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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!"