costs by cutting measures used to detect disease in its earliest stages doesn’t make sense to me.

For women in general, the new guidelines are dangerous because they narrow the gate by which we enter the doctor’s office.  I don’t see my doctor very often.  I have a pap smear every year, and unless something else is wrong within the year, I don’t see her in between pap smears.  But as she talks to me before I strip and put my feet in the stirrups, other issues come up.  They could be about my physical, emotional or sexual health.   The issues could be about fatigue, diet, relationships, exercise, vitamins, unusual patterns in urination or problems that I’m having with other health care providers who aren’t as informative as she is.  When I saw her in 2008, just before I lost my job, she and the billing department in her office were able to tell me what they knew about what to do for insurance while unemployed.  Each year, we cover a lot of ground in about 15 minutes, and if there is anything unusual, I get tested for it.

The problems I bring up to her are usually minor and easily traced to changes in circumstances or diet.  But the point is I bring them up.  If I follow the guidelines released last week on getting pap smears, I probably won’t see her but once every three years.  And those minor concerns that come and go and that are probably nothing but that could very well be something that will slip through the cracks.

For black women in particular, the new guidelines are dangerous because we’re more likely to die.  Earlier this year, the American Cancer Society estimated that about 192,370 new cases of breast cancer would be diagnosed in American women in 2009.  There’s a higher rate of breast cancer among white women over age 40, but a higher incidence of the disease among younger black women and a higher rate of death from breast cancer among black women, which may be because black women tend to get more aggressive forms of breast cancer.

Also, black women tend to be poorer, have less access to affordable health care, go to the doctor less often and have higher incidents or death rates of almost every disease than white women.  To now have guidelines that instruct black women to wait even longer to see their doctors makes it too easy for us to put our health on the back burner.  How many times does, “I’ll do it next week,” turn into next month, next year, and finally never?  How easily can not until you’re 21, not until you’re 50, every three years, every other year, I don’t have to do that until, or I’m too young to be worried about that, turn into death?

My issues with the new recommendations continue in a related article.

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© Mariam Williams, aka The Pink-Slipped Girl, and The Pink Slip Blog – Living Life Laid Off, 2009. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Mariam Williams and The Pink Slip Blog – Living Life Laid Off or http://livinglifelaidoff.com, with appropriate and specific direction to the original content.  Any use and/or duplication of any photo contained within this blog without express and written permission from Mariam Williams is strictly prohibited.

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I learn something new about healthcare every day

I want to move on from this topic, but pain currently has a starring role in my life, and issues I didn’t run into when I had adequate health insurance keep surprising me.

For instance, the reason people without health insurance use the ER as a primary care facility became clear to me last week when I finally caved in and sent detailed notes about my chronic pain, and some rather grotesque pictures, to my primary care physician.  She referred me to a specialist, but due to the exclusion rider on my pre-existing condition that basically states that nothing having to do with my chronic pain will be covered, I would be considered a self-paying patient, and the doctor she referred me to doesn’t take any self-pay patients.

“So that’s why people go to the hospital when they don’t have health insurance,” I said to myself.  A hospital has to treat everyone.  A private doctor does not.

When I explained the situation to another specialist’s office, its billing department said to come in anyway and that I would be billed after the doctor decided what he wanted to do.  Perhaps self-paying patients get second-class treatment in his office; for some reason, he saw me for less than five minutes even though I was at the office for an hour and a half.  In that five minutes, he wrote a prescription and ordered another diagnostic test.  A representative from the billing department later called me about the appointment I had set for the test.  The rep told me that my insurance company said that “no diagnostic tests relating to (my pre-existing condition) are allowed until the year 2011.”  This really means they’re allowed, but I would be paying for the $1800 test out of pocket.

If she had said those words to me face to face, I think I would have punched her.  That’s not true; I just would have been embarrassed because she would have seen the rage heating my face and the tears forming in my eyes.  I smiled through the droplets and in my most chipper phone voice, I said, “Cancel all my appointments.  If I have an emergency, I’ll just go to the hospital.”

