Pay Up Or Else

I was going to take the day off from blogging today, but Sam had an interesting comment that made me want to start writing. Even as I type this, I’m not sure how I feel about the whole situation.

If you read through Sam’s blog, he has had a lot of things happen in his life that he didn’t deserve. The latest problems seems to have been a sudden medical event that caused him a significant amount of medical debt. Now he is in the process of filing bankruptcy because he did not have health insurance. Despite all this, with help from God, he has persevered and seems to have a close loving relationship with his kids.

His case reminds me of another blogger, Steph, who I wrote about back in February. She, too had a tremendous amount of medical debt and was trying to climb out of her “debt hole.” Unfortunately it looks like she has fallen upon harder times as well.

The plight of these bloggers is not uncommon. Hospitals seem more and more willing to sue for medical debts. Should hospitals be able to force people into bankruptcy for the medical services that they provide?

A hospital is a business. Without money, the business goes bankrupt.
If you walk into a lawyer’s office, many times you’ll need a retainer or the lawyer won’t take your case. If the retainer runs out and you don’t pay, then the lawyer stops providing services.
If you walk into a supermarket, fill up your basket, and leave without paying, you’ll be arrested for theft.
Stop paying the guy to cut your lawn and you’ll have to do it yourself.
Why do people expect that medical care should be free if they don’t have any money?

Part of the answer to that question appears to be the sentiment that some people get medical care for free, so therefore I should get medical care for free. No one walks into the supermarket and walks out without paying for their groceries, so the general public does not expect that they should be able to do the same. People don’t regularly get free services from their accountants or their attorneys, so the public doesn’t expect that going to an accountant or an attorney should be free. On the other hand, a lot of people get “free” medical care. Those in similar financial situations but who are forced to pay for their medical care then feel cheated.

That idea seems to be at the center of the deportation issue I wrote about yesterday. If you look at the comments to the Chicago Tribune article, you’ll see that many people state things to the effect that “these people pay nothing into the system and take everything out of the system” and “we have to take care of our own citizens before we take care of foreign nationals.”

I agree. The “system” has to be more equitable.

The problem is that for all the beliefs that “we” have as individuals and that “we” project to others as moral directives, “we” don’t want to be personally involved in advancing those beliefs.
There are many homeless people that deserve shelter, but “we” don’t offer them a place to stay in our basement because although “we” believe the homeless deserve a place to live, “we” don’t want to be personally involved. In fact, “we” don’t even want a homeless shelter anywhere near us because that would affect our property values. It’s OK to provide these services as long as it isn’t in our back yard.
More and more families are finding it difficult to put food on the table. Food at food pantries is drying up. “We” believe that no one should go hungry, yet “we” don’t offer the food we purchase to others because although it is morally correct to feed the hungry, technically “we” think it is someone else’s job.

Medical care is different, though.

People in emergencies “need” medical care and they need it immediately. It is morally objectionable to risk people’s lives and health by refusing to provide services because people can’t afford to pay for those services.

That’s the crux of the problem.

Medical care is a business, but it is a different business.

Hospitals are in the business of fixing people, and some people need to be fixed immediately – money or not. Who pays for the increasing number of people with little or no money?

“We” pay.

“We” pay taxes. The taxes we pay are no longer sufficient to fund the care “we” think that “we” deserve. In addition, those taxes are going to a thousand other places because “we” believe that those thousands of other things are more important than providing medical care to “ourselves.” In fact, “we” are finding more and more devious ways to cut payments for medical care to “ourselves” in the form of “never events,” payment cuts for programs to train new doctors, and payment cuts to medical providers in general.

One of the ways that hospitals earn money is by charging inflated prices to those who can afford to pay for their medical care. Unfortunately this game has become ridiculous.  I wrote about the high cost of medical care in a previous post. Read it – maybe it will help you if you need to negotiate with the hospital about a bill. $129 for a box of Kleenex? $90 for a 70 cent IV line? My recent surgery ended up costing $72,000. Medicare’s payment for the same procedure is $6,500.

When payments dry up, medical providers have to make a decision – find other sources of revenue or close up shop. More and more providers are choosing the latter option. But some of the hospitals that are trying to stay open are suing to get their money and making the lives of those with limited incomes a living hell.

What’s the right answer?

All this rambling and I still don’t know the right answer.

