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Tuesday, December 15, 2009

A million bucks a day...

will get you a congressman, and not only that, but a congressman who'll vote against healthcare reform. That's right, insurance companies are now spending that much to derail coverage for the citizenry of this country. A few, like Rep. Slaughter, condemn such obvious bribery, and refuse such lobby money. But almost everyone else has their hand out--actually they probably have both hands out (can you say Senator Lieberman?).

We could have had an expanded Medicare for people 55 (or even 45) years of age and older...except for Joe Lieberman. We could have had a public option...except for Joe Lieberman. This morning I listened to a tape of Lieberman spouting off in September (of this year!) saying how he thought expanded Medicare coverage would be a great idea. Apparently it was a great idea until some insurance companies thought it would eat into their profits. So I guess they rang Joe's doorbell or slipped a nice thick envelope under his door. Presto, change-o, Joe thinks Medicare is just too wasteful for the country.

Can you believe we almost had that joker for vice-president?

Tuesday, December 08, 2009

Tuesday's U.S. News and World Report didn't have a lot of good news for the makers of Tamiflu, that overpriced non-miracle drug that has received so much publicity in the wake of the H1N1 influenza virus.
Here's the link:

The original article about Tamiflu appeared in the British Medical Journal on Wednesday. Here is a snippet:

Based on the data available to them, the authors of the new review concluded they have "no confidence in claims that Tamiflu reduces the risk of complications of influenza in otherwise healthy adults," and said the drug should not be used in routine control of seasonal flu.

The article also notes that Tamiflu hasn't been shown to do much other than reduce the symptoms of flu by...ONE DAY.

Countries around the world have been stockpiling the drug--which by the way is none too cheap--which now appears to be less than miraculous.

Tuesday, December 01, 2009

CVS in hot water…again!

Seems good old CVS has been at it again, caught red-handed selling those rotten expired drugs to grandma and grandpa. Why those greedy little rascals! Well…
The story is a little more complicated than that. I have no great love for CVS (or Rite Aid or Walgreens or any of those boxy corner chain drugstores), and this is one of the reasons why.
Pharmacy managers have a duty to check for expired products. And I haven’t met one manager in my life (well, maybe one) who did not take their job seriously enough to check for expired medicines.
So why isn’t it being done? Let me think for a second…how many drugs are stocked in a typical pharmacy? One bay in a pharmacy can easily contain a thousand drugs and there can be four or five bays. So, understaffed (and every pharmacy I’ve ever seen has been understaffed) and filling a prescription every minute to two minutes, how can anyone expect expired products to be up to date? Well, guess what. They’re not. Not likely to be for the foreseeable future either.
All CVS and the others have to do is give pharmacists enough staff to do their jobs. Period. End of problem. But I tend to think that CVS would rather risk the penalties than have to pay employer salaries and benefits. It’s really about the bottom line; don’t let them kid you into thinking they are looking out for the public’s benefit. They’re not. Never have; never will.

Sunday, November 29, 2009

(Sung to “I Dreamed a Dream” from Les Miserable):

There was a time when men were kind
And they all forgave their debtors
And insurance was not needed
When all was done by shaking hands, not needing to be signed…
All transactions done in cash,
Town meetings civil and seated.
There was a time…then it all...was trashed.

I dreamed a drug was well-tested
And offered something new
I dreamed it was low-cost
And not just another me-too.

I dreamed the dream I had when young
When costs were paid in dollar bills;
No forms filled out, no effigies hung;
No need for insurance and other frills.

But the lobbyists come at night.
With their voices soft as moleskin.
The PACs and pol’s keep out of sight
They’ve crossed out Lipitor and Ceftin.

When I was young and unafraid,
I could read a doctor’s writing without specs.
E-scripts simply don’t meet the grade--
Is it Prilosec that’s meant or Phisohex?

I dreamed that copays were all the same
I felt as if in a wonderful trance.
I dreamed the sick could not go broke,
That health care was as it was in France.

He filled my summer with endless joy.
He saw the poor had medication.
MTM was everywhere
Even time for vaccinations.

And still I dream he’ll sign a bill.
A bill for us and congressmen.
Where we can all get our fill
Of tests and beds and pills.

I had a dream that life’s worth living.
That lick-and-stick would be a passing thing.
I’d be up above it all and counseling—
Now life has killed the dream, I dreamed.

Saturday, November 07, 2009

Time magazine (Nov.2) has a recent article of note, "You don't know him but he may be the biggest winner in health-care reform. So who loses?" In it, a particular paragraph caught my eye:

    The Federal Trade Commission (FTC), though, argued in June that giving biologics makers any period of exclusivity at all could actually stifle innovation. Biologics are so much more complex and expensive to produce than traditional drugs that the barriers to would-be "biosimilar" competitors are already high, the FTC said. Giving biologics further protection—particularly the 12 years of exclusivity that the industry wants—would merely encourage firms to tinker with what they have rather than drive them toward "new inventions to address unmet medical needs."

The authors, Karen Tumulty and Michael Scherer, are speaking to the controversy re patent exclusivity on expensive biologics, which will soon comprise a hefty share of the pharmaceutical industry's product base as well as their future profits.

The principle sentence here would be the first, that the industry would be driven to produce "me-too" biologics instead of bringing out truly innovative drugs.    What happens now in the pharmaceutical industry when a patent drug expires is that the drug maker produces a similar drug, the active metabolite for example (Nexium from Prilosec), or another drug form, controlled release say (Ambient CR from Ambien). Instead of trying to market a new, unique drug for diabetes or blood pressure, the drug companies instead follow the less expensive pathway of producing drugs that offer no significant difference in efficacy than those already on the market.

If, however, these companies could not count on the easy play of "me-too" then the economics of medicine would start to pressure those corporations into a more risky territory, giving the green light to more R & D in areas that desperately need true innovation.

The medicines that are being sampled in doctor's offices now are merely another ACE inhibitor, another beta-blocker, another sulfonylurea, another this and another that. Oh, it might last longer, sure. Big deal. It also costs a lot more, with no or little increase in effectiveness. That is one reason behind the big push to get sales reps out of physician offices. The newer agents being pushed are often just expensive alternatives that are given out free at the start but greatly increase the over-all burden to health-care as a whole down the line.

Of course, given the huge influence that the industry has on congressmen/women there is no hope for change. What a waste.

Friday, October 30, 2009

In the olden days if a Mafioso ratted on somebody he'd get thrown off a bridge or tossed off a rowboat wearing cement shoes. Nowadays nobody's ratting on nobody. And why's that? Because the new mafia has made it darn near impossible to rat anybody out, just because it's all so stinking complicated that hardly anybody knows what's really going on.

But the end game is still the same: kill any bugger that gets in your way or costs you money.

When somebody gets killed every half hour in this country you'd think it might just get noticed. Nah. First you'd have to know the links, how it all fits together. And with a body on the floor who's going to notice the dozen different things that caused it to happen in the first place? Nobody, that's who.