Would a visit to the ER cost twice as much as the diagnostic test in a private office?  Probably. Would I get the treatment that I need?  Definitely. Would I end up paying the bill? Maybe. But there’s also the chance that the hospital would just pass the cost along to all of you lucky, fully insured people who are afraid of losing health insurance that you don’t even realize sucks.  And you don’t even realize that one of the reasons it sucks is because you’re covering what the very company you pay won’t cover.

Wake up!

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Happy Sunday! A quick thought about the Christian stance on universal health care

by Mariam Williams

I recently read this post by Rev. Jim Rigby, Pastor of St. Andrew’s Presbyterian Church in Austin, TX, and wrote him the message below to thank him for calling the Christians out on this one. (Those damn communists in the early church …)

If our much revered original apostles were among us today, many Evangelicals would have painted Hitler mustaches across images of their faces and hurled the insult “Socialist!” at them while attending their prayer meetings with guns.  Acts 4:32 says believers shared everything they had.  Acts 4:34-35 says no one was in need because “from time to time those who owned lands or houses sold them, brought the money from the sales and put it at the apostles’ feet, and it was distributed to anyone as he had need.”

We have lost sight of that concept today, and your essay had me wondering how the church contributed to the attitude.  Perhaps we didn’t read Acts enough and instead concentrated on our blessings as heirs of Abraham too much?  Maybe we read too much into 2 Thessalonins 3:10 (enlarge my territory) or were so impressed by how God took care of the widow in 2 Kings 4 that we just figured we don’t have to do anything.

Then again, there have always been, and probably will always be, people who do not believe this country is for everyone.  They will be very disappointed that they no longer have anyone to stand on if all the poor die off because we are uninsured.

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© Mariam Williams, aka The Pink-Slipped Girl, and The Pink Slip Blog – Living Life Laid Off, 2009. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Mariam Williams and The Pink Slip Blog – Living Life Laid Off or http://livinglifelaidoff.com, with appropriate and specific direction to the original content.  Any use and/or duplication of any photo contained within this blog without express and written permission from Mariam Williams is strictly prohibited.

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Sen. Mitch McConnell’s response to the concerns of someone living life laid off

by Mariam Williams

During the first full week in September I wrote a letter to Sen. Mitch McConnell, expressing my views and concerns about the national healthcare debate.  His response – or rather, his lack there of – is disappointing at best.  At worst, especially when I consider how poor in health and indigent the state of Kentucky is as a whole, McConnell’s “response” is the equivalent of him using the state he represents as a piss pot.

He sent a form letter. A FORM LETTER! While this is understandable for a busy person, it’s disturbing in this case because it shows that nothing that has been said in the past month and a half – none of the “liberal” perspectives, none of the heart-wrenching stories about people who have died or gone bankrupt because of the greed of the health insurance industry, none of the President’s speeches – has had any effect on McConnell’s resistance to full and thorough healthcare reform.  I know this because, even though Sen. McConnell, on his website, claims that he spent the month of August going throughout the state to talk to people about this issue, he sent the EXACT SAME LETTER to a friend of mine ON AUGUST 11!  The letter he sent to me is dated September 11.  My friend scanned the response letter and posted it on facebook.  This friend did not even write the letter that the senator refers to in his generic response.  And we wonder why people feel like they don’t have a voice in government.

Before I continue with counterpoints to the generic response, I have to ask a favor of all of you reading this: If you wrote to Sen. Mitch McConnell and received this same letter, which you can read by clicking here for page one and here for page two, please write a handwritten note saying whatever you want directly on the aforementioned letter and then fill out the contact form on this blog.  I will then reply to you asking you to mail a copy of the letter to me or to scan it and email it to me.  Cover your address but leave the date line.  I would like to send as many generic form letters with handwritten responses back to the senator at one time as I can.

Since it is a form letter, Sen. McConnell’s generic response does not address the specific situation I included in my letter: unemployed people who have pre-existing conditions that aren’t covered by their inefficient, self paid, non-employer sponsored insurance, and that they can’t afford to treat.