I do know that “we” need to start taking better care of “us,” though. “We” need to pass meaningful health care reform. “We” need to talk to our legislators about improving the state of health care in this country. “We” need to vote for elected officials who make the medical care of the citizens in this country a priority. E pluribus unum.

But most of the people reading this are young and healthy and this issue probably doesn’t apply to them, right?

Think again.

Catastrophic events happen regularly. I see them all the time. You’re just a clogged artery, a busted blood vessel, a blown tire, or a drunken driver away from becoming the next case of medical bankruptcy.

Just ask Sam.

Picture credit here

22 Responses to “Pay Up Or Else”

  1. Jamie says:

    When my husband and I filed for bankruptcy it was because of medical debts. I felt awful about it, but we couldn’t afford to pay the bills and lawsuits were starting to come in. I hate that we had to do it, but what else were we to do? Fortunately we’ve been able to get medical coverage since then, but it was a nightmare for a while. I’ve given this issue a lot of thought, but I still can’t come up with a solution. The one thing that’s changed for me is that at election time I look for a candidate that takes medical reform very seriously. Something has to be done before we run all the doctors out of the medical field.

  2. bridget says:

    Medical economics are different from other economics. If you’re hungry, you can make various decisions about how to solve the problem within your budget. Flush? Filet mignon at Morton’s. Not flush, exactly, but still healthy of pocketbook? Filet mignon on the grill at home. Tight budget? Chicken instead of filet. Barely have two nickels to rub together? Beans and rice. Any of those options will get the job done, you know in advance how much they will cost, and the choice is entirely yours. Not so in the medical arena, particularly if the problem is severe. The options narrow. You don’t make the call; your doctor does. Not even the doctor has a clue what it will cost.

    Medical care feels less like a purchase than like something imposed by an outside force — aliens, perhaps. When people wake up and find themselves recovering from some health disaster and suddenly in debt beyond their wildest imagining, it’s natural for them to feel unfairly treated.

    I don’t know how to fix the system, either. I used to work for a health insurance company — I won’t say which one, but the name involves a color and a shape — and volunteer at a public hospital, and I saw this problem from all angles. I will say, I think the growth of for-profit entities in the health care system is a big part of the problem. I also think health insurance companies work hard to block solutions, which makes them also a big part of the problem. This is something that deserves real national discussion, not Harry and Louise theatrics.

  3. Katie says:

    Well, stories like this makes me glad to be Canadian! Yeah, I probably pay higher taxes than you Americans, and we have to wait for surgery and specialty consults. But Canadians don’t file bankruptcy over medical bills, and uninsured Canadian children don’t die from lack of proper health care.

  4. hashmd says:

    Yes, Katie. Canadian children won’t die from lack of proper health care. But would you or your mom and dad survive the wait for surgery? Can you sue someone if they were to die waiting for such surgery or other lifesaving procedure? Do you mind having some bureaucracy or default system decide that a new chemo agent is too expensive for you or your parents?

    Somewhere among all the above questions the Canadian system can say “no” and the Canadian population are willing to accept that “no”.

    In the American system we say “yes” to providing everything possible. And that is the problem. We would be sued if we made ourselves or our parents wait to receive lifesaving care, no matter what the cost. We get sued trying to say “no” to illegal aliens receiving care, no matter what the cost. We get sued for not allowing access to the latest and greatest treatment for Stage 4 cancer even if it were still experimental.

    Yet, we as Americans refuse to be held accountable for paying for it all. Even though we must start saying “no” because there is not enough money to fund delivery of healthcare to everyone in America. There are only 2 working people supporting every one Medicare beneficiary now, and the baby boomers have only JUST started becoming Medicare beneficiaries!

    Come on folks, there is no where else to get the money from. The government only gets it from taxes (or else creates more inflation by just printing the money).

  5. MM says:

    “Part of the answer to that question appears to be the sentiment that some people get medical care for free, so therefore I should get medical care for free. No one walks into the supermarket and walks out without paying for their groceries, so the general public does not expect that they should be able to do the same.”

    I disageree with your analysis but I agree with Briget (see above).
    The supermarket, by law, is obligated to post its prices. I choose to buy or not. A lawyer will tell me the price of his retainer, hourly fees etc. Again, I choose to go forward or not.

