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Tuesday, December 14, 2010

Still dying, still arguing

People are still dying.

Since America has this system whereby profit is the engine for curing disease, many will go bankrupt or simply die.

On the Huffington Post today there is a story of a little blond 5 year-old girl with leukemia, living in Montana. The father is a disabled vet and the mother works as a house cleaner. Once diagnosed, the first bill was larger than what the family makes in one year.

Another family, the Petriekis' family from Indiana, lucked out when Medicaid of Indiana refused treatment because of a bureaucratic snafu (the treatment was labeled "experimental" despite a 73% success rate) but the insurance handling Medicaid claims for that state finally stepped in. A catastrophe narrowly avoided. (One has to wonder if the insurance would have acted if the situation hadn't become widely known.)

The cases go on and on...it is not hard to find them.

Reading the comments on the Huffington Post is instructive, too. People from the U.S. are embarrassed by our country's lack of affordable care. People internationally are simply shocked at how horrific things are here.

Here, from a commenter on the Huffington Post:

If this child and her family were living in Germany where I live, or any other western European country they would not have to worry about paying for the little girl's treatment.

In these countries there is still a great sense of solidarity on which health, old age, unemployme­nt insurance and social security are based. Those who earn more contribute more to the system. Everyone has access to the same coverage.

As the cost of medical care increases (thanks, big pharma) and more people are enemployed and contribute less to the system (they still get the benefits), there are financial strains. The bottom line is that the system continues to work very well.

My friends and familiy here are simply flabbergas­ted that so many Americans who themselves are only one illness away from financial catastroph­e are againt universal heath insurance and brand it "socialism­" and "communism­".

Remember, Sarah Palin and Joe Miller admited (sic) to slipping across the border to Canada for medical treatment. Talk about hypocrits!

While money is important, finding a stem cell donor is even more important for this child. Everyone can be typed and become a potential donor for her or for other leukemia patients. Ask your doctor (If you have one) or enquire at a hospital about getting typed.

I am a donor. My stem cells went to a leukemia patient in California­.

It is a scandal that Americans have to die because they cannot afford healthcare­.


And still we have perhaps a majority of Americans who still label ObamaCara a government takeover, or socialism. I personally wish that it was. In truth, what we were given is the biggest gift to for-profit companies in the history of our country. Despite the speeches to the contrary, Republicans will never vote ObamaCare out, simply because the insurance companies fund their campaigns, and the insurance companies love ObamaCare.

I just wish the people of America felt as Ghandi felt, that "a nation's greatness is measured by how it treats its weakest members."

Saturday, October 02, 2010

Big Pharma Spins the Science

http://www.huffingtonpost.com/dr-mark-hyman/dangerous-spin-doctors-7-_b_747325.html#

Doctor Mark Hyman's latest blog concerns a hefty topic: How science is disappearing from our major--and still trusted--journals. He reports how French scientists selected the very best double-blind studies in the leading journals over the past year and independently verified if their conclusions were indeed correct. They found that 40% of these studies lied about the conclusions. Here, Dr Hyman writes:

In plain language, 40 percent of the studies we count on to make medical decisions are authored by scientists who act as "spin doctors" distorting medical research to suit personal needs or corporate economic interests. "Spin" can be defined as specific reporting that could distort the interpretation of results and mislead readers. If the conclusions in 40 percent of the papers published in medical journals are being spun toward independent interests, how can we consider the medicine we are practicing "evidence based?"


Big Pharma not only influences doctors' drug prescribing with their handouts of pens and sticky notes and lunches, but they directly effect what doctor's read in the medical journals by spinning the data to allow for better conclusions for their drugs. The media plays a role here too. They will often simply read the conclusions (wrong about half the time) and report on that with a nice juicy headline, rather than fully investigate. Follow the money? Not in today's media.

Is it any wonder that some state governments have had enough? (Vermont has outlawed pharmacy rep lunches and the handouts; the routine sampling by companies, which again results in huge profits, will come next.)

Another problem is the ease with which people with pharma ties go on to government positions. Here, Dr Hyman writes about the National Institute of Health:

Another example: In 2004, the National Institute of Health's National Cholesterol Education Program, dramatically lowered the ideal "bad" or LDL cholesterol level. This led to guidelines that expanded the number of Americans who "should" take statin drugs from 13 million to 36 million. There was only one problem. Eight of the nine panel members who established these new guidelines had industry ties. An independent group of over 30 scientists in a letter to the National Institutes of Health publicly opposed these recommendations.


Dr Hyman writes that 47,000 people died unnecessarily as a result of Glaxo's failure
to adhere to guidelines for posting data to the FDA. Finally, after being forced to do so on a public website, the companies data was independently analyzed and the drug came up for review. Still, the company's money trail still allowed the drug to stay on the market though under restrictive use.

So we have proof of a drug company allowing people to die so that profits can be made on a drug known to cause heart attacks. A drug company!

We have, in this country, drug companies actively killing patients for the sake of profit. We have insurance companies actively killing patients, again for profit. Yet the United States still remains convinced that private, for-profit care is the best model.

We have to one day wake up and stop trusting these corporations. They are mindless, and evil, no matter how nice and fuzzy those commercials are.

Wednesday, September 22, 2010

Need insurance for sick kids? Fuggedaboutit!

I sometimes get looks of puzzlement when I tell people that there is plenty of money out there to support a single-payer healthcare system. But when you look at the amount of money going to support the administration of claims for all the tens of thousands of private plans out there in this country you suddenly see hundreds of billions of dollars.

Rick Ungar writes a blog for Forbes. He recently wrote an article pointing out the recent decision by some big players to pull out of the child insurance business altogether (rather than have to underwrite sick kids). I've posted the link here: http://tinyurl.com/2u2cj7m

At one point he writes:
We can’t have it both ways. If we have an obligation to provide for the health of our children – and we do – and we don’t believe it is right to put this responsibility on the shoulders of the private market, then it falls to the public sector to take care of this obligation.

I know. We can’t afford it. And why should people without sick children be obligated to assume the responsibilities of those who do have a sick child?

For the same reason that people without children bear the tax burden of paying for the public schools your children are attending. And while schools may be suffering cutbacks due to stressed out budgets, I have yet to hear anyone, with the possible exception of a few extremists, suggest we do away with our public education system.


So, I wrote him a comment, which I paste below:
Disagree with only one thing. You state we cannot afford for a socialized healthcare for our children. I believe that to be inaccurate. Not only could we afford child healthcare but we could also fold in birth-to-grave care as well. By eliminating all insurance carriers and only have single-payer we would save hundreds of billions of dollars (each year). So why not do it? Well, there’s that itsy bitsy thing called a lobbyist and he happens to own Congress.

He was kind to reply:
I don’t think I said that we cannot afford it. I was saying that those who are against say we can’t afford it or it is not someone’s responsibility to take care of another’s child.
I agree with you completely. We not only can afford it, we have to afford it – even if it means making this a higher spending priority than other expenditures — like a useless war in Afghanistan.


He also later on agreed that sadly it is too true that lobbyists for the insurance carriers control the debate on healthcare reform.

A big shout-out Thank You! to Rick Ungar for spotlighting another evil machination of our precious insurance industry.

Saturday, September 04, 2010

A defense of Arizona Governor Jan Brewer and citizen candidates - National conservative | Examiner.com

A defense of Arizona Governor Jan Brewer and citizen candidates - National conservative | Examiner.com

The last line in this little defense is a killer. I read it and just had to put my two cents in. Gov. Brewer's transparent authenticity? But let's delve into the meat of this article first. It boils down to don't judge a book by its cover. That is, TV just cannot adequately portray the substance of policy. So it doesn't matter that Brewer became absent minded in the debate. And I agree. God knows I'd be a basket case in that scenario. No question. And who wouldn't? So I don't have a problem with her embarrassing exhibition.

What I have a problem with is the substance...or lack thereof. The video of her question-and-answer session with the media showed this quite clearly. She was asked point blank about her bogus claim concerning headless bodies found in the Arizona desert. She paused. And paused. Paused some more. Then she just turned and ended the session. Just like that. How's that for substance? How's that for transparency? How's that for being authentic?

I don't think this whole immigration thing is about immigrants, to be truthful. I think it is about money. It so often is, isn't it? Gov. Brewer has been led around by her nose by the state senator with the big interest in those private, for-profit, prisons. Now that makes some sense. After all, Arizona border towns haven't shown an increase in violence or crime in ten years, so that can't be the real reason behind all this. The economic drain on our country can't be the real reason either (studies consistently show that illegal immigrants have a small positive influence on our economy).

Well, whatever the real reason behind this circus, it sure has nothing to do with transparency, nor authenticity.

Saturday, August 28, 2010

Physicians know best...but not ex-lieutenant governors

http://www.timesunion.com/opinion/article/Physician-really-does-know-best-617040.php

Betsy McCaughey, Ph.D. (make sure you see that big ol' Ph.D. cause it's real important, though it does happen to be in constitutional history, not anything to do with medicine as letter writer Forrest Gatton point out--cf. http://tinyurl.com/24rjt6v) used to be the lieutenant governor under Pataki during his first term as governor of NY. Remember her? She was the one who insisted on standing up the entire time during Pataki's State of the State speech. You may not also know she was largely responsible for killing the Clinton health plan basing it (falsely, in this writer's opinion: cf. The White House. Analysis of New Republic article on health care reform. Little Rock: William J. Clinton Presidential Library and Museum, January 31, 2004) on a complicated algorithm that highlighted a bewildering bureaucracy. You probably do know her as the author of the so-called "death panel" report that tried to paint ObamaCare as some kind of Grandma killing machine. Thankfully, most people saw through her idiocy. So apparently she likes to dip her toe into the tepid waters of medical knowledge.