He says in his letter that “private companies couldn’t possibly compete with government.”  I addressed this argument, and another argument that public-option opponents make that cancels it out when I said, “Opponents say, ‘A public option would obliterate private health insurance providers.  It would be so good, who wouldn’t join a government-run health insurance plan?’ and then they say, ‘How could the government efficiently run a health insurance plan? It would mean long waits and more red tape for your treatment.’”  He says the federal government would fund its plan through taxpayers, who are essentially an unlimited resource.  So here’s my question now: If you have all the money you would ever need to run a health care plan, you could afford to make it good, right?

He says another reason a public option “would soon become the only option” is that the government could dictate prices to doctors.  I’m not sure why this is or if it’s true, and if it is, I don’t see how it’s different from private insurance companies who negotiate to pay doctors and hospitals at a discounted rate.  Granted, this does cause problems.  Locally, the Norton Healthcare hospital system and Anthem, a health insurance provider, are in battle over how much – or how little – Anthem pays doctors.  This has forced patients to a) switch healthcare providers, which we all know sucks because you don’t want to leave a doctor you like and you don’t want to have to repeat your history to a new physician; b) switch insurance providers; or c) pay the out of network price to remain with Anthem and with their physician of choice.  I guess if we had a single payer plan, doctors would either make minimum wage and like it, make minimum wage and give me crappy care, or just not be doctors, and I guess that should make me shudder in fear.  But knowing that people in other countries who have a single-payer system still get cared for makes me unafraid.

I find it very interesting that Sen. McConnell is concerned about the government limiting the amount of money doctors can earn, but he wants to limit the amount patients can obtain in medical malpractice lawsuits.  Other than the obvious reason, it’s also interesting because there is no proof that medical malpractice lawsuits are crippling our healthcare system.  A recent article in Business Week says studies show that “comprehensive, nationwide reforms would lower overall health-care costs by 2.3% at most.”  In Texas, where the medical malpractice limit is $250,000, “health-care costs are still among the highest in the nation and are growing at a faster rate than in most other states.”  This isn’t common sense reform if it doesn’t work.

I completely agree with Sen. McConnell on this statement: “We should encourage insurers and employers to expand prevention and wellness programs that have proven to reduce costs.”  If my insurance providers’ underwriters had asked me what I eat every day or how often I exercise instead of only asking about the few things I had seen a doctor for in the past 10 years, they would have found that I’m doing everything I’m supposed to do to take care of myself and prevent heart disease and cancer, the sometimes preventable diseases that cost the most money to treat. And maybe they would have charged me less money (hahaha!).  Again, Sen. McConnell doesn’t address those who are unemployed or uninsured, but on this point he’s right.  As the saying goes, an ounce of prevention is worth a pound of cure, and in this debate, it may be worth millions of dollars in treatment.  If prevention measures included seeing doctors annually, adults would know about problems earlier, which means they could get treated for a minor, inexpensive problem when it’s minor, instead of for a major problem when it’s life-threatening.  It would also keep more people out of the ER, that place they go when they don’t have a regular doctor and know their condition is at a breaking point.

Of course, a lot of the people who end up in the ER are uninsured and/or poor, like many of the people in Kentucky, and I still don’t know what Sen. McConnell’s plan is for those (his) people…

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© Mariam Williams, aka The Pink-Slipped Girl, and The Pink Slip Blog – Living Life Laid Off, 2009. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Mariam Williams and The Pink Slip Blog – Living Life Laid Off or http://livinglifelaidoff.com, with appropriate and specific direction to the original content.  Any use and/or duplication of any photo contained within this blog without express and written permission from Mariam Williams is strictly prohibited.

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Lives Unlocking Powerful Unexpected Strength

I know everyone reading this knows that I’m unemployed and that in the midst of such desperate times, people create scams to get money.  This is out of place for this particular blog, but it is not a scam.

On Saturday, September 19, I will be participating in this year’s Walk for Lupus Now® in Louisville to benefit the Lupus Foundation of America, Mid-South Chapter.  We hope to raise $25,000 this year allowing the LFAM to provide education and support services to people living with lupus, and support much needed lupus research.  There has been no new FDA approved drug for the treatment of lupus in 50 years.

