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I had one hell of a ride yesterday. I fell ill very suddenly during lunch (I already had a bit of a cold) and took a cab to go see my doctor. Downtown San Francisco, so it just made the most sense. By the time I got to my doctor I was having trouble breathing. That's when things get all too normal...

I'm on an HMO, through work. Having had health issues before, I have a good feel for what things cost.

At the doctors office, once they saw me everyone put on masks immediately, including me. The doctor checked my breathing and said "you need to go to the hospital. We're calling for an ambulance."

And here was my moment of panic. An ambulance ride is $100 on my health plan, within city limits. The hospital is 30 blocks away. I told the doctor, "call me a cab."

The doctor accused me of not taking this seriously, and the staff were talking about H1N1. "You need quick medical attention, and more than we can provide here," she said.

I replied, "I know, but a cab costs $10. An ambulance costs $100."

I wound up going by ambulance. The paramedics thought I had had a heart attack (I hadn't - but I'm a large man so I understand the thinking). Turns out that I only had the flu after all (not H1N1 but serious enough thank you - this thing does kill). A few hours in the hospital and a couple of IVs later and I was sent home. I'm laid up for a few days, but that beats the alternative.

The sad part is that I was obviously sick. Trouble breathing is a major clue, and I knew it. But the only thing I could think of was the cost differential between $10 and $100. Hell, I can afford the $100 - which I'm now on the hook for.

But this shouldn't be what a sick person, especially one who's doctor tells him to his face "you're in critical condition" should have to think about.

I'm going to be fine. I was damned lucky. It was also so ordinary in today's world. There have been stories posted here on kos so much more heartbreaking than mine that I barely register on the sympathy meter - and that's how it should be. But how many people do you think died yesterday going through exactly the same thing I did - worrying about the cost? One would be too many and I'm certain the number was higher.

I've said it before and I'll say it again - there is no reason whatsoever for the health insurance industry to exist. Yesterday it nearly delayed me going to the hospital. And I'd bet yesterday it killed someone.

UPDATE: By the way, that pol below should read "Should the health care insurance industry even exist?" Give me a break - I've been sick ^_^

Originally posted to Animeraider on Fri Oct 16, 2009 at 11:02 AM PDT.


Should the health care industry even exist?

8%8 votes
59%58 votes
31%31 votes

| 97 votes | Vote | Results

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Comment Preferences

    •  Understand your concern (9+ / 0-)

      My father is a diabetic (has been since he was a teenager).  I was out visiting (don't see him often enough) and walked into the living room and he was convulsing in his recliner.

      I called 911 and the EMTs showed up and gave him glucose.  The glucose made him coherent and he refused the ride in the ambulance to the hospital.

      In this case, I was there to take him to his primary care physician, but normally, he would have had to take the light rail and walk several blocks.

      Again, not a situation where he should have to be making a choice.

      The election of Barack Obama as President of the United States puts an exclamation point on Democracy!

      by SnowItch on Fri Oct 16, 2009 at 11:31:17 AM PDT

      [ Parent ]

    •  Glad you're feeling better! (3+ / 0-)
      Recommended by:
      Angie in WA State, cfk, greylox

      Ambulance service around these parts....$850 first 5 miles....$55/mile or portion of!  Unless you know the owner and it's $125?

      Amazing the Time I waste Here! Sometimes it's not wasted though!

      by raster44 on Fri Oct 16, 2009 at 12:10:48 PM PDT

      [ Parent ]

      •  **That's our case too. (1+ / 0-)
        Recommended by:
        Flaming Liberal for Jesus

        The hospital is only two miles away, but we were billed $800.  No insurance.  Still paying.  That's JUST the ambulance ride.

        **I'm calmer now, and a little bit hopey.

        by greylox on Fri Oct 16, 2009 at 12:40:49 PM PDT

        [ Parent ]

      •  A caveat: (0+ / 0-)

        the 'unless you know the owner' is not legal.

        There are subscription programs where citizens of a community can 'subscribe; to a program that allows the ambulance service to accept the insurance payment for medically necessary trips, and write off the remainder.

        Medicare law requires that ambulance services charge all patients the same (consistent for services rendered), regardless of 'who knows who'.