And yet it seems she has absolutely no medical knowledge to speak of. If you read her letter you will come away with the thought that somehow generics are abysmally inadequate to the task of healing. She implies that there are studies that prove this. She writes that "generics are less effective or cause side effects in some patients."

Well. I could also add that brand drugs are also less effective or cause side effects in some people. Generic drugs are bioequivalent to brand drugs and undergo scrupulous testing. There may be occasional lapses in manufacturing quality control, but that is equally true for brand drugs. Remember the Tylenol recalls of about six months ago?

Now, anyone with a scintilla of medical knowledge knows this woman is entirely ignorant as regards matters pertaining to healthcare, as this latest letter of hers attests. But I find that she is currently in New York City, as chairman of the Committee to Reduce Infection Deaths. God help us. And who appointed her to that important committee? Who?

I like what James Fallows of The Atlantic Monthly says regarding her (I got this, yes, from Wikipedia): "She has brought more misinformation, more often, more destructively into America's consideration of health-policy issues than any other individual. She has no concept of 'truth' or 'accuracy' in the normal senses of those terms, as demonstrated last week when she went on The Daily Show." (If you'd like to track that show down go to August 20, 2009)

Monday, August 16, 2010

What's your total cholesterol? Who cares?

Caveat: Although after reading this article you may realize there is evidence for questioning the effects of your cholesterol lowering statin drugs, always consult your doctor and have a frank, and open discussion regarding your medication.

So what is your Total Cholesterol? Well, in the article above, Dr. Joseph Mercola makes the case that your total cholesterol number is a "straw man," a number manufactured by, well, manufacturers in order to sell you medication that you probably do not need. The AMA, as the article states in the bottom third of the article:


"Eight of the nine doctors on the panel that developed the new cholesterol guidelines had been making money from the drug companies that manufacture statin cholesterol-lowering drugs."

Dr. Mercola points out that it is the underlying inflammation doing damage to your arteries that is vitally important. The body then makes more cholesterol (by your liver) in the attempt to repair the damage (cholesterol is made to repair cell membranes). Prevent the inflammation and you prevent the problem.

He goes on to also point out the many adverse effects of these expensive statin drugs. These are not innocuous agents.

Do yourself a favor: read the article and ask your doctor about these medications if you are currently taking them or thinking about the possibility.

Sunday, August 15, 2010

First sentences

I am endeavoring to produce a blockbuster, earthshaking, and potentially an academically career-ending theory for literary criticism:

I read the first sentence and judge accordingly.

Witness the following time saving reviews (totally at random):

In the beginning God created the heavens and the earth.—But can He follow that up?

On an exceptionally hot evening early in July a young man came out of the garret in which he lodged in S. Place and walked slowly, as though in hesitation, towards K. Bridge.—Heck of a sentence. I predict great things from this writer, a Mr. Fyodor Dostoyevsky. Note to Hollywood: Don't change that name.

For a long time I used to go to bed early. —Ok, maybe this loses in translation. (Swann's Way by a M. Proust.)

Look at a map that shows the north Pacific Ocean. —Obviously written by a Neanderthal. (The complete Idiot's Guide to American History, 2nd Ed.)

On my right hand there were lines of fishing stakes resembling a mysterious system of half-submerged bamboo fences, incomprehensible in its division of the domain of tropical fishes, and crazy of aspect as if abandoned forever by some nomad tribe of fishermen now gone to the other end of the ocean; for there was no sign of human habitation as far as the eye could reach.(Joseph Conrad's "Heart of Darkness") —Well. You know darn tootin' that if this was submitted to a dozen publishers today it would be rejected right here. A red highlighter would be followed with the marginalia "Are you kidding me? I don't have time for this."

A-OK. —How cliche. (The Dictionary of Cliches.)

"The marvelous thing is that it's painless," he said. ("The Snows of Kilimanjaro," by E.Hemingway) —This first sentence proves Ol' Hem is far from painless. Reading Hemingway is like going to the dentist.


Well, I guess you by now have an idea of the time savings proffered by this revolutionary technique. Try it yourself. Your only problem will be in finding enough things to keep yourself busy, what with all the hours and hours of wasteful reading you have by then uncovered.

Thursday, August 12, 2010

Death By Handwriting--escripts to the rescue!

Death By Handwriting

About five years ago I read in one of my pharmacy journals about a new fangled fix for doctor's bad handwriting (technically known as "cacography" and is responsible for thousands of hospital admissions each year, billions of wasted dollars, and millions of wasted phone calls from pharmacists, so hey, no laughing matter), utilizing e-scripts, or electronically transmitted prescription which are generated on a handheld PDA by the prescriber then transmitted to pharmacies. The process, besides eliminating illegible scripts, had the additional benefit of potentially alerting MD's to possible interactions and drugs that would require prior authorizations by insurance companies before being transmitted. That way, the doctor would know that the Biaxin script he/she wrote for on a Friday night would need to be changed to something else that the patient could actually pick up.

(I personally like Montana's solution, fining a doctor $500 per illegible prescription. But who decides what is illegible?)

So, a good thing all around, yes? Well, um, I guess you could say there's a glitch or two.

First, probably because of additional costs, doctor's don't seem to be utilizing the functions, or potential functions, of these e-scripts. Prior authorizations are still common in all types of prescriptions, including e-scripts.

Second, though the scripts are easily read, what the pharmacist is actually reading isn't necessarily what the prescriber meant to write for. Many programs have the medications closely spaced together, allowing for errors of selection. Allegra-D 24 hour can be right below Allegra-D 12-hour. Whoopsies.

An interesting error that I recently ran across was an e-script that had the word "until" next to "7 days." What came out on the potential label was "l7 days." That's a lower case L, not a numerical one. It seems that some programs that doc's use do not allow for automatic line formatting. This particular error was caught by the pharmacist, as he saw that the 17 day supply was unusual. But what if it wasn't? Whoopsies.

So with the new technology we have to be aware that there will be new types of errors occurring, errors that we as yet may not even imagine.

Tuesday, August 10, 2010

The march of the generics!

For those wishing to know, there are many medications slated to lose patent life in the next several months. One caveat: once the patent expires, there is often litigation which results in a prolongation of the legal life of the brand. There are several events that may occur that prolong brand exposure, including litigation, patent settlements (manufacturers will agree to discontinue litigation in exchange for some monetary reward--nice, huh), final FDA approval, submissions of citizen petitions on behalf of brand manufacturers to the FDA, and "at risk launches" which means that once a generic is approved the generic manufacturer can go ahead with the generic but risks further litigation with the brand manufacturer.

That being said here's a list of some drugs going off patent:
Skelid
Cardene SR
Iopidine eye drops
Vistide
Combigan eye drops
Androgel
Androderm
Arixtra
Carbatrol
Concerta
Duac
Lovenox
Lybrel
metadate CD
Sanctura
Tarka
Elestat eye drops

Thursday, July 22, 2010

(S)news

I grew up watching the news. My family would watch the news--network news, of course, as this was before cable--while having supper. Usually NBC. I remember the peacock logo. For the longest time, into my twenties, I assumed that that was how people knew what was going on in the country and world. The newspaper was delivered as well; my father read it dutifully. I, on the other hand, mainly read the comics and the sports section.

Eventually I came to love the print media, preferring magazines and papers for their more in-depth coverage of events and political analysis. I gave up on TV news. For a good long time.

Lately I've been watching again. More out of curiosity, to see what's being covered. What I've discovered is that there really isn't anything being covered anymore (was there ever?). Every evening there is a run-down of four or five stories, and I do mean stories. These are all feel-good human interest stories, devoid of any analysis of causes or conclusions. Tonight, on NBC, I watched a story of laid off workers at the Ameripure Oyster Company. Lasting less than three minutes, we learned next to nothing of the economics of the event, but we did get a concentration of feel-goodness about how people are helping these unfortunate unemployed people. Going to the NBC News website I thought I'd check to see if there would be some in-depth-ness but sadly, no. Only an embedded video that was identical to what I'd already watched. Pathetic.

Another story had more promise. It reported on the new Arizona immigration law. There was a sentence or two on why the Federal government was filing suit even before the law has come into effect (power, said a university professor), and there was a statement by a pro-Arizona law person condemning the Federal inaction on immigration reform. The report--again under three minutes--closed with a, you guessed!--human interest angle with a woman married to an illegal immigrant, begging that the good people be allowed an easier option to become legal civilians.

Almost enough time passed in all these stories to allow some to convince themselves that they actually learned something. But not quite. There is no question why viewers are leaving network news: no substance. What can you say in under three minutes that shows real intelligence and might be influential for viewers?

The network news programs are a desert. They are surpassed in their myopia only by FOX and, yes, MSNBC. Both have their adherents, choirs loving the sound of their own voices.

There simply are not a lot of people searching for real news. People do not search for news, they search only for the viewpoint that they already have, confirming the great amount of respect that they have for only themselves and those like them.

It is my opinion that the country would be much better off if all the conservatives watched MSNBC, and all the liberals watched FOX--OK, maybe not FOX but at least CNN. Something other than that which spoon feeds us our morsel of regurgitus.

Wednesday, July 14, 2010

The reason why market forces will never work with healthcare

I recently underwent a preventative procedure at a local hospital. I thought it might be instructive to follow it through from start to finish, just to see how the system actually works, or doesn't work, as the case may be.