Here, I'll give you an example. Say Johnny Walnuts starts to notice his crew isn't taking in nearly as much as it did last year. So he ups his premiums, say. Things start to look better, but not as much as Joe, aka "Prior Auth" Lucchese, the Godfather to his cronies, expects to get from his pals. So he thinks, Maybe double the copays. Yeah, that's the ticket. Oh, and while we're at it we're going to put limits on cancer drugs. And biological. Heck, anything that costs a lot. People will assume they're still covered, but they won't be really. If they get the Big C, Joe says, then we're collecting the benefits without paying the dividends, see? Beautiful!

Everybody saw the beauty of it: big money flowing in, very little paying out. And with every little bit of small print added the complicated became even more complicated, which just meant fewer and fewer people would be able to connect the dots. The Barzini family at Aetna, the Tattaglias in Humana, the Corleones of BC/BS, and the smaller families that feed off the crumbs left them, they all began to multiply the separate plans within each family, until there was over ten thousand different "insurances" offered over the entire country. Each had the same complicated structures—which the families changed month to month without even notifying anyone! The plan worked perfectly, until some smart accountants started noticing all the money we'd been spending compared to other countries. They thought that maybe the country was getting ripped off. Of course they were right.

When it turns out that some poor schmuck's cancer isn't covered the guy can't afford the treatments. First, he goes bankrupt, then he dies. The girl waiting for the new liver never gets it approved. Sure the girl's mom takes "The Company" to trial but by then it's way too late. And the company's lawyers still get paid! Oh the plan is so perfect the old time Mafia must be weeping over their beers. They thought they had it good, knocking on the doors of a strip joint and speak easy, "asking" for insurance money just in case somebody might happen to want to burn down their joint. The real money, they learned, was in the real, actual insurance business. The new mafia is making mince meat out of the old, all the time acting like they're all hot shot businessmen. They even have their own political party, the Republicans, to try and complicate things even further, blaming government for the mess. Can you imagine! That'd be like the Gambinos blaming the FBI for all the mafia mess. The weird thing is that it's working. It's like somebody once said, killing is their business, and business is good.

Sunday, October 04, 2009

If the pharmacy industry can finally solve the riddle of how to serve a patient's need for personal consultation (now vastly underserved) while demanding more and more of the pharmacist's time, then we will enter the next stage of medication management.

As I wrote earlier, robot dispensing of medications holds great promise to free up the pharmacist to actually do what he/she is trained for: medication management (known in the biz as MTM, short for Medication Therapy Management ), inoculations, and training patients to better manage their disease states.

It is amazing that students spend six years in training for disease and medication management but when introduced to the business world none of what the newly graduated can offer is actually used.

Can pharmacists reduce the costs of health care by catching provider errors? Yes.

Can pharmacists reduce hospitalizations, and emergency room use through Medication Therapy Management, increasing adherence to medication use? Yes, again.

Could pharmacists save doctors time (and money) by being allowed to make therapeutic substitution when the insurance denies certain claims? Of course.

These are all proven. MTM is even now included within Medicare reimbursement to providers. There is really only one missing piece: Time.

No one has the time to actually talk to patients. No one has the time to give vaccinations. The only thing I have time for is to dispense one prescription a minute. Barely. Even with robot use, as in Rite Aid and Walgreens, time is still a precious commodity. There are too many silly regulations by state boards that waste a pharmacist's time (make sure that you sign every single line of that 222 form! And date that invoice that is already dated. And put that address on the line that the doctor was supposed to put in even though it's already in the computer record.)

The pharmacy of the future holds great promise. I see technicians doing pretty much what pharmacists do now, possibly even including the verification stage of prescription processing. Technicians aren't going away, even in a robot driven world. They will always be needed. And pharmacists too will be needed, just differently, to be used instead as a real member of the health-care team, instead of as an ancillary player. We simply have too much to offer to be ignored for much longer.

I've been wondering lately if retail pharmacy is dead or at least ready for some major triage.

It's not that the local pharmacy is going to go the way of the dinosaur. Pharmacies will never disappear. But I do think they are going to evolve into a different "animal" than what we see on the corner now. I say that because of the different circumstances faced by the retail druggist than existed even just five years ago.

In January of 2006 millions of elderly Americans began prescription coverage with Medicare Part D. This was not only a boon for seniors; it brought increased foot traffic into drug stores. The volume of prescriptions filled sky-rocketed. Then a couple of years later Wal*Mart brought its own brand of insurance reform by instituting their list of $4 medications. In an industry not known for creativity this was an earthquake high on the Richter scale of business practices. It brought price point back to prescription drugs, competition where none had existed for years. "Me-too'ism" crept in and soon Target and Rite Aid and CVS and everybody else soon had some version to compete with Wal*Mart. More foot traffic. More volume. More prescriptions than could be filled quickly and safely.

Back before the days of Medicare Part D we routinely told our customers that we could have their prescriptions filled for them in under fifteen or even ten minutes. Now we doubt very much if we can fill anything in much less than forty-five minutes. We may say "a half hour" but we really mean "we're going to hope for less than an hour unless we get some insurance problems which really is a given anyway."

Can we keep traveling on this road? As baby boomers age the numbers are going to go up astronomically. Things are going to have to change. Something has got to give.

Robots might be introduced. Rite Aid first got on board with robots back in the late '90's, but I see all drug stores eventually filling scripts with robots within the next ten years. Or five. This is one of the things retail stores must learn from mail order firms. You simply need a fast, efficient, and safe way to fill more than one prescription a minute and robots are the only way to do that. Although the public will balk at first they will eventually see that getting their prescriptions fast will be a nice trade-off to an unfamiliar system. And whether they know it or not the millions of people already receiving their medicines from a mail order company get their scripts processed by robots.

So the next time you wait an hour or two you might want to reconsider your aversion to mechanized pharmacy. Science fiction isn't just for trips to Mars. It might be as close as your corner drug store.

Saturday, September 26, 2009

When did a pharmacy become a part of the fast-food nation? You walk into a pharmacy with your prescription in hand, present it to the technician or pharmacist, and start to walk away, confident that in a few minutes you will have your medicine and begin your life anew.

When did that happen? I started in this business in 1983. At that time I remember this same expectation of quick, efficient dispensing, though I also remember that a busy pharmacy back then did about 100 prescriptions a day. We were still typing labels, though a few envelope-stretching chains and independents did have computers. So if we did ten Rx's an hour that was a busy. That works out to be one Rx every 6 minutes. Nowadays we do one Rx every minute or two. (That doesn't mean you get your prescription in two minutes; it's more likely to be an hour as the volume has sky-rocketed.)