        In honor of the Obama Administration's actions on GLBT issues during Pride month, Pride 2009 is proclaimed "Back of the Bus Pride Month".!

        by emsprater on Fri Oct 16, 2009 at 12:43:00 PM PDT

        [ Parent ]

  •  Central IN Emergery Rooms are telling HINI people (10+ / 0-)

    to stay home so as not to infect other Hospital patients.  What kind of system is that?

  •  I guess I lucked out back in January... (9+ / 0-)

    ...I had a bleeding diverticulum in my large intestine, and I had Calamity Jean drive me to the hospital. Our two insurance plans are still dickering over paying for that little adventure!

    Float like a manhole cover, sting like a sash weight! Clean Coal Is A Clinker!

    by JeffW on Fri Oct 16, 2009 at 11:12:53 AM PDT

  •  Did you know hospitals CONTRACT w/ taxis? (21+ / 0-)

    I'll tell you a very ugly little story that is completely true. Right here in the Bay Area, there are a number of hospitals Kaisercough* and even some local hospitals that contract their services with taxi companies.

    Now this is supposed to be for discharge only, but is sometimes abused for inter-hospital transport, blood drops, and very occasionally, to take indigent people off of the property.

    The blood drops are problematic because the blood isn't refrigerated and sometimes does spoil. Also, cabbies aren't always very careful with it.

    Obviously ER orders to drop psychiatric releases at local gas stations or 7-11 are also a problem. But they definitely happen.

    But far more troublesome is taking someone from, say Terra Linda to Santa Rosa Kaiser, obviously insured through Kaiser, in a taxi cab, with...

    their eye glue to their finger. Or, having a miscarriage! That's a popular one for Kaiser. Or, with their leg shoved in a giant hefty bag taped around the uncontrolled bleeding from their leg. Or a minor drug overdose. Or... let me try to remember now, because it's been a while... bad prednisone reaction where the client is virtually on the ceiling. Bar fight wounds. Methadone withdrawals. Unmedicated psychiatric cases. Anything that isn't technically classified as an "emergency" but probably is, from one ER to another.

    It actually warrants exposure.

    I've never talked about it much.

    Horrible that you went through that yesterday... very sorry.

    "Heidegger? But I didn't even know her!"

    by mahakali overdrive on Fri Oct 16, 2009 at 11:13:48 AM PDT

    •  I forgot to mention there's a code: rant (12+ / 0-)

      that a taxi service uses for the hospitals they're contracted with. So this isn't like some totally untraceable phenomenon. It might be on the end of hospitals, BUT, in order for a cab driver to be reimbursed for the drive, they have to turn their IOU slips in to the parent company at the end of the week.

      It gets deducted first off of their overall rental fee, and if it surpasses that, translates into profit.

      Some of the slips are probably shredded, mind you, because no cab company on earth reveals its actual profits, and these IOU slips are a great way to delete the paper trail.

      But the actual codes are on every taxi dispatch wall, and most cab drivers will have slip receipts with the codes throughout the week.

      You could audit the slips from a taxi service and still see the post-profit slips as well. There aren't a lot of these, but from time to time, someone will make out lucky over a week.

      Shady, isn't it?

      Cab drivers are... not properly trained in medical care or anything.

      "Heidegger? But I didn't even know her!"

      by mahakali overdrive on Fri Oct 16, 2009 at 11:22:06 AM PDT

      [ Parent ]

    •  That happened to me on a business trip to SF (6+ / 0-)

      a few months ago. I became ill while in San Francisco on business a few months ago. The Hotel staff called an ambulance (if you ever want to have fun, get wheeled through the lobby of a hotel on a stretcher at about 1:00 in the morning with your colleagues are drifting in from their night of drinking).

      I do not know anyone in SF and so Kaiser offered to send me back to my hotel afterward in a taxi with a voucher. The cab driver became angry with me for not telling him when I got it that I had the voucher. Silly me, I was still worrying over the fact that I had nearly stopped breathing in the middle of the night in an unfamiliar city.

      I received a bill about 2 months ago for over $900 for the ambulance ride since the doctors and ambulance were outside of my normal coverage.

      There is an endless demand for people to speak, There is a limited supply of intelligent things to say--Jon Meacham

      by smartdemmg on Fri Oct 16, 2009 at 12:06:56 PM PDT

      [ Parent ]

      •  Kaiser billed my 8-year old son (5+ / 0-)

        for being in a car wreck with an unconscious driver, 13K for ambulance transport to a non-Kaiser hospital. I feel you on the bill. That's shameful and well, so are they.