My visit began with a routine examination at my primary physician. After determining that I just turned 50 he told me that it was time to schedule a colonoscopy. Yikes, I thought, but if it was good--or bad--enough for Katie Couric then I guess I could put up with it too.

So, after giving me the name of a specialist, I called and made an appointment. Pretty simple. He advised me on what was going to happen and why it was important, what to expect and so forth. He gave me a prescription for MoviePrep and I went to the pharmacy. Being a pharmacist myself, I already knew all about the stuff so I just went to pay for it. $50! Yes, the MD had kindly given me a coupon, but that still made the total out to be $30. (Note: one month later I still haven't received the rebate.) My outlay so far totaled $22 MD visit Primary Care, $22 specialist office visit, $50 medication. $99 total (minus the $20 rebate, but I'm not holding my breath there from past experience).

Then the day of reckoning. The procedure is by far the easiest part of the whole thing. If you can get the MoviePrep (or Colyte, or GoLytely, or PEG Sol'n) down you're already pretty much done with it. They give you some valium and the opiate of choice and you're in La-La land.

Then the difficulties will start. My insurance--yes, I know, many of you won't have insurance and I hope you know by now after reading my blog that I'm a fierce advocate of Medicare-For-All--is supposed to pay 100% of any preventive care procedure like this. Of course, to an insurance company "100%" can mean so many things. You'd think it would include office visits too("100%" actually translates mathematically to "everything" after all). But such isn't the case. Does it include deductibles? It should but not necessarily.

Now let's experiment a little here. Let's suppose we're market people, capitalists all who feel that all we need to do is have low cost catastrophic insurance along with HSA accounts. That's where the employer or government puts money into an account and you can draw on that for medical bills. Sounds great. I used to think so. I lobbied for HSA's for years. Then I got one and found out that it is actually impossible to shop around for care. That is the whole idea of HSAs, to empower patients to shop around for the lowest cost, but highest quality care.

So let's say that instead of my insurance I have an HSA. I call up my doctor and ask how much the colonoscopy is going to cost. He tells me $1500. Wow, I think. I'm going to call up a few other people. Turns out they all are about $1200 to $1800. My guy is right in the middle, and what do I know about how good this guy is? He was recommended to me, but I have to honestly say I have nothing to go on but my gut (so to speak).

My HSA has about $3000 in it so I'm just going to go for it. I'll still have enough in there for the dentist and some more visits to the doctor in case I need them.

But what I didn't know was that I'd receive a bill for the Recovery Room. Hadn't thought of that. Didn't even know there was a billing for special rooms. Got a bill for Medical Supplies too. Another for those cool opiates. The one I really like, my favorite of favorites, is called "Other Hospital Services." Turns out that that one was almost the greatest amount, too. The next time someone tells me HSAs are the answer I'm going to ask him how the heck you're supposed to shop around for "Other Hospital Services." If I'd had an HSA I'd be out of luck, as the total wasn't the $1500 I'd shopped around for, but over $3000 for the "Other Services" etc.

So, you ask, what is the upshot? About 2 hours ago I received a bill from the hospital. A bill, say I? It's supposed to be free. So I dutifully call the insurance company and ask about the $300 "free" bill. I call the number on the back of the card and speak to Andrew. Andrew seems a pleasant fellow, so I with-hold my rising frustration. He tells me he's having trouble locating my ID number. I had inputted it into the ridiculous phone tree, but I tell him again. Nope, he says, I can't find it. "That prefix is for [company name XYZ], right?" he asks. Right, I say. Well, we don't handle that here. What number did you call? I told him the phone number and that it is listed on the back of the card. "Something must be wrong with their phone system," he says, pleasantly enough. I can tell he is a bit perplexed himself. "But what is your problem and maybe I can be of assistance," he offers anyway. So I tell him. It is supposed to be a free preventative service, yadayadayada. "Yeah," he says. "And I see that we paid them more than what they billed for." Well, ain't that interesting, I think.

He advises me to wait two hours and call the number again. Maybe the phone system will work then.

I call them back and this time they--Sherri, actually, this time--find me. They also locate the problem. The balance due, which should have been nothing, came out as $285 and they put that through toward my deductible. The hospital, in other words, feels they are owed this amount, even though it is a routine preventative "Wellness" procedure. So now the insurance company--actually the benefit manager for the insurance company--is going to go ahead and re-bill it again, as the customer service rep couldn't get the amount fixed over the phone. I have the option to call the hospital and basically tell them I don't owe them a thing and to wait about ten days for it to clear the insurance, or just do nothing and hope I don't get billed again in the mean time. I elect the latter, knowing through experience that healthcare billings are routinely inefficient and it will take about a month before anyone notices. At least.

So if I was the type who didn't know the system, didn't trust the company, didn't know the hidden inefficiencies, then I might just have figured I owed another $285.

Lesson: Never assume the bill is correct. Never assume even the insurance reps know what is going on. Never, ever, ever assume you will even have a clue as to what will eventually be billed.

And never believe simplistic solutions like HSAs will solve our problems. You'll just get burned.

We basically have two options: Stay with our current tinkering (and ObamaCare, while a vast improvement over the existing "non-system" is still tinkering) or go with an overhaul such as Medicare-For-All. I vote strongly for the latter.

Friday, June 04, 2010

Big Oil and Bobby Jindal (cont.)

Continuing my rant from yesterday's post re Bobby Jindal's utopian air of laissez-faire oil drilling, I'd like to point to the map, specifically to Nigeria. The country, sitting in the middle of the African continent on the crook of the western coastline, is the most populous in Africa. It is rich as well. Rich in oil. Unfortunately is is poor in just about everything else, also mainly due to oil.

From 1970 to 2000, according to Nigerian government estimates, there were 7000 oil spills in the country. One of the most devastating spills has occurred in the Niger Delta, and is at least as large as the Deepwater Horizon disaster now pummeling the Gulf of Mexico.

But in Nigeria there is no camera crew to cover it. No Brian Williams to interview some government hack. There isn't even a Shell Oil executive appearing on TV wearing a look of frustration. There's pretty much nothing, except for a lot of oozing ugly greasy black stuff.

Nigerian light crude--the most desired of the grades of oil--accounts for 40% of the amount of oil the US imports. 40%! But do we care about the Nigerians living in this hell-hole? Heck no. (Nigerians now have a life expectancy of...40!) Do any of the oil companies? No. Shell waited six months to even send somebody out to the latest spill. As long as BP cleans up our mess (not a sure thing, by the way) we don't seem to have a concern. But we should. Here's why:

1) Nigeria and Mexico and other large third world countries that live on the income that oil gives them are proving grounds for the basic truth of the oil industry: Greed matters and it is the only thing that matters. Fishing industry ruined? That is not the concern of Big Oil. Human rights? Not the concern of Big Oil. General welfare of the populace? Not the concern of big oil.

2) Oil drilling is hazardous, not only to those brave souls who live--and die--doing the hard labor, but for those living nearby and those living even not so nearby. Water in Nigeria may very well become more valuable than the oil that has poisoned so many wells, simply because it is becoming scarce. Here's a clue: we can believe that oil is becoming scarce when Big Oil starts caring about all the crap it is leaving behind.

3) Oil drilling has one certainty to it: environmental disaster. Let's start adding up the real cost of oil. If we did we'd find that a gallon of gasoline doesn't truly cost $2.86 a gallon but more like $10 a gallon.

4) Bobby Jindal is one of a bunch of government flunkies that will do the bidding of Big Oil, even to the detriment of those electing him. These people get elected by ignoring the reality of the Gulf, of the Mexican spills, of the Exxon Valdez, of Nigeria. They say things like "we shouldn't have to choose between clean beaches and oil."

Well we do. We have to choose. Let's do choose and choose wisely.

Thursday, June 03, 2010

Tonight I was watching NBC News with Brian Williams interviewing Louisiana Governor Bobby Jindal at the scene of the oil spill. Globs of oil covered the beaches. Brown ooze now blankets the Louisiana coastline, coating pelicans and terns and so forth.

You might expect Jindal to be a tad circumspect regarding future oil rigs bobbing up and down the Gulf. But you would be wrong. Jindal adheres to the Republican platform (full disclosure: this author is a Republican, written with a punctuated embarrassment) of Drill, Baby, Drill! Even now. Even now.

He says, "We shouldn't have to choose between drilling for an energy source like oil and clean beaches." Really? And Avatar wasn't a movie...it was a documentary! And Harry Potter is alive and well somewhere in the Lakeside District of England.

If this disaster hasn't shaken the likes of these Republican oil barons (and their lackeys) into reality from their Utopian dream of clean carbon energy sources, then nothing will. And apparently nothing is going to.

The citizens of Louisiana should kick this guy out of office pronto. Any mention of drilling anywhere near the Gulf should be met with an oil glob pie right in the face.

Wednesday, June 02, 2010

Brand v. Generic (this time for pets!)

The New York Times has published an article that neatly dovetails with my previous blog entry, the one concerning brand v. generic. It appears that two renowned scientists, a Marion Nestle, the Paulette Goddard professor of nutrition, food studies and public health at New York University, and Malden C. Nesheim, emeritus professor of nutrition at Cornell University, have taken the lion's share of pet food and sifted the remains in order to find out what precisely is in there, and more to the point, what is really the difference between the high end vittles and the low end (published as “Feed Your Pet Right: The Authoritative Guide to Feeding Your Dog and Cat,” published in May by Free Press). You've probably guessed by now about the conclusions. Right. Not much difference. Maybe a prettier package, but all these pet foods come from the same source: human scraps.