But back in the Jurassic period of pharmacy, independents used to fill prescriptions in a back room, beyond the view of customers (we used to call them patients). This actually has a lot to say for it, as privacy worries are supposedly at the forefront of everyone's concerns. These were the days when a lot of compounding happened, capsules and tablets as well as creams, ointments, suspensions, elixirs, suppositories, would be made in a lab. Labels would be typed. It took a long time to make a prescription. I doubt if anyone left off a script and just stood there tapping their fingers.

Yet now I have to listen to the constant complaint: "How long's this gonna take?" "Forty-five minutes? All you have to do is put pills in a bottle!"

It's just like going into McDonalds or Burger King, isn't it? Place your order and take two steps to your right, wait a few minutes while some technician pours pills into a bottle, and hand over your credit card. Would you like to super-size that? How about a nice stool-softener with your morphine—we have a special today!

Sunday, September 20, 2009


Since everyone else and their pet dog gets to sound off on what is the best plan to overhaul the United States healthcare system, I thought I'd put forth a few of my own.

(Note: anyone who has been following this blog knows my reasons for advocating a single-payer system, so the following remarks are meant to be as an alternate to that most desired of solutions.)

  • Lacking any real reform, which indeed seems now to be the resultant predicament we find ourselves in, we could save millions just by having one uniform billing form, and one uniform insurance card. I have seen insurance cards without any ID number, group number, processor number, or even a logo to let us know whom to bill. Honest.
  • Give pharmacists the power of therapeutic substitution. If your insurance wants you on Prilosec OTC instead of Aciphex I could switch you to that drug without having to fax or call the office and wait the three days to hear back from them. They're only going to say switch it anyway.
  • Advocate the use of free discount cards. We switched a patient taking generic Topamax to the generic saving quite a lot, but then we tried on a lark to send the claim to a free discount program. The price went from about $240 to $28! We use it a lot on the phentermine drugs which are never covered on insurance, causing the price to go from $30 to $12.
  • Reimburse pharmacists to review patient medication profiles with the physician. I could save people—and insurance companies!—thousands, maybe millions, if I could afford to go over profiles. But I now do not have the time and no one can afford to not fill prescriptions in place of examining profiles. This would also probably prevent many unnecessary hospital visits due to adverse effects and interactions.
  • Set up a regional or state-wide pharmacy ad-hoc committee every couple of years to go over ideas to send to government boards and insurance oversight committees. Pharmacists have a lot of great ideas for saving money.

Take away Sen. Chuck Grassley's insurance. See, if he didn't have insurance like the 50 million other Americans you'd have real reform, saving the country, oh, about a trillion dollars a year. Probably the best idea I've ever come up with.

Wednesday, September 16, 2009

or not to err, that is the question.

Lately I've noticed interesting reactions from patients when something unusual is noticed with their prescription. Let's say someone receives a prescription for a quantity that they did not expect. Joe Schmoe gets some Zantac 150mg, and takes it twice a day. He looks at the bottle before he leaves and sees that it is for sixty tablets. He points out, none too courteously, I might add, that we've made a mistake. He had asked for a ninety day supply. We should have given him a quantity of #180.

Note: We've made a mistake. Us. The pharmacy team. The druggist. The stoopnagle with the white jacket who can't count. You know the guy, the one who can't read the prescriptions with the silly handwriting on them.

Except that guy didn't make that mistake. Didn't make too many others either. This is the guy whose job it is to catch mistakes. That's right. The job of a pharmacist is to catch the mistakes of others. It is not—principally—to dispense medication. That really is secondary. His first job, and this is really what he gets paid for (because the drugs are sold at a loss or close to it, believe it or not), is to act as a gatekeeper of sorts. He—or she—watches for errors in the prescription process. It used to be that many errors were the result of bad handwriting. This was especially tricky to catch if the pharmacist was new to the area and unfamiliar with a particular doctor's script. Now it is even worse, I'm afraid, due to the increasing percentage of prescriptions sent to pharmacies via electronic software, e-scripts as they are called.

E-scripts are tricky because you never know if a doctor (or nurse or secretary or physician's assistant or the pet dog) merely clicked on the wrong line. For instance—and this is only one of a myriad examples, some much more subtle—did a doctor mean to write for Lisinopril+Hydrochlorothiazide 20/25? Or did he click the wrong drug? Let's say that the patient has been on plain Lisinopril 20mg for years. But the patient's blood pressure might have recently changed causing the doctor to add another drug to the regimen. Well? Do you call the office? Sure, you say. Just call. But know this: you are filling a prescription every minute for twelve straight hours. You also know you won't be able to talk to anyone. You'll get a voicemail message (after navigating through some stupid voice prompt: push "1" if this is an emergency; push "2" for the office manager; push "3" for the dog warden…") and likely won't hear back until hours later or even tomorrow. Or ever. In the end I usually just jot a note to ask the patient if there was a change meant. Sometimes they know. Sometimes they don't have a clue. Ah, well, another day at the pharmacy.

Oh, and when I show Joe Schmoe the original prescription for #60 Zantac, proving that it was his precious perfect physician's assistant who wrote the wrong quantity he treats it as nothing wrong. He even still insinuates that the error happened in the pharmacy. Nice. It seems doctors don't make errors, only pharmacists. Even when they catch them.

Sunday, September 13, 2009


As reported in The New York Times today, Sunday Sept. 13th, 2009, Nikki White died not from her lupus but from a horrific health care system that refused to care for her.

Every half hour another person dies from lack of care in this country (National Academy of Sciences).

And there is no outrage.

As Nicholas Kristof writes, every two months as many people die in this country as died in the World Trade Center attack, which resulted in this country spending hundreds of billions of dollars to prevent such an attack from happening again. But we balk at universal health care.

No outrage. Christians sit on their hands. Republicans call the President a liar. Fox News spreads misinformation. And no one cares.

If you care that Nikki White died needlessly, then you need to do something. Fax a congressman, the president. Something. Anything. Why be part of the problem when you could be part of the solution?

Sunday, August 23, 2009


in England. Not here in the good old U.S. of A. Here it's $148 for that prescription of a highly popular cholesterol lowering agent.

But, you say, maybe that's just for that particular drug. Nope. Doesn't matter how newfangled a drug is. In England it's $12.

Yeah, but they must have some expensive health care system over there, right? Nope, again. Per person they spend about half what we do in the U.S.

What about the horror stories? The rationing, the death squads? The people in the UK seem quite happy—only 1 in 10 people think there's something deeply wrong with their system. In the U.S. it is 1 in 3 people. And they're right.

Maybe the argument has been high jacked in favor of the insurance industry? Perhaps.

With all the money we're currently spending, you'd think we'd be all as healthy as newborn babes (babes born in England anyway; babes born in the U.S. don't often aren't quite so lucky), but sadly we're not.

So where's all the money going if not to true, make-a-difference health care? Remember: our system is made for profits. If your insurance doesn't make a profit then your premiums go up and you care gets rationed. And think of all the different companies with all their administrators and bureaucrats and their salaries and pensions. That's a lot of people to pay. Nothing to do with health but…

Tuesday, July 28, 2009


It is becoming clear that the U.S. is going to have some form of health care reform this year. Equally clear is the inevitability that this reform package will be lacking in some important aspects. What we're left with might be considered one of those "half empty, half full" sorts of questions.