        Yes, those vouchers. They get completely exploited. Obviously they aren't just used for outbound transport. They get used for all sorts of bizarre things that Kaiser and other hospitals want, although Kaiser is the worst offender I've seen.

        I wonder if Kaiser patients and the general public know about this?

        I wonder if this is area-specific or does this happen in other parts of the country as well?

        Please don't be upset with your cab driver. I guarantee they had no idea what to do, and the way the cab industry works... it's so exploitive of labor, it's unreal. There are some perks, for sure, but overall, most drivers just get screwed all the time and constantly endanger their lives to do it. The procedure is poorly laid out by the companies and you sometimes wind up owing money to work. It's complex.

        Point being that I'm suddenly wondering if this is common or uncommon?

        We had no mental health facility here, so ALL psych releases from ER's were "stabilized" and then... released. We have few homeless shelters, so in the winter, all releases went to the street corners.

        "Heidegger? But I didn't even know her!"

        by mahakali overdrive on Fri Oct 16, 2009 at 12:20:06 PM PDT

        [ Parent ]

  •  Health care , yes. Healthcare insurance, no. (9+ / 0-)

    Perhaps you could fix your poll heading and add clarify.

    I have faced the situation you are talking about several times.  I took a cab. I will not call 911 for an ambulance unless it is truly a life or death situation needing equipment an ambulence would have.

    I hope you made the doctors who were giving you a bad time aware of your concerns.  You can always release them by signing some kind of 'against medical advice' paper when you feel you are better off and not putting your self in jeopardy.

    For you it was $100, but for someone without coverage, the city would charge about $600.

    •  Just going to post this, so I'll rec you instead. (2+ / 0-)
      Recommended by:
      FarWestGirl, noe44

      You said you don't think the Health Insurance Industry has no reason to exist - a p.o.v. that many here on Kos have reiterated many times.  However, your poll asks "should the health care industry even exist", which is different.  I have to vote that I want the Health CARE industry to exist, so my doctor can still treat me and new drugs can be found, etc.

      The error probably came from your illness.

      Don't know if you can change a poll question, however.

    •  I didn't rec or tip this yet (4+ / 0-)

      Because of the wording of the poll.

      The health care industry certainly should exist. The healh insurance industry? Not so much as it is at present - it needs major modifications.

      "Ridicule may lawfully be employed where reason has no hope of success."

      by QuestionAuthority on Fri Oct 16, 2009 at 11:50:20 AM PDT

      [ Parent ]

    •  Polls cannot be edited. n/t (0+ / 0-)

      Float like a manhole cover, sting like a sash weight! Clean Coal Is A Clinker!

      by JeffW on Fri Oct 16, 2009 at 02:16:15 PM PDT

      [ Parent ]

  •  Shouldn't the poll ask if the Health Insurance (4+ / 0-)

    Industry should exist? I'd answer No to that. We don't have a Food Prepay Industry. You don't have to make monthly payments to a faceless monolithic industry to qualify to see the grocer. They don't appear to be afraid that we'll walk around the store for hours for no apparent reason so much so that they have to levy a surcharge to keep the riff raff out of Ghastlymart or Inorganic Solids and Chemical Waste Superstore. "I see you skipped lunch last thursday, that qualifies your hunger as a pre-existing condition, you won't be able to purchase food for the rest of your life. Maybe you could beg?"

  •  Not to be a jerk, but (3+ / 0-)
    Recommended by:
    borkitekt, Nespolo, FarWestGirl

    I think your poll should say "should the health care insurance indusry exist"

  •  Try $29,000 plus another $1,000 (11+ / 0-)

    Coming up on a three year anniversary I went to an ER in Chinle, Az to see about what turned out to be gastro-enteritus (a lot of vomiting and diarhea) which was on top of Diabetes, that at the time I didn't know about.

    They wanted me to go to a hospital for testing, for about a day or so.  The closest hospitals were about 150 miles away by air in any direction.  So they shipped me off.

    When I got the bill later, I was sticker shocked.  The ambulance ride, about a 3 mile ride was billed at over $1,000 (each way!)  THe air ambulance, over the desert at night, 150 miles was billed at $28,620.  