So you can spend a lot on your pet and feel all fuzzy good that you are doing your best for good old Max but who--or what? but then again, corporations are people now aren't they?-- you are really doing your part for the bottom line of some rather large food conglomerates. So give yourself a big pat on the back. Bravo! Now hurry up, as fido wants his filet mignon biscuit and I want my stock dividend!

Sunday, May 30, 2010

Brand Loyalty and Tylenol

I confess to a slight measure of satisfaction on hearing the FDA is weighing (See? Measure, Weighing...Ahh, metaphorical congruity!) penalties on J & J (Johnson and Johnson). The manufacturer of Tylenol products has been found less than upfront about certain irregularities at its manufacturing plant.

I remember so well trying to convince customers to save a lot simply by buying generic versions of the Tylenol brand products. The generics were often half the price for the same stuff. The vast majority of people, not having money to burn, bought the generics. But once in a while someone would come to the counter and insist on brand only, usually with a huff, saying in effect, I only buy the best!

Well, I thought to myself, I remember that Tylenol poisoning thing going on (though no fault to the manufacturer) about thirty years ago. Didn't seem to hurt people's confidence in the brand. But now, given J & J's current display of quality abandonment, perhaps these people will realize their mistake, that trusting some huge corporation because they've created a "Brand" doesn't mean squat.

So to all those suckers out there buying brands because they don't want to sully their wallets with faux fillers: Told you so!

Friday, April 02, 2010

Public Option just a matter of time

The Public Option is coming...

It's only a matter of time before the public option in healthcare comes back to the table. Why? Because the insurance company's shenanigans will eventually anger enough people that both Republicans and Democrats will see that it is to their advantage to have it implemented.

The insurance industry has already begun to exploit the loop holes. People between the ages of 55 and 65 will see their premiums triple. Many will not be able to pay their premiums and will have to forgo insurance entirely and pay the penalty. If there was a public option they wouldn't have been able to get away with that (thanks Republicans!).

Think pre-existing conditions went away with this new legislation which outlaws pre-existing conditions? Think again. According to the Huffington Post [http://www.huffingtonpost.com/2010/03/31/insurance-industry-alread_n_519503.html], the companies are allowed "to charge as much as 50 percent more for people who engage in unhealthy behaviors." As Marcia Angell says (a former editor of The New England Journal of Medicine who now teaches at Harvard Medical School), "With anyone who's chronically ill, you can always find an unhealthy behavior. So that's the new preexisting condition."

And just think: the regs haven't even been written yet. Think the insurance lobby isn't going to have a hand in that? Think again.

People are going to want a public option some day. Let's hope it comes soon. And who knows? Maybe there will be enough people sick enough to throw all the bums out and come up with Medicare for All...saving hundreds of billions of dollars.

Sunday, March 28, 2010

New York's Sugar Tax

New York state, the state I like to call the "Fiscally Challenged State,"--and yes, I know that California is a worthy contender--is contemplating a tax on soda and sugared drinks. The idea is that government can alter the behavior of people, dissuading them from purchasing an unhealthy product. The real reason behind this is of course to bring money into the coffers of the state--New York is facing a 9 to 13 billion dollar deficit (and that's only what they are telling us).

The Times Union newspaper has come out in favor of the tax, saying that the state needs the money and the people need to be told what not to ingest. "Yes, it would be easy to say, just cut spending" posits their recent editorial. Right. But they left one word out: drastically. Just cut spending...drastically.

The problem with New York is not that they don't have enough money coming in. They have plenty. The problem is that they have too much going out. And yes, that means that a lot of people are going to be upset with their particular projects being cut. Too bad. Welfare needs cutting (45 billion dollars!) and education needs cutting.

Did I just say that education needs cutting? How can anyone say that? Because it is true, that's why. New York is #4 in spending per pupil, and #36 in SAT ranking. Iowa, spending at the national average leads the SAT pack. What I propose is to lower spending per pupil to the national average. Spending more money does not help education; it may just hinder it.

More money coming into the state is just more money to be spent, and where will this end? Even the Times Unions writes: "Still, it would be easy to say, isn't this a slippery slope? What's next? Pizza? The all-American hamburger and milkshake?
To that argument, we say, let's take this one battle at a time. As for this one, proponents of the soda tax clearly win on the merits."

One battle at a time. Fine. Let's win this battle and put an end to the war. Stop the soda tax.

And stop re-electing representatives, OK?


Read more: http://www.timesunion.com/AspStories/story.asp?storyID=916123&category=MONEDIT#ixzz0jTSF38ES

Thursday, March 18, 2010

Lou, the Proctor & Gamble Guy

I thought I would answer Mr. Lou Pritchett, who wrote A LETTER FROM A Proctor & Gamble Executive TO THE PRESIDENT. For those not familiar with this letter please see my previous post.

Lou,
You are a former soap salesman, which seems at first glance to be a real nice, clean sort of a job, but you scare me more than WWF Smackdown star "Lethal Weapon" Steve Blackman. Why?
You scare me because after just fifteen minutes of Internet fame, hundreds of thousands of people have read your letter. And apparently you really did write this. Most people would have said, Heck no, that must have been some other me.
You scare me because after a day of trying to figure you out I still can't. And I don't know where you went to school.
You scare me because I don't know who paid for you to put that, um, um, stuff out there.
You scare me because I don't know how a simple salesman--and I do mean simple--of soap could rise to become a vice president of Proctor & Gamble...and then write this, um, stuff.
You scare me because you haven't let everyone know how much you made as vice president, who are your friends, what political affiliations you have, and who you give money to. You are really scary.
You scare me because I don't know if you've ever been in the military. Only military men are worth anything.
You scare me because you've never been on Medicaid. Only those on Medicaid really know what is going on in the real world. Vice presidents know squat.
You scare me because you lack humility and class...and you don't know when to use quotes.
You scare me because you don't seem to be the kind of guy who will stand by your friends and pastor even when you disagree with them...you seem pretty extreme.
You scare me because you are a cheerleader for Rush Limbaugh's America, which by the way, isn't the real America.
You scare me because you want to say, No, to a European style government controlled healthcare system which would save 40,000 lives a year. Really scared.
You scare me because you want to convince people that it's better to Drill, baby, drill, than to put OPEC out of business and make America great again.
You scare me because you seem to love banks. Who loves banks????
You scare me because even your own Republican friends won't tell you the truth that it was them who revved up the ol' deficit wagon.
You scare me because you probably won't realize that you are not one of those "intelligent friends."
You scare me because you falsely believe that you are both omnipotent and omniscient---see? Only people who really think that of themselves say that about others. Scary.
You scare me because you like and want to encourage the Limbaugh's, Hannitys, O'Reillys and Becks who offer opposing, conservative-and wrong--points of view.
You scare me because you seem to prefer idiotic letter writing to actually learning about something.
Finally, you scare me because I have a feeling I'm going to have to read another of your letters spammed to me in four more years when Obama is re-elected and it isn't likely to make any more sense than this one.

You Scare Me

Had to report this, as it surprised me to no end. I recently received from a friend (yes, I have those), a letter circulated the Web by a certain ex-vice president of Proctor Gamble, a Mr. Lou Pritchett (author of Stop Paddling and Start Rocking the Boat).

After reading the letter I was sure it was fake. These sorts of letters are easy to spot and they are constantly flooding everyone's in-boxes. The style is normally a bit high school, their logic jejune, and they are more than a bit combative.

The letter I speak of exhibits all those traits, but incredibly, at least according to Snopes.com, it is confirmed by the author to be, in fact, from his own hand.

The letter is printed as follows, and I am preparing a persnickety answer and I will post it hence.

AN OPEN LETTER TO PRESIDENT OBAMA

By Lou Pritchett

Dear President Obama:

You are the thirteenth President under whom I have lived and unlike any of the others, you truly scare me.

You scare me because after months of exposure, I know nothing about you.

You scare me because I do not know how you paid for your expensive Ivy League education and your upscale lifestyle and housing with no visible signs of support.

You scare me because you did not spend the formative years of youth growing up in America and culturally you are not an American.

You scare me because you have never run a company or met a payroll.

You scare me because you have never had military experience, thus don't understand it at its core.

You scare me because you lack humility and 'class', always blaming others.

You scare me because for over half your life you have aligned yourself with radical extremists who hate America and you refuse to publicly denounce these radicals who wish to see America fail.

You scare me because you are a cheerleader for the 'blame America' crowd and deliver this message abroad.

You scare me because you want to change America to a European style country where the government sector dominates instead of the private sector.

You scare me because you want to replace our health care system with a government controlled one.

You scare me because you prefer 'wind mills' to responsibly capitalizing on our own vast oil, coal and shale reserves.

You scare me because you want to kill the American capitalist goose that lays the golden egg which provides the highest standard of living in the world.

You scare me because you have begun to use 'extortion' tactics against certain banks and corporations.

You scare me because your own political party shrinks from challenging you on your wild and irresponsible spending proposals.

You scare me because you will not openly listen to or even consider opposing points of view from intelligent people.

You scare me because you falsely believe that you are both omnipotent and omniscient.

You scare me because the media gives you a free pass on everything you do.

You scare me because you demonize and want to silence the Limbaughs, Hannitys, O'Relllys and Becks who offer opposing, conservative points of view.

You scare me because you prefer controlling over governing.