    When I am sick and in the hospital, I am given tests and procedures:
    a/ nobody tells me about ahead of time
    b/ nobody tells me how much it is going to cost
    c/ I have no choice in the matter
    Consequently, we find ourselves waiting in great anticipatation for all those hospital, doctor, lab bills, having absolutely no clue how much the grand total is going to be.

    There has been many instances where my PCP has told me to have tests done and I have politely nodded and never had them done because I find those are unecessary expenses. Luckily, he does not seem to remember from one time to another what he tells me and I take full advantage of that. :-)

    I understand that sometimes, there is no alternative if we want to be cured/treated, and it is the doctor’s call, and this is the point: it is the doctor’s call and most the time I am not even sure he knows how much what he orders is going to cost his patient.

  6. MM says:

    Sorry about the above typos! This is what happens when I speak to fast :-D

  7. MM says:

    Aaaargh… TOO fast. See?

  8. Paul says:

    HASHMD – Canadians do NOT wait for emergency procedures, tests, etc. but Americans of course want everything done NOW.

    MM – are you a doc? Or a well-trained health care worker? If so, good for you for not getting tests you feel are not needed. If not, well …. glad you feel that way.

    MY surgery in May was billed at $62,000+. Insurance payed $11,000+ – full payment. I owed nothing. Had I NOT had insurance I would be selling my house.

    This system is ridiculous. It is based on for-profit insurance, hospitals, etc. Insurance co. alone draw off $100,000,000,000 that does NOT go for health care.

    We need a single payer system that covers everyone. Like Canada. Yeah, learn to wait for the MRI of your knee sprain (which you probably do not need anyway).

    I don’t care if the rich can buy MORE care. That is their privilege.

    But this great country needs to provide for its PEOPLE and quit taking care of the rest of the world.

    And, yes. I’m a doc, for 35 years. I SAW what not-for=profit insurance and hospitals provided. the present system, dependent on MBAs, coding for profit, and cow-towing to Wall Street, disgusts me.

  9. MM says:


    I have no connection to the medical field – except for two dear friends from college, one PCP and one general surgeon.
    What I have is common sense and at the risk of being booed, I don’t take what my doctor tells me for gospel truth. I used to question some of his requests for numerous additional tests, but that seemed to upset him, so as I mentioned earlier, now I still resist, but quietly. ;-)

    Some doctors would argue that the abundance of tests is a necessary CYA procedure and I believe it.
    However, I am not the sueing type, so I do not feel I have to follow these guidelines and the savings are good. :-)

  10. Nurse K says:

    I see homeless people, middle class people, rich people, famous people, important people, people with no friends, people who give millions to the hospital—guess what ALL these kinds of people have in common?

    At some point they’re all going to get sick or have an accident. So, come on people, you have to do something. At least buy a catastrophic policy so your finances aren’t ruined because something that you KNOW is going to happen sometime actually DID happen. All this let’s tax everyone until they scream to provide health insurance is a joke. Get a job. Buy a policy when you’re young ‘n healthy or, if you have a chronic illness like I do, find a job where you know they don’t exclude you from the company plan due to a pre-existing condition (I knew that I could never be self-employed, for instance). Stop eating so much crap. Stop smoking.

    There are health care reforms that need to be done to make these policies more affordable, but don’t sit around waiting for that to happen.

  11. Don Salva says:

    For me as non-american (I live in germany, but am from poland) it’s kinda hard to wrap my mind around the state of things concerning medical care in USA.

    I don’t know the US medical care system well enough to form a well thought opinion. So forgive me if I’m wrong along the lines somewhere.

    Let me put Germany in prespective. In germany there’s mandatory public medical insurance and there’s the private medical insurance.

    No one in Germany is uninsured, it’s against the law, unless said somebody specifically choose so for whatever reason. So if there’s one person out there, having an accident then being taken to the hospital, if the hospital sees the person has no medical insurance, they still are, by law, required to care. The bill will go to the public medical insurance, which in turn has to take the uninsured person in.

    They can not deny him in any way.

    The poor are in the public medical insurance, while the middle class and upper class usually chooses privat insurance.

    The public insurance has a “catalogue” (which again is being regulated by the federal government) in which the basic health care is covered. Extras has to be paid, BUT up until a reasonable sum the insured person CAN pay and WON’T slip into poverty.