On some points anything might be considered an improvement over what we currently have. There is near unanimity on the need to cover those without insurance, for instance. That would be a decided improvement. The greatest need right now in this country is the need to provide for those people without the ability to pay for health care. That is job #1, and it looks like we're going to get there.

Unfortunately the packages making their way through Congress are protecting the insurance industry, not the people needing better care at lower costs. So what we might very well have at the end of the day could be similar to what we now have—plus coverage for 47 more million people—at an exorbitantly greater cost. It will be like the insurance in Canada, or England, or France (or Spain, or Italy, or Germany, or Japan) but instead of paying merely double what they pay we'll get off paying quadruple. But rest easy, your insurance company will be safe and secure in profit-making heaven.

Friday, July 17, 2009

Is Canada the best example of a nation's regard for its citizenry (this side of Great Britain), or is it the bumbling bureaucracy portrayed by FOX News?

Which Canada is the truer picture?

Today, after another stupid encounter with a patient's insurance company (the group number on the card was not actually the group number), I conversed a bit with the rather patient patient. Turns out she's a nurse and has little regard for insurance. She said that she didn't know what the answer is to our predicament in this country. Not being shy about my own particular views I shared with her my own views. The only good answer is single-payer. She said that that might be good, but not if it produced the lines in Canada that her friends see there.

I said that that wasn't due to any single-payer plan, but simply to a lack of doctors. Massachusetts has the same problem now that they've mandated insurance coverage for everyone (except legal immigrants!).

Americans seem to regard the Canadian system as proof that single-payer cannot work. According to some there are lines around hospitals at the border of desperate Canadians pleading to be let into a modern fully staffed emergency room. "Please, sir, let us in!?"

And yet if you talk to Canadians, and I've tweeted some Canadian pharmacists on this, they all love their system. Wouldn't they rather have the sweet private complexities of the US? Um, no thank you come the responses.

And who can blame them? In a recent finding by Harvard researchers (see almost 80% of all bankruptcies in the US are due to health causes. Get sick in the US and hope for the best, I guess. And note how many of these bankruptcies were by people with private coverage--60.3%! What does that tell you? I tells me that private insurance companies are there to protect shareholders, not those with "coverage." And in the US we definitely need those quotes around "coverage."

We Yanks, I guess we just like spending more and getting less.

Monday, July 13, 2009

So what would you say is the best drug out there now?

What should the criteria be? Low cost. Effective. Easily dosed at once a day. Curative. Likely to be reimbursed by one's insurance, that is, it won't require prior authorization.

Hard to beat Penicillin VK. Inexpensive and curative. But wait. There are so many bugs out there resistant to it that curative is now iffy. And it is dosed at one tablet every six hours. How many times do you remember to take those things every six hours? Thought so.

Prilosec OTC? Often reimbursable by insurance, it is powerful enough to be considered curative. Even if you don't have an insurance that will pay for it it isn't terribly expensive and you can pick it up right off the shelf. Once daily dose, too.

Steering away from strictly OTC drugs though (like Zantac, Pepcid, etc. which are all quite good), what else? Generic Fosamax is a good one: cheap and effective for osteoporosis, the drug is dosed once a week. Curative, though? Well, I wouldn't go that far.

Carvedilol? Generic and inexpensive (Wal*Mart has it on their $4 list), it is dosed at twice a day--not the once a day that the CR has but still respectable. A member of the beta-blocker class for heart problems and lowering blood pressure, carvedilol (brand name Coreg) has recently had a run of great press in the clinical literature, to the point that if you just had a doctor give you a prescription for a beta-blocker other than carvedilol then you should make a point of having it rewritten. It seems to be that good. Beware of prescriptions written for Coreg CR though: this is merely an attempt by its manufacturer, GlaxoSmithKline, to lengthen it patent rights by altering slightly—and not significantly affecting its effectiveness—the dose form into a controlled release form. The price of the CR form is high and will often require a prior authorization from your insurance. Get the generic.

So for my money, I would be hard pressed to come up with a better drug than carvedilol. For those on the drug, I say, "Well done, and bon appetit!"

Monday, June 22, 2009

“Is Everybody All Right?”

"Is everybody all right?" These were Bobby Kennedy's last words after being shot by Sirhan Sirhan. Now these words are beginning to resonate with the American people as his brother, ailing from a brain tumor, hopes to finally see his own efforts at championing national health care for everyone come to fruition.

Is everybody all right? Everybody? OK, you, the guy working the union job at the Ford plant in Atlanta. We all know you're fine with it. You got all the bells and whistles. When you step up to the pharmacy counter you don't expect to see any $50 copays. So you're happy. Right? Well maybe you shouldn't be. Maybe you should have a little more concern for those of us who are unemployed. Or working in a small business that doesn't offer health insurance. Or even those of us who have that $50 copay when you get to pay next to squat.

Maybe, just maybe, this isn't about you. Maybe it's about somebody else. Maybe it's about everybody else. Everybody, just like Bobby Kennedy said.

At his funeral, Senator Ted Kennedy quoted a famous statement by George Bernard Shaw, saying, "As [Bobby] said many times, in many parts of this nation, to those he touched and who sought to touch him, some men see things as they are and say 'Why?' I dream things that never were and say, 'Why not?'"

So dream a little. Dream about that mother down the block with the two kids and the out of work hubby. Dream about a country that cares so much more about them and people like them than about corporate profits and dividends and rationing and authorizations and paperwork and deductibles and copays and lab fees.

Dream on.

Saturday, June 13, 2009

The Public’s Indifference is the Real Problem


What is currently wrong with the pharmacy/health care picture is still a nonchalance and "so what?" attitude by so many people. Even when it directly concerns people, when they are even pissed off at the insurance companies (which might—Oh My!—go out of business if we have a public plan).

A customer getting some morphine—long term customer, not an addict trying to get a fix—couldn't get the insurance company to go along with the dosing. Had to get a prior authorization. Well, obviously this was needed NOW because the guy was in some serious pain, but he didn't have the $57 to pay for it. He assumed—never assume this people—his insurance company ("his insurance company": Why do we say this like they are a member of our family?) was going to pay for it and he'd have to pay about $5. So he got pissed at me and stormed out.

Later he came back and apologized. I got talking to him, and basically stated that until Obama gets backing from people like him, people telling their congress people to get on the stick and change things, then nothing was going to change.

"Oh I don't know about that," he said. He was angry still, but not quite angry enough to say that he was ready for the government to step in and fix things. He'd rather still have his precious insurance companies oversee his health care, these greedy, immoral—OK, EVIL—shysters than a public plan that gives everybody equal access, equal—and fair—copays, and covers everybody.