Finally, you scare me because if you serve a second term I will probably not feel safe in writing a similar letter in 8 years.

Lou Pritchett

Note: Lou Pritchett is a former vice president of Procter & Gamble whose career at that company spanned 36 years before his retirement in 1989, and he is the author of the 1995 business book, Stop Paddling & Start Rocking the Boat.

Separation of Church, Politics

Though the gates of Hell shall not prevail against it, the Church is having a tough time.
Although most Americans view themselves as spiritual, they seem less inclined to stand by religion’s banner. In December, a PEW poll showed an increasing likelihood that people identify themselves with New Age beliefs. A recent Newsweek poll showed that nearly 9 of 10 people identify as believing in a higher power. So people still see themselves as spiritual, just not as inclined to join a church.
Something is happening for people to invoke a sense of spiritual need. God still calls to us somehow, but where to?
The Church has one job, given it by Jesus Christ with these words from the Book of Matthew: Therefore go and make disciples of all nations, baptizing them in the name of the Father and of the Son and of the Holy Spirit, and teaching them to obey everything I have commanded you. And surely I am with you always, to the very end of the age.
Note the two parts of this injunction: 1. Make disciples 2. He is with us.
How has the Church made disciples throughout Aemrican history? By means of force (the Puritans with their brand of Taliban-ish Christ-by-fiat Christianity), and by means of emotion (the Great Awakening revivals) and inculcation (passing the torch down through generations in a kind of spiritual DNA).
The results have been mixed. New England began as the bedrock of Pilgrim influence, but is now the least religious part of the country. Roger Williams, founder of Rhode Island, was driven off the colony for being too tolerant of other’s beliefs. He felt government wasn’t the best place to find “the Church.” Coercion of faith was anathema to Roger Williams.
Did appealing to emotion work better? The Great Awakening of the 1730s changed the course of America, influencing the founding fathers. The Awakenings of 1800 and 1850 (the Salvation Army) and 1903 (Pentecostalism) created the American Protestant church as we know it today. But with every high tide of passion came a low tide of disinterest. The Church now calls for another revival, in hope that the Holy Spirit will baptize people into their congregations where the Church itself has failed to in the Great Commission to “go and make disciples.”
What of the method whereby discipleship is transferred by example, those “points of light” of President George H.W. Bush. Many work tirelessly out of love and respect for mankind — and God. World Vision, for example, does Christian work without being a church. It lays the groundwork with honest hard work and devotion, but does not attempt conversion. Many Godly charities are being drowned out by more dramatic, political speech.
To ride the political train, looking to get the best seats on the railway to heaven, risks losing touch with those who need to hear Christ’s message. When politics becomes dirty (when isn’t it?) people in association with power appear dirty too. It shouldn’t surprise anyone that the young see the Church as part of the problem. What great cause has galvanized it in this age of seemingly insurmountable problems — looming financial panic, a health care system that forgets the uninsured? Neither. What seems to unite the Church has been the fight against gay marriage, the so-called Sin of Sodom. And did you know that the real sin of Sodom wasn’t so much the sex? No, it was the sin of arrogance (look it up: Ezekiel 16:49).
So instead of reaping the harvest of the Great Commission, we risk pushing people away from Christ’s message of love. The Church is perceived by many to be a political player, alongside corporations and lobbyists, another secular tile in a game of dominoes.
There will always be Christians who stand out by presenting their burning candles, offering shelter, giving succor to the poor and sick. This is the real Church, unconcerned with political gamesmanship. And the people of the Church will be easy to spot: “by their fruit ye shall recognize them.” Remember, Christ said, “Not everyone who says to me, ‘Lord, Lord,’ will enter the kingdom of heaven, but only he who does the will of my Father who is in heaven.” My guess is that some have forgotten it is Christ’s will that we should seek, not that of some political party.
He is with us always. The gates of Hell shall not prevail. I assume that means Washington, D.C.

Friday, February 26, 2010

Who'd a thunk it? Health Care Debacle Leads to Love!

As reported in The New York Times the awful U.S. healthcare "system" has one shining virtue: It forces people to marry.

Philip Swift wanted to marry his sweetheart, Katie Robbins. But she didn't seem to want the commitment, in a reversal of the normal man-commitment-phobia. Three years went by and Mr. Swift developed kidney stones.

Mr. Swift, like millions of other Americans, doesn't have access to health care. But Ms. Robbins did. Thus:

Katie and Philip
Sittin' in a tree.
M-E-D-I-G-A-P.

Sunday, February 21, 2010

The future of pharmacy

Which is better, a store with many registers where you have to guess which line will be faster (think Wal-Mart, Target, grocery stores)or a store where there is but one queue, one line, and where you are directed to a eventual open register (think Best Buy, Marshalls, TJ Maxx, Borders)?

Well, Richard Larson, an engineer at MIT, but also known as Dr. Q--a "queue psychologist"--says that there are definite advantages to the single queue line. Though wait times average the same, anger issues are lessened by the knowledge that there is a definite first-come, first-serve.

There is also an advantage to the store. While Q-ing up, your attention is focused on all the little things up for sale along the way whilst you wait. Nice for impulse buys (always high profit items for stores).

But while Q-ing up at a local Marshals, I thought of another advantage to such a queue: privacy. Here I was waiting for a register with a pair of pants and socks, and I noticed that I was about fifteen or twenty feet from the nearest register. I couldn't even hear what was being said by the clerk or customers. Now wouldn't that be just the ticket for a pharmacy where some druggist has to explain to some poor bloke about his ED drug, or some woman about her miconazole?

If you've been at a drug store lately you know how the procedure works. You pick up your medication at the register and if you want to be counseled there is a little window cubby just to the left or right where you scoot yourself to so that there is "privacy" and the nosey-nancy just to your right can still hear every word. And usually the pharmacist is so busy he/she tries to counsel the person right at the register but getting the person to say all the "private" things so they aren't liable for HIPAA (Health Information Portability and Accountability Act).

Wouldn't it be great if pharmacies had a system like Marshalls, and the other people couldn't overhear private, sensitive conversations that are really none of their business?

Thursday, February 18, 2010

Mail Order Prescriptions?

Mail order prescription service is now 6.7% (as of 2008) of all retail prescriptions sold in the U.S. That's 238 million scripts...and growing.

Want to know what happens--and the pitfalls along the way--when filling your prescription through mail-order? Well, follow along.

1) You've got the prescription from your doctor. You need to contact your PBM (that's your Prescription Benefit Manager which you probably think is your insurance but really is a partner with your insurance). The largest PBMs are Express Scripts, Caremark, and Medco. They will send you a form--maybe you already have it--for you to complete and send in along with your prescription. But wait--before you lick that envelope take a good look at that piece of paper. (It would be better to do this at the doctor's office, but if your already home, don't worry.) Looking at the prescription, does it look right to you? Any mistakes? No? Good, but it's a good idea to fill in your address, or better, write it on the back of the prescription along with your phone number and date of birth. Also, any allergies or any information that would be pertinent. If you did find something wrong, call the doctor and have them fax the correct prescription to the PBM/mail-order company. If your doctor agrees to fax prescriptions (almost all do) you can save yourself some time and trouble and just have the doc do that when you're at the office. Just be certain you have the correct fax number. Double check them!

2) So you've sent out the prescription. What actually happens to it? First it gets scanned into a computer system, front and back, along with everything else that came in the mail: order forms, even the envelope! Data entry technicians then enter the information from the scanned prescription (they're looking at a computer image, not the actual piece of paper, which is filed away). Now do you see the importance of a well written or typed prescription? Any ambiguity here gets put into the computer and if not caught will result in your not receiving the correct medication. Good handwriting counts! Also, if the prescription is clear and read easily you will get your medication in a much shorter time interval than one that has to be sent back to the troubleshooters who then have to call or fax the doctor and start all over again. The prescription is then sent on to its next station, DI (Drug Interaction). There it is screened by pharmacists specially trained in drug interactions for any possible problems that might occur with other meds you are taking, even over-the-counter medications (be sure to fill out all the information on the forms: think pain relievers, herbals, vitamins, diet pills...anything).

3) If and when all the problems are taken care of the prescription then goes to the insurer who if they agree to pay for it then sends the prescription back to a pharmacist verifier, who compares the prescription image with the entered data. If it matches up fine it goes to a fill center, often not even in the same building as the pharmacists checking the prescription. Do you picture these places as giant warehouses where pharmacists are busy counting pills by fives on counting trays? Um, no. They are giant, though: Medco has one that is about as large as six football fields. Express Scripts--the nations largest PBM--has one coming online next April that will fill 110,000 prescription in a single day! But not by hand. By robots. These places all fill by robotic machinery: it's safer and faster.

4)The prescription once it is filled is put into a shipping container and put in the mail.

From start to finish it should take two weeks. But that is IF there aren't any snafus along the way. The most common reasons for longer waits are bad handwriting and errors by doctors. If either occurs then the pharmacists or technicians --or both-- have to contact the doctor and that can take days. That's the reason you should give the prescription a good look-see before you send it off. Errors are very common. Very. Saves you time to look before you send it out.

One caveat: if you're sending out a prescription for a control drug, DO NOT CHANGE ANYTHING ON THE FACE OF THE PRESCRIPTION. It could be considered as altering a controlled prescription, which is a felony. Not a smart thing to do. Better to write something down on the back of the prescription, or attach a note.