    I called everyone I could think of who could answer questions about what the charges were made of.  There was only a blank wall of black granite with no access.  Certainly no transparency.

    Arizona, like most states has a board somewhere that assesses what a reasonable rate it.  The people involved are vested interests.  They might as well be helping themselves to an assessment about a fair and reasonable ransom.

    $1,000 for an ambulance trip is not uncommon, even for a short trip down the block.  That seems to be regarded as a minimum standard.  

    Air ambulances generally advertise somewhat lower rates.  However, I heard from a woman in California who got charged about $28,000 for a very short run in a helicopter.  

    I think everyone ought to know what is going on with these little known vendors.  

    Also, you would think that insurance companies have an interest in keeping the costs down.  Not so.  Apparently, there is an interest in the excess profit somewhere in the system.  This is why the issue of cost control is pernicious.
    Costs rise and people accept it when the insurance company is willing to pay.

    After I raised the issue, the insurance company in this case negotiated the air ambulance fee down - to only $20,000.  

    I found out that, by contrast, the Bureau of Indian Affairs will only pay $1200 or so for the same 150 mile trip that I got charged $29,000 for.  I'd really like to see the actual financial model behind this.

    It makes me very skeptical of anything the insurance industry says, and a bit apprehensive about the likely success of any Congressional plan, by any name to actually force cost control on this system.  

    hope that the idiots who have no constructive and creative solutions but only look to tear down will not win the day.

    by Stuart Heady on Fri Oct 16, 2009 at 11:34:01 AM PDT

  •  Should the industry exist? Yes. However, ... (4+ / 0-)

    the health INSURANCE industry is another matter entirely.

    Single payer is the answer.


    I do not belong to an organized political party -- I'm a Democrat. [Will Rogers]

    by Ed Drone on Fri Oct 16, 2009 at 11:59:46 AM PDT

  •  Poll comment (0+ / 0-)

    Most of us are vigorously supporting a public option where all Americans can have health care.  Why? Because we recognize that health insurance spreads the risk so all of us can have a chance if illness or tragedy hits our home. So to posit the question as health care industry (which would not only include the insurance company, but the doctor and the hospital etc) as evil would suggest that you believe we would not only be better without insurance, clearly untrue, and better without doctors, nurses, hospitals etc (double untrue). While this criticism is likely partly semantic and you don't really mean to suggest that the health care industry shouldn't exist, but perhaps exist without modification, I think the question is over the top and inflammatory.

  •  $100.00 is nothing. (3+ / 0-)
    Recommended by:
    Angie in WA State, mataliandy, JeffW

    A family member recently had occasion to need an ambulance.  It cost $1500.00 to take him to a hospital that couldn't treat him and another $1000.00 to transport him to the hospital that could.  That was with health insurance.  Oh, and he also had a $500.00 charge at each facility for the ER visit.

    The religious fanatics didn't buy the republican party because it was virtuous, they bought it because it was for sale

    by nupstateny on Fri Oct 16, 2009 at 12:12:32 PM PDT

    •  Except in some very ... (2+ / 0-)
      Recommended by:
      Fabian, JeffW

      well controlled situations, most ambulance services are either required by local protocols to take the patient to either the closest ER or to the ER of the patient or patient's family request.  Stroke Centers, Heart Attack Centers, Trauma Centers and OB/GYN services are often spelled out in local protocols, but not in every part of the country yet.

      Often, Medics will do their very best to help a patient or a patient's family understand why one hospital would be more appropriate than another, but without success.

      If a Medic advises you that you might be transferred from the hopsital where you insist on going, don't blame them.  Also, some localities prohibit medics from making such a suggestion.  It's not their decision.  Best advice; learn the services offered in your area so you will have knowledge beforehand to make the best decision.

      In honor of the Obama Administration's actions on GLBT issues during Pride month, Pride 2009 is proclaimed "Back of the Bus Pride Month".!

      by emsprater on Fri Oct 16, 2009 at 01:24:11 PM PDT

      [ Parent ]

      •  Definitely. (1+ / 0-)
        Recommended by:

        If you have a choice, know what those choices are.  I traveled to TX when I was in my third trimester.  Before I went, I looked up the best Neonatal ICU in the city - just in case.  If anything happened, that's the place I wanted to be taken.

        I had worked in a children's hospital and we'd get newborns transferred to us all the time.  We had the specialized facilities, other hospitals didn't.