Lupus is an acute and chronic (lifelong) autoimmune disease in which the immune system is unbalanced, causing inflammation and tissue damage to virtually every organ system in the body. It affects an estimated 1.5 million Americans and approximately 24,000 living in Kentucky.

I’m walking because I know four women with lupus personally.  Some 90 percent of individuals diagnosed with the disease are women.  The four I know deal with such issues as respiratory infections, hair loss, taking 21 different medications each day, monthly blood treatments, extreme fatigue, and arthritis so severe, you would think they were well into their 70s instead of in their 20s and 30s.

It’s also worth noting that these three women are African American.  Lupus is two to three times more prevalent among women of color — African Americans, Hispanics/Latinos, Asians, Native Americans, Alaska Natives, Native Hawaiians and other Pacific Islanders — than among Caucasian women.  African American women’s symptoms also tend to be more severe than those of other groups.

My friends with lupus are mothers, daughters, sisters, aunts, cousins, friends and community leaders who touch the lives of those around them.  You never know who your kindness will affect, and making a difference starts with one step.

Readers, you can take that step by making a secure online donation. I haven’t asked for a specific amount from people I know, so I certainly won’t ask it of my readers.  I’ll only ask that you consider brown-bagging it one day for the remainder of this week or skipping one midafternoon smoothie or latte, and donate that amount instead.  Click here to go to my personal donation page.  If that feels weird, click here to donate to team L.U.P.U.S. (Lives Unlocking Powerful Unexpected Strength), here to find out more about the event, and here to find out more about lupus.  We also have very cute t-shirts that can be purchased here.  All proceeds go to the LFA Mid-South Chapter.

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Adapted from the form letter provided by the Lupus Foundation of America Mid-South Chapter.

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Making the health care debate personal

I shared a prayer request and call to action with my friends and family over the weekend that some felt should be shared.  As I said to them, I’ve been blogging a lot lately about health care reform, but I’ve been concentrating on insurance and leaving out details about ailments.  Under the suggestion that details make it more real, I’m posting some of what I shared with those who care about me, and some of what I shared in a rather angry letter to Sen. Mitch McConnell.  I am just one example among millions of others, and if you’re not already in a situation like mine, remember: you are just one pink slip away from becoming just like me.  I hope my words will spur them, and now you, to action.

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For the past two weeks, I’ve been in severe pain due to something my insurance provider refers to as a pre-existing condition.  The pain normally comes and goes with varying and highly manageable severity, but in recent weeks, it’s been more intense than I’ve ever felt it before.  Other oddities about the pain show me that I undeniably need to see a doctor, but I’m afraid of what the diagnosis and costs associated with it might be.

I should also note, I’m in my late 20s, representing the largest group of un- or under-insured people in the country.  (Click here to read or hear two women who were diagnosed with cancer when they were in their 20s talk about their experience with insurance and the disease.  One chose to return to her family in Prague to get treatment rather than spend her energy fighting with insurance companies here.)

I have the kind of health insurance meant for catastrophic events.  I have a high-deductible plan with a low monthly premium and a health savings account that might have just enough money in it to cover my well-woman annual, which is due in October, and associated lab fees.  I pay for everything out of pocket until I hit the deductible, unless of course my treatment has to do with my pre-existing condition, at which point I could hit the deductible and spend an additional $1 million after that and still not get one cent of help from the health insurance plan.  I could have gone with a plan that would have eased the out of pocket expense in exchange for a higher monthly premium, and as of late, I’ve been thinking about switching to one that does just that.  However, I would be out more money each month and the results would be the same: nothing having to do with my pain, the pre-existing condition that needs to be treated, would be covered.

The pain also has me seriously questioning the determination – and I would say, even the God-given vision – I have had for almost one full year to not take or even apply for just any job that comes along, but rather to apply for jobs that I would enjoy as I simultaneously grow my free-lance writing and research assignments into a fully functioning business of my own.