    This of course has many downsides one of which is raising taxes, raising costs and of course 2-class-medicine. (the rich get better care with their private insurance, while the poor have to do with basics and some extras).

    It’s an old system: The rich pay for the poor. Solidarity. And it’s regulated by laws.

    This is, in my eyes, what America misses. America IS the most liberal country. Freedom above anything else. That’s the set mentality, with this mentality many things are being done in USA be it medical care, be it economy, or whatever else.

    What America needs to do is a reevaluation of the set mentality of Liberalism. They need to ask themselves if the current system of Liberalism is working at all.

    By no means I am being to be rude but just trying to express my thoughts. Excuse my bad English.

  12. JC says:

    I am not making a political statement about Mrs Obama or this article in general: http://www.suntimes.com/news/politics/obama/1122691,CST-NWS-hosp23.article. I would draw your attention to her salary of $317,000 at UIC Medical Center as VP. Could someone tell me how her salary as well as the myriad of other VPs should be $317,000? How many VPs at this pay scale are needed to deliver quality care? Something tells me not many. This bloated “middle” of healthcare between the providers and the patients also contribute to the need for hospitals to charge $129 for a box of Kleenex.

  13. mottsapplesauce says:

    Same thing goes for the private insurance industry’s bigwigs. Only difference is they’re the ones who are looking to save money by not paying (or delay payment) on medical claims–many times flat out refusing to authorize treatment, regarless of medical necessity.

  14. samwrites2 says:

    Thanks for the rant and link love.
    A lot of your readers stopped by my blog and I feel like more detail is needed to clarify and add to your entry.
    1: I did not want to stay in the hospital – it was a “Behavioral Health Unit” where the emergency room doctor and nurses put me when I said I was having suicidal thoughts – and ONLY thoughts.
    Despite my voluntary commitment and belief I could leave when I wanted they wouldn’t let me leave the second day when I realized the costs I was racking up. The doctor told me SHE would decide when I can leave when she deems I’m no longer a danger to myself or others. I found myself acting a part and doing everything I could to be a model patient and get the hell out of there ASAP instead of really concerned about my health.
    Really, when you work three months in a row, 12-hour days every day at a factory lifting 15-pound to 30-pound bundles, live in a motel and eat mainly ramen and tuna (plus the free coffee and continental breakfasts) you might get a bit depressed. I thought at most I’d be in the hospital a few days, get my diet and rest straightened out, get a presciption for anti-depressants and be discharged.
    2: After my 16-day stay I tried to negotiate with the hospital several times based on my budget. I made it clear I was willing to pay $60 a month THE REST OF MY LIFE if need be to clear the debt. They insisted on at least $300 a month when my take-home pay at the new job I’d obtained (ironically part of the job duties involves counseling employees about their health insurance benefits) came to $1,200 a month. I do live in the Metro D.C. area so figure in a high cost of living when asking why a hospital wants 1/4 of my monthly income.
    3: I went to court and told the judge and hospital’s financial officer I wanted to pay the hospital back – but please stop taking so much of my pay. The hospital said when the current garnishment ended they would work with me. When it did, I called several times to try and negotiate a payment but could not even get the hospital to acknowledge my correct address. Finally, a representative told me based on my record they plan to continue to garnish my pay.
    So that led to my bankruptcy after two years of negotiating with this hospital and four years of negotiating with an insurance company over prior claims stemming from chest pains and treatment at another hospital. The insurance company said my treatment and exams should have been pre-approved.
    Regardless, I guarantee you that my family and I will always have health insurance and pay for it before paying anything else out of our budget – even if I lose my job. I’d quickly enroll in college somewhere and sign up for health insurance there rather than go through what I and countless others are going through judging from civil court dockets.
    Or move to Great Britain.

  15. pax says:

    [quote]MY surgery in May was billed at $62,000+. Insurance payed $11,000+ – full payment. I owed nothing. Had I NOT had insurance I would be selling my house.[/quote]

    That’s unconscionable. The rate for one should be exactly the same as the rate for the other, since the services are the same. If the insurance company can get an 80% discount off the “real” price — it’s not the real price. It’s just a shell game.

    It is no wonder at all that nobody wants to pay for health care when the allegedly “real” charges are such a blatant and stupid lie. It’s just thievery, pure and simple, just as much as if you were tricking people into joining a poker game run by a card shark with a rigged deck.