What is wrong with people? And how do you fix this when few care enough to?

Monday, April 20, 2009

Change? Who needs change?


When the status quo works so well, I mean. That's the impression I get when I visit the government affairs section of APhA, the site for the American Pharmacists Association. On the docket for the Advocacy Agenda is … Single-payer insurance? No. Health care reform of any sort? Nope. How about controlled substance policy and medguide management? Well, of course. You know, the really important things. After all, we need to nip these medguides in the bud. In…the…bud! We're bud nippers at APhA, that's what we are (apologies to Barney Fife).

Why doesn't APhA get it? Not sure. I suppose they might be afraid their members could be on the short end of the stick (again), but if that is so it seems to me that the smart course of action would be to get in on the ground floor and advocate for change that benefits pharmacy. And change is coming, sure as shootin'.

APhA might also like the existing system. Nah. No one likes this system short of the insurance companies.

So what gives? My take is that the bigwigs on board are simply too far behind the times. They've been caught up in the same arguments for so long that that is all they know. Arguments for greater dispensing fees? Check. Higher reimbursements? Check. Compensations for pharmacy services? Check. Medication Therapy Management? Check. Argue for the establishment of Single-payer government insurance? Um, we don't know anything about that! What do we say? What do we do? Gosh!

APhA, get with the times and change. Think big. Think way big.

Sunday, April 05, 2009

Toxins everywhere!

Fads come and go, they say, but one that keeps on coming back is the Detox Diet. This is where you take certain herbs, or adjust your diet, or even put pads on the feet—I'm not kidding!—and the body is detoxified, rid of dangerous poisons.

Exactly what are these toxins? The ads don't like to say, but they're dangerous, taking years off our lives, we're told.

The one getting all the attention is called "Master Cleanse." This diet has you drinking about ten glasses of a lemon juice, cayenne pepper, and maple syrup concoction. Expect to spend your next ten days in the bathroom. Essentially you are starving your body, thereby releasing "toxins" from fat cells. What you are really doing is forcing your gut into diarrheal states for ten days. Not a good idea.

Another is the Martha's Vineyard Diet, started by a nurse (so it has to be good for you, right? Wrong.) Here you get to drink a lot of distilled water, protein shakes, vegetable shakes, and a lot of round-the-clock colon cleansing. Yeah! Oh, but people with heart problems, liver problems, kidney problems, diabetics and so forth shouldn't use it or any of these methods. Why? Well, you might die or something. But it's got to be good for you, right? Wrong.

There are others (the Joshi diet that Gwyneth Paltrow shills is omnipresent lately), but they all basically make you poop you heart out. These things are all:

  • Silly
  • Dangerous
  • Expensive
  • Designed to make the promoters a lot of money

No medical person worth his salt will tell you these things are good for you. Because they are not. They will alter your electrolyte levels, sugar levels, put stresses on your circulatory system, and flush out the good probiotic bacteria in your intestines.

Think about this: Your body already is designed to get rid of the bad stuff. Things like your liver, kidney, lungs, and even your skin, are all designed to metabolize and neutralize the bad stuff. Next time you hear somebody say that they're thinking about detox-ing their body, ask them why. When they say to get rid of all those toxins, ask them exactly what toxins they are talking about. They will stare at you as if everybody knows what those things are. Tell them "toxins" is another word for money: That's what these diets are really good at: flushing your money down the toilet.

Saturday, April 04, 2009

"Imagine waking up one day and all your medical decisions are made by a central, national board," says one Richard L. Scott, who seems intent on bashing Obama's plan for a health care re-do.

Before we get to Mr. Scott (see New York Times article "Health Critic Brings a Past and a Wallet," Thu, Apr 2, 2009), I'd like you to ponder that sentence. First, waking up at all is a nice thing these days, given the state of care in this country. If you're a pregnant female, a child, or an elderly person, or anyone with a chronic condition such as diabetes, debilitating pain, heart disease, etc, then God help you. Doctors are too busy with insurance issues to care too much for you and your problems. And they are too afraid of you to actually get to the bottom of things. Afraid you'll end up suing them, so they end up testing you for anything, but don't want to say too much, or spend time with you listening. Just test, bill, test, bill.

But let's say you've succeeded in waking up one more lovely day. What about all those medical decisions? Well, you're doc makes them, right? Um, no. Your insurance company—if you have one (if you don't then you don't see a doctor anyway because you can't afford one)—makes them. What medication are you on? Your insurance company gets veto power over every prescription your doctor writes. Same with the tests. Even the time spent with your doctor ends up being determined by the insurance mafia.

Now comes the real point of Mr. Scott: that nasty national board. But wouldn't it be more transparent, wouldn't it in the end be easier to navigate one board…than the thousands out there now? Does anyone even have an idea on how to navigate their way around the insurance industry today? I don't, and I work with these bleeping people daily. Believe me, you don't want to call these people for anything. I'd much rather have one agency to call, one board to petition, one representative responsible.

I'll give one example, which just happened yesterday, or rather over the last few days, as it tended to drag on and on. Joe Shmo comes in with two expensive prescriptions for inhalers for his mother, who has a bad case of COPD (Chronic Obstructive Pulmonary Disease). I'm talking expensive. But necessary. Anyway, she has Medicare part D, and Medicaid. No problem right? Problem. What plan did she have? Wellpoint. But the card was not forthcoming yet. OK. We'll call Wellpoint (didn't want to but did). After some twenty minutes (but everyone else waited so patiently right?) we have information that Joe Shmo's mom doesn't seem to have Wellpoint at all. At least that's what Wellpoint said. Not that you can trust the information you get from any of these companies. Sometimes it is just who you speak to at any given time (see previous blog).

So we bill to the secondary, Medicaid. Medicaid won't pay unless the primary pays first. Nah, nah, na-nah nah. Joe said to call the local Medicaid gal. Said she said just call her if there's a problem. So we did (didn't want to because, well, everyone was still being so patient but for how long?). It became clear that this person didn't know her job—not exactly a rare occurrence, I find, in dealing with Medicaid agencies. She basically said to call Wellpoint and everything would be OK. Joe said he'd take it from here, and thanked us for our efforts. Back to work everybody!

Next day the process repeated, as Joe said he'd talked to the Medicaid gal and she said everything was finally working. Except it wasn't. More calls. More perplexed discussions with Joe. Another day goes by.

Joe calls yesterday and says it all is supposed to work. Finally. Except it doesn't. More calls. I finally get some information though that his mom doesn't have Wellpoint anymore, that she was switched to Silverscript (unbeknownst to everyone involved, including the government!). OK, so I call the Medicaid gal and ask for the billing info. She doesn't know a thing. Can't even give me a phone number. Useless. But I do get some info from another Medicaid worker who tells me that she put through some extra fancy prior authorization for Joe's mom and that I could now just bill the State and it'd go through. At this point I told her to stay on the line, because I was sure it wouldn't work and I wanted somebody I could yell at when it didn't. But it did! Something actually worked in this lame-brained system of ours! Eureka!