This is what the current health care debate should be about – sick people who are afraid to go to the doctor and/or who can’t afford to go and would-be entrepreneurs who can’t go out on their own and possibly create more jobs because they can’t get health insurance because they or someone in their family has a pre-existing condition.  It’s not about constituents who already have insurance, it’s not about the ones who hate the black president (yes, I said it), it’s not about the representatives who hate him, and it’s not even about the word “socialism,” which most people can’t even give a correct definition of when asked.  It is a true testament to some people’s deep-seeded hatred and selfishness that fixing a for-profit health care system that bankrupts thousands of families every year, and that has left sick people who need help in the hands of an underwriter who is only qualified to diagnose what shareholders want, is even up for debate.

Yes, I am concerned about the national debt, and if there is ever a point at which I make over $250,000, I won’t want to pay more taxes on it.  But I don’t fear “big government” or more federal regulation being involved in my health care. I am already a part of an incredibly large, bureaucratic, government system, as I receive unemployment compensation.  For the most part, it runs efficiently, and it does cover my most basic needs (except health care) with the taxes I already paid when I was working full time.  Whenever there is a complication, however, it does indeed take two to three months to get it resolved.  While I wouldn’t want to wait two to three months for treatment of an illness, the complications with unemployment are no different from what I’ve experienced with private and even group health insurance plans, in which there is a great exchange of paperwork and phone calls within a large system with a lot of red tape whenever there is an unusual circumstance, like an out-of-network provider who was in the network the day before I went for treatment, or the policy that’s canceled when someone actually gets sick.  Mistakes will happen and great training will have to be invested before unusual circumstances cease to be a hindrance in a government-run plan, but I have confidence in its potential efficiency, and because it will be non-profit, I will know that I’m not being mistreated so that a lobbyist can pad my senator’s pocket.

The much-rumored “death panel” is already in place; the underwriters at every health insurance company are death panelists.  They are accountants, people with no medical training who decide which medical conditions and treatments will be covered.  They do so with one thing in mind: shareholders.  They make these decisions without regard to the welfare of those whom they effect the most, and the only time they change their minds is when a news program investigates them.

A public option, not just insurance reform, would enable me to see a doctor before my health gets worse, without fear of cost.  I don’t mind paying for health insurance or health care, when it goes toward research, technology, and qualified physicians.  I mind paying astronomical amounts for medical treatment that I NEED just because I was already sick and a bean counter was concerned about how that would eat into his profit. A public option, like Medicare for everyone who wants it, would provide a low-cost option for me and millions of others like me.  By forbidding exclusion riders, it would also force private insurance companies to abolish them from their own plans, giving me the option to do what I would like to do now: ditch the high deductible HSA plan and pay a higher monthly premium in exchange for the traditional co-pays and prescription drug benefits.  Provided I chose to stick with a private insurance company, I would actually be giving them more money annually than I am now.  Studies show that only about 3% of the American population would join a government-run plan.  The rest of us would do what I would like to do.

Have you ever noticed that arguments against this plan cancel themselves out?  Opponents say, “A public option would obliterate private health insurance providers.  It would be so good, who wouldn’t join a government-run health insurance plan?” and then they say, “How could the government efficiently run a health insurance plan? It would mean long waits and more red tape for your treatment.” These statements cannot co-exist!  If a government-run plan would be so bad, what do private insurance companies have to worry about?  And if it’s that good, what sensible CEO concerned about shareholders wouldn’t step up his game to stay competitive and retain customers?  And why are so many people – including my senator – so against it?

Reader, if you’re against real reform, please reconsider.  If you’re for it but you haven’t been vocal, please speak up.  And if you’re happy with the way things are, just wait.

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© Mariam Williams, aka The Pink-Slipped Girl, and The Pink Slip Blog – Living Life Laid Off, 2009. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Mariam Williams and The Pink Slip Blog – Living Life Laid Off or http://livinglifelaidoff.com, with appropriate and specific direction to the original content.  Any use and/or duplication of any photo contained within this blog without express and written permission from Mariam Williams is strictly prohibited.