        Proud member of the Cult of Issues and Substance!

        by Fabian on Fri Oct 16, 2009 at 02:06:55 PM PDT

        [ Parent ]

      •  No, no. That wasn't a complaint. (1+ / 0-)
        Recommended by:

        They took him to the closest hospital according to protocol.  They quickly determined that he had a ruptured cerebral aneurysm and that they couldn't treat him.  

        They did what they were supposed to do, but my point was the cost to him even with health insurance is staggering.  

        The religious fanatics didn't buy the republican party because it was virtuous, they bought it because it was for sale

        by nupstateny on Fri Oct 16, 2009 at 04:05:21 PM PDT

        [ Parent ]

  •  as a former Luxor cab driver, (3+ / 0-)

    I wouldn't want sick and dying and contagious people in my cab.  It's a hard enough freaking job.

    Hey, I'm depraved on account of I'm deprived! Dear Officer Krupke..

    by bryker on Fri Oct 16, 2009 at 12:18:47 PM PDT

    •  Were you unionized? (0+ / 0-)

      And also, Luxor is in SF, right? Were you also contracted with hospitals for patient service?

      "Heidegger? But I didn't even know her!"

      by mahakali overdrive on Fri Oct 16, 2009 at 12:24:11 PM PDT

      [ Parent ]

      •  cab drivers are independent, you rent the cab (1+ / 0-)
        Recommended by:
        mahakali overdrive

        called a gate fee, pay gas, anything else is yours. Vouchers, as I remember were the same as cash to the cabbie, you just cashed them in at the end of your shift, the company dealt with it after.  Some people would write in a pretty good fare on those vouchers, those who knew.  this was about ten years ago, so some things might have changed, but I really doubt it.  I know there was something to do with medallion ownership/transfer that came up, but I don't think that would change the basic operation.  Yes Luxor is SF, has the best radio too, I think.

        Hey, I'm depraved on account of I'm deprived! Dear Officer Krupke..

        by bryker on Fri Oct 16, 2009 at 01:00:42 PM PDT

        [ Parent ]

        •  I know, I was one too (2+ / 0-)
          Recommended by:
          Fabian, bryker

          3 1/2 years :)

          I was about as long ago myself. A few counties north of you. Some of the big companies in NY are unionized. I asked because there wasn't a fare I'd have turned down on a slow day, which is probably why I got so many strange ones (and I was on graveyards, sometimes the only one).

          I'm trying to figure out if this is just Kaiser, or around the country, because while yes, we made out well (I know how to tip myself kindly and blame everything from traffic to "they said the other Kaiser"), it's totally and completely screwed up for an hmo to do this!

          I had a 92-year old woman, outbound from an ER, in a wheel chair, told I was going to assisted living. It wasn't. It was a private residence. She fell out and split her skull open! I mean, I'm not liable for that, no way. I did my best to break her fall, but that's the hospital's fault.

          You know exactly how sketchy it is on this one.

          But turn down a call? For sickies? I never did that. I needed the cash far too badly (or wouldn't have taken that job: I'm female).

          "Heidegger? But I didn't even know her!"

          by mahakali overdrive on Fri Oct 16, 2009 at 01:10:09 PM PDT

          [ Parent ]

          •  I never turned down a call (2+ / 0-)
            Recommended by:
            Fabian, mahakali overdrive

            I just was hearing a lot of talk and nobody seemed to be thinking about the driver.  You know how it is.  Your point is exactly right about the woman who got hurt. Although I have empathy. Same goes for the drunks ;)  

            Hey, I'm depraved on account of I'm deprived! Dear Officer Krupke..

            by bryker on Fri Oct 16, 2009 at 01:20:07 PM PDT

            [ Parent ]

  •  A decision that I am faced with often. (2+ / 0-)
    Recommended by:
    Fabian, emsprater

    I am my mother's caretaker. She has MS. She is bedridden and basically a parapalegic. When it is necessary for her to go to the hospital, which has generaly been twice a year for over 5 years now, I am faced with deciding what is the best way.

    Her primary doctor plays a big role in that decision. He will not admit her to the hospital without first seeing her, even when her homecare nurse insists that she needs to go. He will not make housecalls, eventhough he lives very close to our house and could stop on his way home.