And you know what else? Joe actually thanked me for my efforts. Usually people just walk away cursing, under or over their breaths.

But just imagine, if you will, a system NOT controlled by ten thousand medical boards across this country, but by JUST
ONE! O the dream! The dream!

Wednesday, April 01, 2009

Fox News makes me cringe

Fox News (I'm sorry but saying that always makes me cringe) has a recent piece of propaganda that must have been hot off the Republican National Committee To-Do List press. In its Media Matters for America segment ( Betsy McCaughey (ex-lieutenant governor of New York) and Martha MacCallum speak on the topic of Natasha Richardson's recent death.

The Republicans are trying to derail Obama's health care reform. They, being bought and paid for shills of the insurance lobby, hope to convince Americans (remember Harry and Louise???) that single-payer health care is the devil's plaything.

Trying to pin the blame of the gifted actresses' death onto the Canadian system, McCaughey invokes the "cost-benefit" analysis innuendo. As if Canadian doctors carry around calculators and clipboards along with their stethoscopes. As one of the commenters on the site remarks,

"I find this "report" appalling on so many levels. Being Canadian and having worked in the health care industry for 11 years, I have NEVER heard of ANYONE being denied all tests and/or procedures available for treatment. That is simply not factual. As is true in the U.S. I assume, anyone can refuse treatment which clearly seems to be the case in this particular incident. Nobody can be forced to seek treatment no matter the situation. Unfortunately, with head injuries time is of the essence. Hindsight is always 20/20, and there are a great deal of "ifs" being bandied about here. Blaming the Canadian Health Care system is not even remotely appropriate."

Another remarks that he's never known one instance of anyone being denied care because of a "cost-benefit" analysis.

Isn't it obvious what is going on here? A supposed news organization makes hints that America might be making the same "mistake" that the Canadians made years ago when they set up standards for their health care (Canada doesn't have a single-payer system so much as a standard that the provinces must meet or exceed). Fox then fills the report with "might's" and "maybe's" instead of doing what a real news organization is supposed to do: find the facts. Was a CT scan done? Was it not done because of some probably fictional cost-benefit analysis?

Don't know? Well, find out! You're a news organization! Oh, but what you really are is a media arm of the Republican National Committee. Remember the Obama birth certificate fiasco? Why does anyone take Fox seriously???

And I hate to go into ad hominem attack mode, but why is it they couldn't come up with someone with a little more political heft than Betsy McCaughey? Her career was ruined a long time ago with her bizarre behavior in New York. Could it be that no one with any reputation wanted to be anywhere near this obvious example of mis-information?



Someone I follow on Twitter gave me this site. I think you should read it and sign it. Anyone interested in fair health care for Americans needs to get on board. Here is the petition:


EVAN BAYH (IN) has organized a conservative democratic caucus called CONSERVADEMS specifically organized to oppose several Obama agenda items that we voted FOR him because we hoped they would be … accomplished! There are 15 senators that are willing to admit to being CONSERVADEMS AND 3 OR 4 MORE WHO attend the meetings but refuse to be named.  They actually want to PREVENT HEALTH CARE LEGISLATION FROM PASSING BY MAKING SURE THAT IT IS BROUGHT UP IN A WAY THAT WILL BE SUBJECT TO REPUBLICAN FILIBUSTERING.  They also want to water down the president's climate change legislation and reduce federal spending. 
   Didn't we work, contribute and vote for President Obama and his agenda for a reason?  Now 59 days into his term and they are fast at work undermining him and us!!  These turncoats need to go!!  The other 14 CONSERVADEMS are TOM CARPER (DE), BLANCH LINCOLN (AR), MICHAEL BENNET (CO), MARK BEGICH (AK), KAY HAGAN (NC), HERB KOHL (WI), MARY LANDRIEU (LA), JOE LIEBERMAN (CT), CLAIRE MCCASKILL (MO), BEN NELSON (NE), BILL NELSON (FL), JEANNE SHAHEEN (NH), MARK WARNER (VA) & MARK UDALL (CO).

Sunday, March 29, 2009


In Bruce Weber's latest book, "As They See 'Em: A Fan's Travels In The Land of Umpires," he wonders a bit at why someone would put himself (note: they are all men) in the position of being routinely spat on, cursed, and hollered at. I realize that I too could have been a baseball umpire. All of us in retail pharmacy, it seems to me, have the requisite training and inherent abilities to be a big league ump.


I've had spittle discharged in my general direction as a matter of course. Cursed? Practically every hour of every day. Yelled at? Please. Only the linoleum saves my shoes from being covered in dirt. 


And the comparison does not stop at the abuse. Pharmacists, like umpires, must make split second decisions and then move on, ready for the next. I continue to recall the episode on "I Love Lucy," where Lucille Ball gets a job in a chocolate factory. The chocolates speed down the line faster than she can pick them up. Finally she begins to shove them into her mouth. (I don't recommend that for any but the choicest medications.) In my pharmacy we do about one script every couple of minutes. That's a pretty good pace, especially when one of those insurance rejections comes up and we have to stop "the line" to make a phone call to an insurance company that puts you on hold for twenty minutes, then transfers you to the other department that you should have called (if you only knew of its existence, that is). 


For every prescription coming down the line, unlike those chocolates, you have to make decisions. Is this the right dose? Did the doctor write for the wrong drug or the wrong strength? Does the Nurse Practitioner really know what is going on here? Did the Physician's Assistant hit the wrong button before sending his e-script? Is the patient still taking drug X which interferes with Drug Y? On and on it goes.

Just like umps, those unlovable bumps on a log getting their lumps. Oh, how I envy them! How wonderful their lives must be! For though they receive their abuse as I do, though they have to take it all with a fair dose of equanimity, as do I, they have that not so secret weapon, that discharging of duty up their sleeves—Oh, how I would love to say it, just once, to Mrs. Scrofulous, to Mr. Pin Head!

Crouching low then leaping high, brazen and loud, sung like a Metallica screech:

Yerrrrrrr Outtttttttta Heeeeeeeeeerrrrrrrrreeeeeeeee!

Thursday, March 19, 2009

It all depends on who you talk to.

So I'm filling a prescription for insulin. Simple right? Nope. Not anymore.

The prescription for NPH insulin, an intermediate acting insulin, had been filled and refilled many times for this person. But this time her insurance rejected the claim. Apparently, as the rejection showed on the computer screen, it needed a prior authorization. For those of you not yet aware of this little bug-a-boo, this is when the insurance company says that the doctor needs to make a written statement showing that the treatment is indeed necessary, otherwise the insurance will deny. This is usually encountered for high priced medications new to the market. Usually a drug like Coreg CR or Ambien CR, where the drug maker reformulates to make it last longer but where the real benefit comes to the company making the drug because it gives them another year of patent life. But for insulin? Why would insulin need a prior authorization?