    If you folks are really concerned about the medical care crisis, you — each of you, as individuals — need to quit lying to us about what our health care “really” costs you to provide. If the surgery really costs $30,000 to get the patient on and off the table (once your salary, overhead and profits have been covered), that’s the actual cost of the surgery and that’s what the charge should be. Sucks for the uninsured patient who has to go into bankruptcy to pay it, but them’s the breaks.

    But if their insurance company won’t pay what it actually costs you to provide care, then don’t expect your patients who cannot afford insurance in the first place to pay the extra.

    Why should people who cannot purchase insurance be paying the health care costs of people who CAN afford insurance??

    Answer: they shouldn’t.

    Why should the insurance company be paying the health care costs of the uninsured?

    Answer: they shouldn’t.

    Charge each procedure what it actually costs, and bill the patient directly with a clear statement of your actual flat fee. Let the patients duke it out with their own insurance providers.

  16. EEJ says:

    My younger sister is 24 and almost declared bankruptcy over medical debt. She had to have a heart procedure done that included flying her to another state, and the employer she had health insurance through wasn’t paying the premiums to the insurer (they were keeping them). That company has now gone under and the owner has been indicted, but the hospitals surely didn’t care much about all of that.

    Luckily for her, she is a fighter, and would probably make a damned fine lawyer if she went to law school, and she was able to convince the hospitals, doctors and ambulance company (along with everyone else) to settle for pennies on the dollar.

    I think she essentially told them she could pay 5% of what they were asking, or she would declare bankruptcy and they could sue her to try and get the money back.

    The hospital from another state initially told her that they couldn’t clear her debt because she wasn’t from that state, and they wouldn’t be able to bill the state for her care….

  17. Stacy says:

    This is my first time visiting your blog. (Thanks to http://chrysalisangel1.blogspot.com/)

    The comments are great and allow everyone to look at the situation from many angles.

    I have another one though..

    What about the parents of a child born extremely premature? Not only will you have the hospital bill but you may also have on-going medical care for the rest of their lives? What if both parents can’t work because there is no one to take care of the special needs child? Can one person really work enough hours to cover all of the bills?

    What if said bills are higher than they would be if they were billed from another department? For example… nursing care is billed at a lower rate in the ICU than it is in the NICU? Is that fair? Should one department be allowed to charge higher even though the same skilled staff is used? Should one department be able to charge higher rates so the revenue will cover less lucrative departments?

    What is a person to do? Deny care to their child? Let their child suffer?

    Choose not to resuscitate because the parents will not be able to afford the care?

    States have SCHIP programs to help pay for care of children with costly medical problems.

  18. marcia (2) says:

    I find this topic extremely frustrating, especially the comments from people who think those of us who can’t pay the entire bill have a sense of “entitlement” about medical access. Guess what? I DO believe people should be ENTITLED to needed medical procedures despite their ability to pay.

    This year, my DH learned he had kidney stones in both kidneys that were too large to pass. One was embedded in his ureter, and required two separate laser cystoscopy treatments (at the doctor-owned boutique hospital we didn’t realize was more expensive than the nearby non-profit because his urologist didn’t offer a choice). The second stone was partially broken up by ESWL (at a cost of $6,000+ for a 45-minute procedure, for use of the equipment, only). The entire process cost well over $60,000, all outpatient, and included separate bills for the use of the hospital, the ESWL unit, the anesthesiologist, the urologist, the multiple rounds of x-rays, and yada yada yada.

    Fortunately, we have decent insurance that covered a large portion of the cost, but we are still left with thousands of dollars to pay out of pocket–money we would have had a few years ago before our business went under during the last recession. Now we’re struggling to make the bills each month with very little left over, lousy credit, and a tax lien on our (modest) house. Bankruptcy is out of the question; how are we supposed to pay?

    If all the services could be consolidated into one bill, most likely we could set up a monthly installment plan. But the costs are spread over many providers, each wanting a monthly payment, totaling hundreds of dollars. If we complied with this plan, we wouldn’t be able to pay basic living expenses (and I do mean basic).

    Should I mention that we don’t qualify for any form of government assistance?

    What to do? I feel guilty not reimbursing his providers 100%, so much so that when I broke my hand in June, I elected to forgo treatment so as not to “shaft” anyone else. No bones were sticking out; I survived.