    So my first choice is - do I take her to his office so he can see her and then admit her or do I just take her to the hospital.

    If I take her to the doctor's office, I have to decide whether to put her in her wheelchair and load her into our small and uncomfortable wheelchair accessible van or do I call the county senior citizen large van service which generally requires 48 hour advanced notice, but because the director of the program is a family friend, I sometimes am able to get the rules broken and they will pick up my mom immediately.

    If I take her to the hospital, since the doctor will not admit her, I will have to take her to the emergency room. If I take her to the hospital in our van or the county van, she will have to wait to be triaged in the emergency room. One time last year, I waited with my mom in her wheelchair for 13 hours before she was examined by a doctor. Other times she gets in in less than an hour. If I decide to call an ambulance I know that my mom will be facing a $250 bill once she has recovered and is back home, but I also know that she will be immediatedly see a doctor.

    Decisions, Decisions ... life sure does suck sometimes.

    On a positive note ... my mother has just recovered from a cold ... at home ... for the first time ever!
    Every other cold that she has gotten in the past has resulted with her being in the hospital with pneumonia.

  •  I totally understand your concerns. (4+ / 0-)
    Recommended by:
    Fabian, Catesby, MKinTN, JeffW

    As a Paramedic who daily transports people under emergent condidtions with 20 years under my belt doing it, I can say that I see folks every day with your same concerns. They are valid.

    What I don't like, and won't accept, is the painting of the 'ambulance ride' as the same as a 'taxi ride'.  It isn't, and never should be.  If it is, then the ambulance has been summoned for the wrong reasons, or the service is not what it should be.  People all over the conutry use the ambulance service, or their local 911 service, as the be all for everything.  I once got called because a woman wanted epsom salts to soak a finger in because she had cut her finger nail into the 'quick'.  No lie.  I also respond to roll over accidents on the interstate, gunshot victims, fires, motorcycle accidents, cardiac arrests and drownings, but hey, my safety in these instances is worth ... less than $20 an hour.

    Physicians do call for ambulance transport on any patient they deem to meet medicare's guidelines as a 'emergency' because if they do not, and an unfortunate outcome occurs, then some lawyer somewhere will accuse the physician of malpractice.  Hospital ERs that are associated with smaller hospitals without the equipment or the expertise to be stroke centers or heart attack centers or trauma centers also do the same thing, as do ERs without an operating CT when it is deemed necessary, or orthopedics or pediatrics or ob/gyn in those situations.

    I am faced daily with sick folks who are more concerned about the possibility that medicare won't cover their bill, or any portion of it, same with private insurance, than they are of the possibility of a bad outcome should they not go to the ER by ambulance.  Ambulance services (good ones) and Paramedics all accross the country are more than just a 'ride', they are mobile emergency rooms providing lifesaving care to folks in dire need of it.  Often, the very difference between life and death occurs because of the actions inside the ambulance on the way to the hospital.  I won't go into it all, but it's really sad to see a very necessary service portrayed as nothing more than something out to make money.  

    Many Paramedics and EMTs are underpaid and work with much less in benefits than their other counterparts in Public Safety: Police and Firefighters are usually employees of the government entity for the jurisdiction.  Medics and EMTs are often third service employees (meaning they are contracted employees of a company (think LaidLaw,now another name, yeah the garbage folks) where they get meager wages while a middle man company makes the profit).

    I understand and feel your angst over the charges, but don't blame the physician for acting in your best interest, the abulance for having to charge for it's service or the Medics for doing their job (sounds like they worked to rule out things maybe even your Physician didn't look at).  Blame the insurance industry for not doing a better job of compensation for really necessary service when it's needed.

    One other thing, folks talk about "medicare for all"; that's well and fine, but how many already knew that the reimbursement rates for things such as ambulance service even by private insurance is directly tied to how medicare treats it?  If medicare would deem a trip not 'medically necessary', the private insurance industry follows suit using the very same guidelines.

    None of this to belittle your story, it's important. Just want to make sure that the 911 system, ambulance service in general and Paramedics all over the country don't get the 'short end' of the stick in this story.  They don't deserve it.

    In honor of the Obama Administration's actions on GLBT issues during Pride month, Pride 2009 is proclaimed "Back of the Bus Pride Month".!

    by emsprater on Fri Oct 16, 2009 at 01:14:00 PM PDT

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