So I call. I get this nice sweet voice on the line and I explain that there must be a mistake, that no company—not even an insurance company—would make insulin non-reimbursable. She said that, yes, she understood; but the rejection was correct. They really did require a prior authorization. What about other maker's of insulin? Wouldn't they be OK? Maybe it was just the particular insulin we were using that would be rejected. Unfortunately, no, she said. All insulin would be rejected—except for Novalog, she explained. Well, that wouldn't work, I told her. Novalog was a completely different type, and not interchangeable. Could she just check one more time?

Another problem for me was that she was just too sweet sounding to yell at. I, as other posts here have attested to, enjoy the odd phone call to protest the great injustices that insurance companies inflict on us. But here I was totally disarmed.

I make a note in the patient's file that she would need to get an authorization from her physician, and I faxed the request to the doctor's office.

Two days later I see that the insulin was dispensed and sold—without any authorization on the part of the insurance! One of my staff pharmacists, the day after I spoke with the insurance company, called them and, getting someone different, was told that Oh, it was just a mistake and just to re-run the claim and it would go right on through just as easy as you please.

Well, ain't that something. It just goes to show you that it depends on who you call. If you don't like the answer, just wait a bit and call back. The next person might actually know what they are talking about.

Sunday, March 15, 2009

Bad bugs the new white meat?

As reported by Nicholas Kristof in The New York Times recently (Sun, Mar 15th, "Pathogens in Our Pork), hog farms are now infected with the dangerous bug known as MRSA (pronounced "Mersa"). As estimated by the University of Minnesota, up to 39 percent of pigs on hog farms harbor the superbugs which are resistant to almost all forms of antibiotics. (More people die from MRSA in the United States than from HIV.)

Why? Same reason as why doc's give out prescriptions to treat viral infections like colds and ear infections: mis-use of antibiotics. As Kristof writes, more antibiotics are given to livestock in North Carolina alone than goes to treat the entire U.S. population.

This is all due to the tremendous leverage that the agribusinesses have on Washington politicoes. The citizenry is being plowed under for the sake of increasing the yield of hog, cow and chicken farmers.

It's as if the Congress is doing as Marie Antoinette, saying instead, "Let them eat pork!" I wonder how the average North Carolina congressman/congresswoman would feel if we rubbed a pork pie in their faces? Penicillin anyone?

Monday, March 09, 2009

From (Mar 9, 2009, "The view from West Virginia"):

[Obama] insists that Americans who like the health insurance they currently get through their employer can keep it. But Michael Tanner of the Cato Institute, a libertarian think-tank, predicts that government insurance will crowd out private insurance. The government could offer insurance cheaply by dumping part of the cost on future taxpayers, and so crush its private competitors.
If that happens, hospitals will be squeezed. Currently, patients with private insurance cross-subsidise those in government schemes. (A typical hospital enjoys a profit margin of 48% on each privately insured patient and suffers a 44% loss on each patient covered by Medicaid, the government programme for the poor, according to McKinsey, a consultancy.) If that subsidy disappears because there are fewer private patients left to pay it, hospitals will have to cut back. European-style queues may form, the sceptics fret.

Firstly, why would anyone keep the crap insurance they now have? That's what I want to know. Too expensive, too many restrictions, and too bothersome. Oh, and too wasteful and unfair.

Second, I don't believe the statement that a typical hospital enjoys a profit margin of 48%. Why? Because I've seen this kind of statement before, usually on the financial records of insurance companies. These kind of statements are all pie-in-the-sky reports. They count on the credit side anything and everything, but leave out all the waste and the instances that debits pile up off the books. It's like Aetna or United Healthcare saying that they've saved the average customer X amount of dollars. Yeah, IF you don't count all the time and money you've pushed off onto doctor's offices (hiring new staff for all the authorizations and phone calls) and pharmacies (ditto).

It's easy to say you've saved everyone SO much money IF you don't count this and that.

Sunday, March 08, 2009

What now, Republican?

David Frum in the Mar 7 Newsweek sums up Rush Limbaugh pretty well:

And for the leader of the Republicans? A man who is aggressive and bombastic, cutting and sarcastic, who dismisses the concerned citizens in network news focus groups as "losers." With his private plane and his cigars, his history of drug dependency and his personal bulk, not to mention his tangled marital history, Rush is a walking stereotype of self-indulgence—exactly the image that Barack Obama most wants to affix to our philosophy and our party. And we're cooperating! Those images of crowds of CPACers cheering Rush's every rancorous word—we'll be seeing them rebroadcast for a long time.

Why is that important for a pharmacy blog? Because if you are a Republican, as I am, your party may well be responsible for either sidelining universal health care or watering it down to where the insurance mafia wins what it needs to win for its survival.

As Rush becomes the arbiter of Republicanism, congress increasingly becomes the stop sign on the road to legislation. Of course we might want to wait until 2010 when Obama could go around to the various districts and wave the flag for the Dems (I expect--who doesn't--a landslide Democratic majority in 2010). Then bills will be able to slide along the path to fruition more smoothly.

I personally think the Republican party is doomed to extinction or a long hibernation akin to the post-Depression politics of Roosevelt.

There is a third way: treat Republicanism as a trait, an idea that can be afixed to a certain topic, but not necessarily to the whole shootin' match. For instance, those opposed to abortion such as myself, can be conservative on that topic, but on health care we can be free to oppose the Limbaugh-ites and exercise our minds again to oppose the insurance mafias for the betterment of mankind. We can be the superheroes of the real world. We will not be limited to the dogmas of some blowhard, driven to a slouchfest of behemoth proportions, smoking cigars in back rooms and making nasty comments about our president. No, we will be more in keeping with the way that McCain has transformed himself, advising the president where they both agree, but loyaling opposing him when his conservative principles dictate that he should do so. We will be the real independent party, whereas the Independent party is really just the Democratic party.

We will be the Watchmen for the new world!

Tuesday, March 03, 2009

We want the best and we want it now!

As The New York Times reported today (A Hurdle for Health Reform: Patients and Their Doctors, Mar 3, 2009), what fundamentally drives the costs in America's health care system is the desire on the part of doctors and patients for the best--meaning the costliest to most--new treatments and medicines. It doesn't matter if the upside is slim to none. Stick a high price on something and a few slick ad pages and Bam! you've got a winner on your hands. Ever check out the number of beta-blockers out there? How about ACE inhibitors? Gazillions and none of them work appreciably better than the first ones out of the block twenty-five, thirty years ago.

The Times cited a 2004 study (published in The American Journal of Public Health) that showed that only 1 in 16,000 people benefited from recent technology as regards their health.

