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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).