    So please, when you go talking about “entitlement,” consider what insurance companies and the economy have done to the middle class. Consider that many medical problems can be life-threatening, and not all treatment is “elective.”

    Sorry this post is so disjointed, but it’s hard to think and cry at the same time.

    You should be commended for doing the right thing.
    Read some advice at this previous post. Hopefully it will help you in your troubles.
    People without insurance *are* getting “shafted,” but the answer isn’t creating an entitlement that makes others into indentured servants. It isn’t fair that you force me to care for anyone regardless of whether they pay me any more than it is fair for me to force you to perform services for my benefit without payment. I don’t know all the answers, but I do know that something must change to help people in your situation.

  19. mottsapplesauce says:

    Marcia, your situation is exactly what healthcare reform needs to focus on. IMO, people such as yourselves shouldn’t have to choose between healthcare coverage & putting food on the table,
    keeping a roof over your heads, etc., because you’re doing the right thing.

  20. Kristie says:

    “States have SCHIP programs to help pay for care of children with costly medical problems.”

    As the self employed parent of a premature child, I find this statement pretty much infuriating. SCHIP is a bureaucratic nightmare, and in our state, it has stopped allowing new enrollment for months at a time at least twice since my oldest child was born (she’s 5).

    When our preemie was born, I was actually a medical student at the hospital where she was born. That student health insurance I was required to carry by the school covered less than $200/day of her NICU stay. Thankfully, we were able to get secondary coverage through Medicaid that covered her NICU bills and her care throughout her first year. Unfortunately, at the end of that year, we were left with a child who had seen so many docs she was uninsurable through private health insurance, and we could no longer get coverage under state programs. I was also left without a job, while carrying a couple hundred thousand dollars in student loan debt from medical school.

    Now, our preemie was born at 31 weeks and just shy of 4 pounds, breathing on her own. Thus, there were no decisions to be made about resuscitation. Still, she suffered many costly complications which could have killed her without treatment, including more than one nosocomial infection. She spent a week on a vent and has BPD as a result. She needed physical therapy to avoid surgery. She needed home oxygen and a pulse ox to avoid prolonged and repeated hospitalizations. These things weren’t optional, and they weren’t cheap either. If we would have refused many of her treatments, we probably would have been hauled to court for child endangerment/medical neglect. Somebody has to pay for these services, but what American family can?

    I’m not saying that SCHIP is an easy or stress-free process, but it is an alternative to look into before you pay everything out of pocket. Usually the financial counselors at hospitals will help navigate the enrollment.
    Another possibility if you can afford insurance is to enroll in a group plan.
    Or negotiate with the hospital
    Or call religious institutions and ask about requirements for charity care
    None of this is easy, but what is the alternative?
    You can go on eBay and get a pulse ox for $100. Cheap? No. But once you purchase it, you never have to “rent” one from a medical supply shop again.
    You’re a physician. What would you do if most of your patients didn’t pay for their care while you still have to make loan/mortgage/car payments?

  21. TwinsX2 says:

    And HIPAA doesn’t apply to fee for service Medicaid. So, it’s not truely portable. When I got a job, for a while, that had health insurance, Medicaid (was actually SCHIP) dropped the kids. We had fee for service (or straight) Medicaid. I couldn’t enroll the kids in my employer’s plan because it wasn’t open enrollment time. I couldn’t get special enrollment because we didn’t qualify under HIPAA due to the “straight” Medicaid.

    Thankfully, we were only without insurance for one month. So, we couldn’t get tagged for DS4′s renal failure as a pre-existing condition. And at least Medicaid in all shapes and forms does qualify as continuous coverage.

    DS4 did get RSV that month (it was January). I didn’t dare take him to the doctor because I was afraid she’d want to admit him. So, we took shifts and his dad and I nursed him through it.

  22. stacy says:

    Dear WhiteCoatRants,

    I didn’t want to start a debate here and cloud your comments section. I truly do want your readers to see both sides though. I have written a blog post on the subject. I urge all to come look at the other side.

    I completely agree that people should not assume that they do not have to pay docs, but what is a person to do when their child requires countless medical intervention? Charity organizations pay sometimes but it is usually a one time deal. Yes, some hospitals do work with the parents but what happens when you have so much medical debt that there is no recovery from it?

    Not all parents are out to beat the system. We are simply trying to survive.



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