Today I finally convinced someone not to bother with Tamiflu for her daughter. Was I being too harsh? You decide. Her daughter had had the flu already for three days. Tamiflu needs to be started quickly, at the onset of symptoms. Even then the average flu symptoms will disappear only a half day before they would have without Tamiflu. Would you spend nearly $100 for half a day's symptoms (which would be alleviated anyway with some ibuprofen or naproxen)? I wouldn't and that's what I told her. She said she wouldn't either.

You got your diet, your exercise, your vaccinations, your indoor plumbing, and good old clean water (to drink AND to wash your hands). Everything else is pretty much luxury.

Sunday, March 01, 2009

The return of Harry and Louise?

Remember those ads featuring Harry and Louise, the middle-aged couple worrying over the governments plan for national health care back in '93? Largely credited for destroying Clinton's plan for the country they are back. Last year, during the 2008 Democratic Convention (and the Republican Convention as the Dems paid for the ad to be aired then too--smart!), the two were reprising their role, this time to explain that too many people were "falling through the cracks." Even the lobby--America's Health Insurance Plans--that created those original ads says it wants to play a different role this time (see The New York Times, Sun, Mar 1, 2009, "Liberal Groups Are Flexing New Muscle in Lobby Wars").

Well, good. Maybe Obama has the political momentum to get this done. I do think he has given too much power over the details to congressman. Who do you trust more to deal with this problem, Obama and his policy wonks, or those congressmen who've been bought and paid for by insurance company lobbyists all these years? Yeah, I thought so.

Check out the National Coalition on Health Care, and give them your support. Go Obama!

Thursday, February 26, 2009

Things I'm going to say (or do) when I get old and take a trip to the pharmacy:

  1. "Excuse me, but I don't talk to technicians. Where's the pharmacist!" (Puff out chest here.)
  2. Throw credit card at cashier, preferably landing on the floor necessitating said cashier to bow to me, stating, "I'm sorry, I believe you dropped this."
  3. "How long will this take?" "Half an hour? All you have to do is put some pills in a bottle!"
  5. "So how much is this with my insurance?" "And for 30?" "Huh. How about 10?" What if I use my discount card instead?" "And for 30?" "Huh. How about 10?"
  6. "Now what do I do? Sign my name? Then what? Press clear? Whoops. There, I've signed again! Press clear?"
  7. "Why does this cost more every time I come here???"
  8. "Why do they pay $10 and I have to pay $50? Huh? Huh?"
  9. Wait until the prescriptions are all done and rung out at the register and then say, "How much if I use this card?"
  10. Tell the technician that, Yeah, I have insurance, but I don't know what it is.
  11. When asked if I am going to wait for the prescription, say, No, I'll be back later. Then come back in two minutes.
  12. Wait two weeks for the prescription to be done (and then returned to stock since all pharmacies put them back after a week), then come to the counter and say, "But you've had two weeks to do it!"
  13. When picking up my prescription and asked my name I'm going to say, "What, you can't remember it? I come here every month!"
  14. Talk on my cell phone as I'm being rung up and counseled. That really pisses them off!
"You one of them ... Reds?"

Now let me say from the getgo that the only Red I've loved is of the shrimp variety, especially those found along the gulf. Sweet! I'm no com-you-nist. I belong to the Republican Party, albeit the party of Lincoln, Roosevelt (Teddy) and Taft, not Bush. But I fear I've been labeled one of them Commie lovers on my insistence on a national health care plan.

I will set the generalized scene: Sitting around the living room or at the dinner table, surrounded by fellow church-going folk, I will inevitably bring up my disgust with the current state of health care in this nation. Someone will, in a near whisper, ask me, "But do you think we should have national health care???" The question posed is of course spoken rhetorically. As if no one at the table would dare suppose that this great country of ours would ever, ever stoop to such a low point. Socialized health care? Raising the flag of our fathers they plant firm their feet and cry, Never! Why, there'd be so many lazy, good-for-nothings sittin' around watching Oprah and swillin' beer that ... that ... well, I don't know what!

I ask, What about the thousands of bankruptcies across the country ... due to the sin of people getting sick? I ask, Is that good for the country? Why do we pay, per capita, twice what other countries pay? Why do we have more than 45 million people without health care? Why do all the people getting laid off from work, and who now have no safety net if they get sick, need to have insurance tethered to the workplace? Doesn't your neighbor down the street deserve insurance as much as you? And why should your Lipitor cost $50 but John Doe's $10? Don't you care? DON'T YOU CARE?

No, you don't. That's the upshot of it. Christian churchgoer: shame on you! You hypocrites.

Wednesday, February 11, 2009

And I thought pharmacies had problems ...

In yesterday's New York Times Michael Kinsley had an article ("You Can't Sell News by the Slice," Tue, Feb 10, 2009) detailing the woes that prevail amongst the newspaper crowd. Seems they lose money on every paper due to paper and ink costs (not to mention employment, rents, health care, etc), and advertising dollars, normally their sweet spot, are spiraling down the toilet. In a previous issue, Walter Isaacson, former managing editor of Time, had advocated "micropayments" on the Web issues of newspapers, allowing a paper to accrue a nickle or dime for a "click" on an article. Kinsley says even that income wouldn't amount to enough to save the papers. Seems they are dinosaurs awaiting extinction where a few will inevitably survive as evolved journalistic forms on the Web.

So why does this concern me? It just strikes me as being parallel to what pharmacy went through a few decades ago, when it allowed insurance companies to give them a micropayment per script in exchange for taking the plans in the stores. Of course pharmacies lost money (and still do) on every prescription, but the thinking was that if you also sold the patient (now a customer) a tube of toothpaste then you'd get a profit. So pharmacy became a loss leader (as well as a lost leader). Like newspapers are now.

Pharmacies now sell medicine and charge for that medicine. But the salaries, the electricity, software, hardware, employment costs, these are losses. I remember reading of a study by Rite Aid back in the early 1990's I think, where an empty vial would cost a pharmacy about $6. That is without any medicine in it. Just an empty vial. Nowadays it's probably more like $10. So when Walmart (and all those copying their program) sells drugs for $4 and claims that it is still making money, well, they're lying. But that's their business plan and they're welcome to it. But they are lying.

So pharmacies sell a content--drugs--and give away information free. Newspapers are trying to charge for information while giving away their content--paper and ink. Inevitably more and more information will find its way to the Internet, so there is only the information. But that is where everything is supposed to be free.

I'd hate to be the owner of a newspaper now. That's almost as bad as being a pharmacist.

Sunday, January 04, 2009

A New Year's Resolution ...

to be, yes, less persnickety! But only at work. Looking back at my 25 years behind the bench, I've noticed a tendency to ratchet up the persnickety level a notch or two every year or so. I take that as a character flaw. A man or woman should be able to disassociate him-/ her-self from a disagreeable situation (and we all know retail is chock-full of disagreeable situations) and attempt to treat the person to whom one is talking in a rational and even a charitable way. That is my resolution.

But here, in the blogosphere, I will allow myself the cure of the rant, giving vent to all the combustibles that cross the divide between "them" and "us"!