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Why we should pay for health care but it shouldn’t be about business

(Click here to read about my personal health struggle and why I care so much about health care reform.)

All the talk about health care in the U.S. and how to pay for it had me thinking: What did people do before health insurance anyway?

I found many dates and theories by doing a Google search for “history of health insurance.”  (Listen to a brief history here, or read a detailed presentation here.)  But I wanted a more human, first-hand account, so I asked my mom, a member of the baby boomer generation.

Health insurance existed in the 1950s, but my mom doesn’t remember having it.  She said, “People didn’t go to the doctor for every little headache.  We took Bayer aspirin, Dristan for allergies,” doctors made house calls, there were nurses in schools and a mobile clinic visited neighborhoods.  Families depended on home remedies, like Vick’s vapor rub and a hot towel, a spoonfull of castor oil and on the Watkin man, who delivered both the world’s best vanilla extract and the world’s strongest cough syrup door to door from a truck.

From a historical perspective I have to remember, blacks weren’t always admitted to hospitals, even for the things we now take for granted as essential, like childbirth.  My mom was born in a house.  People knew then, but we’re even more certain now that giving birth is complicated and risky; hundreds of things could go wrong, and it’s best that a mother be surrounded by professionals who know how to handle the what-ifs.

And that’s what we’re paying for.  Advancements in medicine, research and technology cost money.  (That’s why I’m walking to raise money for lupus research on September 19.  Click here for more info.)  State of the art machines and facilities save lives and give comfort, and they don’t just build themselves.  If they did, every country would have them, and they don’t.  Medical treatment in the United States trumps that of almost every other country.

When you can afford to get treated.

There’s something inherently wrong about health care being a business.  It’s different from wellness, from doing basic things to prevent disease.  It’s hard to quit smoking, but no one is forced to start.  Clean water and soap are fully accessible in the U.S.  It’s free to walk outside for 30 minutes a few times a week, and even people in the smog-filled City of Angels do that on days when Santa Ana winds carry ashes from wildfires into their lungs.  Louisville’s own urban center is a food desert, but most people have easy access to fresh fruit and vegetables.  Beyond that, if you want the Bath & Body Works anti-bacterial collection instead of Softsoap on sale for a dollar, for example, or if you want to join a gym or buy exclusively organic, it’s your choice.  Having lupus or breast cancer or a broken leg or a debilitating personality disorder is not.  And to me, it feels wrong that diseases that cost you so much could also cost you hundreds of thousands of dollars to treat.  And never cure.

It doesn’t feel wrong because I don’t think doctors, nurses, aides, and medical technicians should be paid.  Quite the contrary; we pay everyone else for their skills, and if the technicians who run the machines and the doctors who diagnose us based on the machines’ results had to pay to learn how to accurately operate the machines and diagnose us, they deserve to get paid well for their skills.

It feels wrong because someone who is not in the business of saving lives can refuse to help you pay your highly-skilled doctors when you do get sick, even after you’ve paid him for months or years to pay those doctors when that happens.

It feels wrong because I have friends who are doctors, who took an oath to “apply, for the benefit of the sick, all (emphasis mine) measures [that] are required,” but who can’t fulfill the oath because their patients don’t want all measures because they can’t afford them.

It feels wrong because some of those same doctor friends participate in medical mission trips and use their own money to give all available care to people who have no concept of a statement of benefits or of a claim stamped “DENIED,” but in their own country, they’re limited by what’s covered by their health insurance.

It feels wrong to let people die for the sake of profit.

The next post is about my personal health struggle and why I care so much about this topic.  Click here to read it.

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© Mariam Williams, aka The Pink-Slipped Girl, and The Pink Slip Blog – Living Life Laid Off, 2009. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Mariam Williams and The Pink Slip Blog – Living Life Laid Off or http://livinglifelaidoff.com, with appropriate and specific direction to the original content.  Any use and/or duplication of any photo contained within this blog without express and written permission from Mariam Williams is strictly prohibited.

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