Monday, February 15, 2010

Speed kills

Ken Lawton of Newfoundland has a point in his blog. It's not necessarily speed that kills, but recklessness. Not merely a fast driver, but a fast, drunk driver. Or a fast impatient impatient driver holding a cup of coffee and talking on his cell phone while driving with is knees. That sort of thing.

The illustration made me think of what happens in pharmacy. It isn't necessarily how fast we fill prescriptions that causes us make errors, but the lack of focus while we are filling at the speed of light. Try filling a prescription every minute or two WHILE answering the phone, counseling a patient, troubleshooting some insurance rejection and answering a technicians question...oh, and the computer just went on the fritz. Great!

That's what leads to errors, and why people end up in the hospital, or in a grave.

Robots can fill ridiculously fast...and accurately. But you start to introduce the human element in there with all that other multitasking stuff...watch out. You're playing with fire.

What to do? I honestly don't know, except this: check your own prescription meds and find out as much about them as possible. Because truth to tell your pharmacist is too overwhelmed to deal with any of it. That's the honest truth of it. Might as well say it and be done.

Saturday, February 13, 2010

The Christian Church and Climate Change

Persnickety is branching out...

I began this blog as a way to teach others what pharmacy is really about; it was my intent to show life within the profession to those outside.

I want to branch out now to other ideas, and focus on all the things that it takes to make me persnickety. What riles me, what disgusts, nauseates and sickens me. All of my little pet bete noires that lurk in the shadows of my own particular dark forest.

Up for discussion right now is the prospect of global warming, better known as climate change.

I've been so nauseated recently by the comments of right-wing congressmen who've felt compelled to be ironic now that Washington D.C. has received a couple of snowstorms. "It's going to keep snowing in DC until Al Gore cries 'uncle,'" tweeted Sen. Jim DeMint, R-S.C.

I understand why Republicans are against the idea of climate change. If the science is accurate then businesses are going to have to pony up and thus they pay to have their congressmen/women vote in a more business-friendly way. I understand that. It is the way of the world.

What I do not understand is the view of my fellow Christians. Like their views on the healthcare debate, I feel them to be on the wrong side. Shouldn't Christians want to help the unfortunates who find themselves without adequate or any insurance coverage? Shouldn't they advocate for the oppressed and the sick? Likewise shouldn't Christians exhort, as Jeremiah did so many years ago when he said, "I brought you into a fertile land to eat its fruit and rich produce. But you came and defiled my land and made my inheritance detestable." (Jeremiah 2:7 NIV)

What is it about the modern Christian church? Does it beat in lockstep with the Republican Party on every bullet point of its platform? Will it sell its soul to the devil for the purpose of power politics? Did it not learn its lesson during the Reagan and Bush eras, when though aligned with the right it failed to produce any meaningful legislation that could in any sense be called Christian (prayer in school, abortion)?

The Christian Church needs to define itself not by the party in power, not by political means, not by picking sides in a liberal vs. conservative drama, but by the words of Christ, and Paul and the apostles. "Since what may be known about God is plain to them, because God has made it plain to them. For since the creation of the world God's invisible qualities—his eternal power and divine nature—have been clearly seen, being understood from what has been made, so that men are without excuse." (Romans 1:19-20 NIV)

Friday, February 12, 2010

Wait just one sec; I've got to interrupt Newt's fancy schmancy song and dance with this bit of reporting hot off the presses (see Nadja Popovich's piece on NPR.org or http://www.npr.org/blogs/health/2010/02/insurers_post_big_profits_cut.html).

According to documents filed with the U.S. Securities and Exchange Commission, over the last five years the big five health insurance companies' profits have soared to 56 per cent since 2008. That's UnitedHealth Group, Wellpoint, Aetna, Humana, and Cigna. (Aetna was the only one of the five to not post an increase.)

How'd they do that? I mean, especially with the recession and all. Well, according to Avram Goldstein (head of Health Care for America Now, and advocacy group), all they had to do was raise their rates and increase the cost burden for the little guy AND drop 2.7 million sick people who were Oh such a drain on the corporate coffers. So higher premiums, higher copays, made for a nice little "cha-ching".

Now the company CEOs will tell you that the 12 billion dollars in profits during last year alone (remember...a recession year)amount to a mere drop in the sea. A mere penny on the dollar. But as Goldstein makes mention, that penny, if added up over ten years, amounts to $250 billion dollars that America could have saved itself. Not to mention that if we did not have to pay the duplicative administration costs for all these plans (ten thousand prescription plans in the U.S. and counting)...well, we're starting to see this as real money now aren't we?

One thing I can't figure out. How the heck could Aetna lose money when this is a rigged system? They must be real bozos...or nice guys. We all know nice guys finish last in the insurance biz.

Thursday, February 11, 2010

Newt's Tip #3 of our continuing saga:

• Meet the needs of the chronically ill. Most individuals with chronic diseases want to be in charge of their own care. The mother of an asthmatic child, for example, should have a device at home that measures the child's peak airflow and should be taught when to change his medication, rather than going to the doctor each time.

Having the ability to obtain and manage more health dollars in Health Savings Accounts is a start. A good model for self-management is the Cash and Counseling program for the homebound disabled under Medicaid. Individuals in this program are able to manage their own budgets and hire and fire the people who provide them with custodial services and medical care. Satisfaction rates approach 100%, according to the Robert Wood Johnson Foundation.

We should also encourage health plans to specialize in managing chronic diseases instead of demanding that every plan must be all things to all people. For example, special-needs plans in Medicare Advantage actively compete to enroll and cover the sickest Medicare beneficiaries, and stay in business by meeting their needs. This is the alternative to forcing insurers to take high-cost patients for cut-rate premiums, which guarantees that these patients will be unwanted.


Here's where it all becomes laughable. Let's "meet the needs of the chronically ill." Yeah, isn't that what insurance is for? Isn't that the purpose of insurance? Unfortunately insurances don't have to take anyone who happens to be chronically ill? Have back pain? Sorry, it is a pre-existing condition so not covered. Diabetic? Sorry. Mentally ill (depressed? bipolar?)? Have migraines? How about high blood pressure? Nope. All pre-existing conditions and you won't be eligible for any new plan. Now Obama's bill will change that...IF the Republicans allow passage. A big IF.

Oh, and Newt. Just for your info, patients already have devices to monitor asthma. They're called peak flow meters and the cost about $20. But they're not usually covered under anyone's insurance.

As for HSA's (Health Savings Accounts), I used to think these would be great. As a matter of fact, I thought they were the answer to all our healthcare problems. Not any more. I had one for two years. The theory is that since you control the money, you will shop around and get the best quality care for the least money. The consumer controls the money. Smart huh? Not really. You see once I tried to find out what a doctor would charge, what a hospital would charge. You can't do it. You can't even find out exactly what doctor is going to be charging you for what. It is all a mystery until about a few months later when all the bills start showing up. And then, of course, it is too late. Control the money? Forget about it. The system is rigged and you aren't going to be able to do a thing about it.

Now for the kicker: Newt writes of somehow tweaking insurance into "special needs" away from the be all things to all people model. Hello? Aren't we talking about insurance here? We need insurance for those illnesses that we already have AND for those we don't already have. That is, for those times we get sick...in the future...in the unknown unforeseeable future. Newt then continues the idiocy, writing that this is "forcing insurers to take high-cost patients for cut-rate premiums, which guarantees that these patients will be unwanted."

See? That's the problem: Republicans like Newt see this crisis as an attack on insurance companies and their profits. "These patients will be unwanted." Duh...they're sick. They cost the companies money. Anyone who files a claim with an insurance company is by definition "unwanted." That is the problem with having a "system" maintained by for-profit businesses. Get it?
Continuing our Newt's Greatest Ideas About Healthcare, his second bullet hits close to the mark, kinda:

• Make health insurance portable. The first step toward genuine portability—and the best way of solving the problems of pre-existing conditions—is to change federal policy. Employers should be encouraged to provide employees with insurance that travels with them from job to job and in and out of the labor market. Also, individuals should have the ability to purchase health insurance across state lines. When insurers compete for consumers, prices will fall and quality will improve.

I've put the key words in bold. Making insurance portable has been one of those EUREKA ideas for quite a long time. People lose their jobs and find that they are quite vulnerable to catastrophic illnesses that can bankrupt them. Or worse. What's worse than bankruptcy? How about death? It's well known that every two months as many people die from our so called healthcare mess than died in the World Trade Center attack on 9/11. So you could say portability is kind of important, yes?

Except nothing has been done about it. Nothing. Why is insurance even tied to employment? That was a WWII gimmick to give businesses an upper hand to recruit people as they couldn't raise wages in wartime.

Now to those two key words of Newt's. First, "encouraged". Love it. We'll "encourage" companies who currently don't give a good hot darn about their employees--except of course for the bottom line--to shop around for some insurance that could be portable...for the good of their employees! Not for the bottom line...nobody cares for that do they? Of course, Newt might have some financial incentive in mind, but unless it would knock the socks or stockings off the CEO, well, it just ain't happening. And given the current double digit increases in premiums...don't count on this affecting anyone's insurance savings.

The other key word, purchase, is just such a quaint idea isn't it? We all should have the ability to purchase our own plans across state lines. Across state lines? How about the ability to purchase any kind of plan anywhere?

Prices will fall, and quality improve. Well, maybe in Newt's dreams, but here in the real world, it's going to take a whole lot more that Republican dreams.
Continuing our Newt's Greatest Ideas About Healthcare, his second bullet hits close to the mark, kinda:

• Make health insurance portable. The first step toward genuine portability—and the best way of solving the problems of pre-existing conditions—is to change federal policy. Employers should be encouraged to provide employees with insurance that travels with them from job to job and in and out of the labor market. Also, individuals should have the ability to purchase health insurance across state lines. When insurers compete for consumers, prices will fall and quality will improve.

I've put the key words in bold. Making insurance portable has been one of those EUREKA ideas for quite a long time. People lose their jobs and find that they are quite vulnerable to catastrophic illnesses that can bankrupt them. Or worse. What's worse than bankruptcy? How about death? It's well known that every two months as many people die from our so called healthcare mess than died in the World Trade Center attack on 9/11. So you could say portability is kind of important, yes?

Except nothing has been done about it. Nothing. Why is insurance even tied to employment? That was a WWII gimmick to give businesses an upper hand to recruit people as they couldn't raise wages in wartime.

Now to those two key words of Newt's. First, "encouraged". Love it. We'll "encourage" companies who currently don't give a good hot darn about their employees--except of course for the bottom line--to shop around for some insurance that could be portable...for the good of their employees! Not for the bottom line...nobody cares for that do they? Of course, Newt might have some financial incentive in mind, but unless it would knock the socks or stockings off the CEO, well, it just ain't happening.

Wednesday, February 10, 2010

In todays Opinion (found at http://tinyurl.com/ybltpld) Newt Gingrich has deigned to give us his take on the healthcare debate. Obama said he wanted new ideas, and Newt has some, or thinks he has some. The question is, Are Newt's ideas just more Republican blather? Well, I thought we should look at his list, one item at a time. Here's the first bullet in Newt's gun:

• Make insurance affordable. The current taxation of health insurance is arbitrary and unfair, giving lavish subsidies to some, like those who get Cadillac coverage from their employers, and almost no relief to people who have to buy their own. More equitable tax treatment would lower costs for individuals and families. Many health economists conclude that tax relief for health insurance should be a fixed-dollar amount, independent of the amount of insurance purchased. A step in the right direction would be to give Americans the choice of a generous tax credit or the ability to deduct the value of their health insurance up to a certain amount.

Yeah, that's it! We'll just make it affordable. That'll fix everything. (OK, I'll back off a bit.) He's saying that the tax subsidies we currently give to the unions for their "Cadillac plans" should be given across the board to everyone...especially the little guy who has to buy his own stinking plans. Um, I'd like to meet that little guy. Currently the typical healthcare plan costs over thirteen thousand dollars a year. A pretty hefty sum to come up with if you're a little guy. How many of those "little guys" are there I wonder?

The thing that is truly ironic about this idea is that...he's right on the button about one thing: Just let's make it affordable! Oh, not by using tax credits allowing "the little guy"--who is actually pretty much a figment of his imagination--to buy his own stinking insurance, but by actually making insurance so inexpensive that everyone gets to have the same quality care.

Not possible, you say? Well, they do it in England, Canada, France, Germany, Japan (are you going to make me write all the countries in the industrial West? Thank you!). But not here. Here we like to subsidize the private insurance corporations allowing them to soak the public and make gazillions of profits which in turn allows said companies to buy themselves representatives and senators who then vote for more subsidies giving them more profit allowing them to buy even more representatives...

It's the American way. And it seems to have worked quite well. Up until now.

Up next: Newt's Great Idea #2!
We're being invaded by Canada!

Pretty soon we're going to just have to institute the dreaded National ID card...just so we can lock our ER doors to those pesky neighbors to the north. At least that's the impression given by FOX "News".

“This should be a wake-up call to Congress and the administration,” said a Fox News medical commentator. “It is a fact beyond dispute that the United States remains the global destination for patients from all over the world.” Canadian conservatives weighed in as well. “It’s symbolic,” said Brett Skinner, president of Canada’s right-wing Fraser Institute. “These services are not available at all, or not available on a timely basis here in Canada.”

As Daniel Johnson of Salem-News.com states (in much nicer terms which I feel are lost on FOX) these allegations are lies.

What the FOX liars don't tell you is that the folks who come down south (41,000--if true--are a drop in the bucket of the people being treated in America) are seeking "boutique" treatments (limos at the airport, concierge service, etc), which if they can afford it, fine. It's their money; let them spend it as they wish.

What isn't stated in such very fine reporting is the "snowbirds" flying south from Canada, who live in retirement homes in the south of the U.S. Where do they get their healthcare? Why back in the good old Canadian system, of course. If the U.S. was so superior why wouldn't they get it here? Because in Canada they get it less expensively and its better care.

Also not mentioned in the FOX report is the fact that Canadians have better care after their heart surgeries resulting in less readmissions than in the U.S.

So, to sum up, in the U.S. we get sub-par healthcare AND we pay more for it. Great, huh?

As Mr. Johnson states, "The Canadian health care system is at least as good as the U.S. system across the board. At the same time, it’s less expensive and, with most procedures, has a lower re-admission rate because patients tend to be treated completely at the outset. The Canadian system doesn’t treat many Americans who want to come north because of the punitive malpractice system the Americans have.

One thing not mentioned are the number of so-called “snow birds”, well off Canadians who retire to the southern U.S. They keep their Canadian citizenship so they can readily return to Canada for medical care. This is something not available to Americans."

Yeah, and if we listen to the Republicans it never will be.

Friday, February 05, 2010

What is that you say? Your PPI doesn’t work?

Well, that’s OK, as you are in a lot of company. First, for those of you who don’t know, and still care to know, a PPI is a Proton Pump Inhibitor, like Prilosec, or Omeprazole (Prilosec), or Prilosec OTC (Prilosec again), or Nexium (Prilosec’s active metabolite), or Prevacid, or well, there’s quite a few of them. They are used for GERD (fancy for heartburn) and ulcers.

You might know that the regular dosing of one of these gems is once a day. You know how many times I see a Take one capsule twice a day dosing on a prescription? Lots. Many many times. Why is that?

These drugs though dosed at once a day intervals do not actually have long half lives. Some are quite short, four or five hours. So why do they last so long? Because they bind to an enzyme irreversibly and it takes a while for the body to come back on board. The drugs bind to ACTIVE receptors, which means that timing is crucial: take an hour before eating, so that the drug can bind to those receptors that are become active for the coming food-fest.

I suspect that for many of the people taking these PPIs on multiple dosing regiments that they could get away with once a day dosing if taken an hour before dinner. Thus saving themselves mucho denaros (or their insurance company, which really is the same thing).

Bon appetit.

Friday, January 29, 2010

So you have osteopenia? Now what?

As reported on NPR (go to NPR.org or directly to http://www.npr.org/templates/story/story.php?storyId=121609815),
osteopenia began as a term invented to label test subjects who do NOT have osteoporosis, which is a condition of low bone density. Osteoporosis in the 1990's had just begun to be treated with a new drug by Merck called Fosamax (alendronate). Unfortunately for Merck you needed to have a bone density scan to be properly diagnosed. The scan was expensive and usually not covered under insurance (surprise, surprise). The machines were also expensive and only large medical centers had them. So Merck had this great drug to treat an illness that few would be diagnosed with. What to do?

Well, if you're a fancy schmancy big pharma company you decide, Hey! What was that term used for people who DON'T have osteoporosis? Yeah, that one: Osteopenia. We'll just treat that one! And, we'll buy up a bone density machine maker and Presto! Chang-o! We shrink the machine and make it less expensive so that everybody will be able to get a bone density scan.

Now that last part sounds good...until you find out that a scan of the finger or arm doesn't necessarily mean your hip bone is that same density. Basically, Merck funded the ability to treat a non-illness. There is no proof that treating osteopenia lowers fractures...and that's kind of the point isn't it?

That's the power of marketing. That's the power of Big Pharma.

Sunday, January 24, 2010

OK, now for something completely different...

For a while now I've gotten off on a tangent, speaking of insurance and political issues. Soapboxing, basically. But I began this blog as a way to let people know what pharmacy is truly about, what it is like being behind the counter, and also to give some hints as to how better to utilize your pharmacy.

So here's one: People want to save money, right? Well, go to http://www.destinationrx.com/
and you can see how much your medication costs in your area. I put in Lisinopril 10mg, for a typical one month supply dosing, just because it is so common. In my area, it turns out I could buy #30 of these babies for anywhere from $3.33 to $20.89. Quite a difference. I imagine the lower tier belongs to one of the supermarket chains competing with Walmart and their $4 list of meds.

These chain discount lists are a wonderful way to save money. (They will tell you that they still make money on these drugs but that's baloney. They are a loss leader, just a way to get you into the store so they can sell you other things.) The problem has always been that each chain has a different list. You would have to go to one pharmacy for this drug and another for that drug. But there are ways around this.

Many times (and I mean many many times)you can find an equal (though not identical) drug in the same drug class on the list and if you speak to your provider (often it just takes a phone call, not an office visit, but if you happen to have an appointment coming up then just broach the topic then) he or she will change to that drug and save you money.

But lets say there isn't another drug equal to yours in that same class. Or say your provider is persnickety (like me) and just says No, take the stuff I wrote for you and that's that. Is there another way to save? Sure. That drug might be on a competing store's list. So many have them nowadays: Target, PriceChopper, Hannaford, Giant Foods, Publix, and of course, Walmart. If you're willing to go and make a separate trip for that med (and know you can get a three month supply which makes the task easier--Walmart now will even mail you meds) you could do that and save. Now, I know what you're thinking: you're a pharmacist and you don't mind telling people to shop multiple pharmacies? Isn't that a dumb thing to do? Don't they always tell patients to stick to one drugstore so they will know what you are on and can check interactions? Well, yes. And that is all true. But did you also know that these computer systems druggists use can have your entire drug profile loaded into them, whether you go to that store or not?

Just tell the druggist--and it's not a bad idea to write the other meds, and otc drugs too, on the back of the Rx. They will load the info into your profile and the system should catch it. If it doesn't (just ask) then go somewhere else--that system is for the birds anyway and you don't want to have anything to do with it. But I've seen enough places to be able to say with confidence that I'd be very surprised--shocked--if any system now available doesn't have the option of having drugs inputted into it.

There. That's the tip of the day for you. Oh, one other thing: give the pharmacist time. Better to leave off a prescription and pick it up the next day if at all possible.

Wednesday, January 20, 2010

The Fallen Wounded

Massachusetts has spoken and the rest of us may pay a pretty penny in lives and money for it. With the surprise election of Scott Brown, the Republican nay-sayers now can alter the future of health care in this country. Perhaps it was the fact that Massachusetts already has mandated insurance for its citizens that caused such indifference to the remainder of the country.

It is well documented that a person dies in this country due to private insurance every half hour. We care more about smokers than we do about people who lack insurance…and access to care. Surprisingly that includes the Christian right, despite a clear mandate to “love thy neighbor as thyself.” The “moral majority” seems to have made a pact with the devil and will support anything other than caring for neighbors. The attitude of many of my Christian friends is this: I got mine, all’s right with the world—to heck with you.

Some have the mistaken opinion that health care access is plentiful. Just go into a Medicaid office and the government will take care of you (these ideas from the very same minds who abhor “socialist” care). The new Obama-care bill would have raised the family income necessary for Medicaid to $48,000 for a family of four. Sound like a lot of money? Not if you have bills to pay, rent or mortgage, college loans…oh, and medical bills. Some people just don’t want to step into those shoes.

The current situation with regards to health care in the U.S. strikes me as comparable to what we find on the battlefield. We exert tremendous energy to vanquish our foes, but once the battle has ended, we gather up the wounded—both friend and foe. We take our fallen enemies to a hospital and nurse them back to health. The very same people we were trying to kill with a bullet we now attempt to rescue with a bandage.

Here, in this un-Christian country, we blow up—or allow private insurance companies to blow up—individuals, entire families even, until they’ve reached the point—perhaps through bankruptcy or by reaching maximum dollar limits or simply by refusing coverage due to…oh, being sick—reached the point of (you guessed!) of being able to file for Medicaid!! Yeah, we finally get to have insurance…once we are destroyed and forced onto Medicaid!

The kicker is that the people who say just go get Medicaid also like to…yeah, complain about all those people on Medicaid getting a free ride. Gotta love Christian love, don’t you?

The Christian church (see my previous blog on the topic) missed an opportunity big time. They could have worked with those big bad devilish democrats to force out the for-profit insurance companies and said the country: Hey, we hear you. We feel your pain. And we’re going to do something about it.

Coulda woulda shoulda.

Sunday, January 03, 2010


The Christian Church and the Lost Opportunity


The Christian Church has but one job, given it by the Lord Jesus Christ with these words:

Therefore go and make disciples of all nations, baptizing them in the name of the Father and of the Son and of the Holy Spirit, and teaching them to obey everything I have commanded you. And surely I am with you always, to the very end of the age. [Matthew 28:19-20]

Ah, but here’s the rub: How exactly do you make disciples? There is the method of the Taliban whereby a military dictatorship is set up and everyone is simply ordered to be religious, whatever that might mean. Then there is the method of inculcation, the preferred means by which moms all over the world bring up their children under the favored instruction of gentle, and ongoing, instruction. A more subtle technique is to simply live as Christ would have us live, and as others see us living in the Spirit as God intended and as God instructed in His Holy Word, then discipleship will be transferred as it were by a sort of spiritual modeling.

Our country has had throughout its history seen all three methods. The first can best be exampled by the Salem period and that illustrated by Nathaniel Hawthorne in The Scarlet Letter. The second has always been afforded a chance, but I think especially in the post-world war period when families moved to the suburbs and became a kind of unified Wasp type. The third has current vogue status as the method of choice in a tolerate age, when ringing doorbells to offer up salvation’s message is thought at best gauche and at worst an example of intolerance to one’s right to unbelief.
And so how is the church doing in this age of tolerance and unbelief? It seems not too well. Although the majority of US citizens view themselves as spiritual they seem less and less inclined to stand by the banner of Religion. In the latest ARIS (American Religious Identification Survey) study, the percentage of Americans that see themselves as within a particular denomination decreased by 11% in a generation. But in a Newsweek poll this year nearly 9 out of 10 people identify as believing in a higher power. So people are still seeing themselves as spiritual, just not as inclined to join a church.

This brings me to the matter at hand. In 2009 we saw the Democratic Party take a bull by the horns, in the form of national health care. It was stated by the President that this country needed to fix a problem that was killing a person every half hour and forcing thousands into bankruptcy. Lives were being ruined. Was this the great opportunity for the church to stand up and be noticed, as being a broker for an idea whose time had come? Wouldn’t unbelievers then see that Christians were truly about doing good, showing love, and doing the work of a loving God? But if that were the case the country saw a very different church. The church of the evangelical right became a lapdog for the Republican Party and the blue dog left. It was deemed better to oppose legislation offered up by the Democrats than to work with them to solve a seemingly intractable problem.

What would have happened if the Christian church had stood up for the indigent and became their lobby for the right to have health care? Of course the Catholic Church did indeed do just that, but not the evangelical protestant groups. If they had they would have been given the opportunity not seen since the days of abolition when they worked tirelessly to end the disgrace of slavery. The church had the chance to show the country and the world that it had an agenda of its own, not that of being spoon-fed by the Republican right. And that agenda was that of Jesus Christ, Lord and Savior: Blessed are the meek, the poor, and those long-suffering.
But the church, except for a few isolated examples, stood pat, silent, or worse, shouting the words written for it by conservative talking heads, words that were largely lies.

So instead of reaping the harvest of the great commission, we now have fewer disciples than ever. The church is now perceived by agnostics as a political player, a player alongside large corporate interests and lobbyists, seen as just another secular tile in a game of dominoes.

It could have been so different. But in the end maybe it will work out better. As others see the false charade that is going on in church after church in this country, others will stand out, those walking out into the dark night holding a candle burning brightly, offering shelter to those who need it, giving succor to the poor and sick. This will be the real Church, unconcerned with political gamesmanship and power politics. And the people of the Church will be easy to spot: “by their fruit ye shall recognize them.” Remember that Christ said, "Not everyone who says to me, 'Lord, Lord,' will enter the kingdom of heaven, but only he who does the will of my Father who is in heaven.” My guess is that quite a few Republicans have forgotten that it is Christ’s will that we should seek, and not the Republican Party leadership.

Norway cures the superbug!

Norway discovers "cure" for superbugs

Though not technically a cure, as it is not a cidal chemical agent nor some fancy schmancy surgery, Norway has indeed found a way around the problem of the MRSA superbug. First, many may not see this as a huge problem. It is. More people die from MRSA (Methicillin Resistant Staph Aureus) than from AIDS in the U.S. (and 48,000 people die in the U.S. from hospital acquired infections). Across the world, especially in Japan--perhaps the country with the highest reputation for high tech medicine in the world--MRSA costs billions of dollars and hundreds of thousands of lives. So what did Norway do to virtually eliminate the bug in their country?

They banned antibiotics. In all but the most severe cases, doctors do not, even cannot, prescribe antibiotics. Here in the U.S. if you have a cough or some sniffles we hop in our car and see our providers expecting to get a prescription for an antibiotic. And our expectations are thoroughly met. Off we go to the pharmacy for our macrolide antibiotics, our penicillin, our tetracycline, our quinolones. But in Norway doctors are not even allowed to prescribe these things, at least not for common ailments. They give out some Tylenol and tell the poor Norwegian to get over it, as he or she will feel better in ten days or so on their own.

Also of note is the ban on drug marketing. Big Pharma is told to stay the heck away from advertising, which led in that country to a decrease in patients asking for this cure and that. Doctors had in the end more control and more information.

Once someone is identified with MRSA in Norway they are isolated and screened for history: who might they have contacted the infection from; whom they might have given it to.

The result has been sensational: the only people who contract MRSA in Norway now are people who have brought it into the country from visits to foreign lands (like the U.S.).

Will these results, as amazing as they are, cause the U.S. to make some changes? Um, I wouldn't bet on it. For one thing, our system is profit driven; pharmaceutical manufacturers would buy any number of politicians to defeat legislation that would curtail antibiotic use in this country. Republican and Blue Dog Democrats would be hollerin' about how we were condemning grandma to an early death (though saving tens of thousands of lives...each year) just so Big Pharma could recoup big profits on Zithromax, Levaquin, Cipro, Omnicef, etc.

So if you happen to be one of the unfortunates diagnosed with MRSA this year, take heart. Glaxo, Merck, Abbott and their pals are going to be doing better on the stock exchange, which is something. Isn't it?
Exchange or refund?

This is the season for exchanges and refunds. Presents are returned to the customer service counters across the land and exchanged for other things of different size, different color, or just something altogether different...like cash.

Apparently our political "servants" in Washington, D.C. had this in mind with the recent healthcare bill. The Senate version creates "exchanges" in every single state, whereby we the people can come and shop for health insurance. I have no bone to pick with the idea of mandatory insurance coverage--it's the only way to make the pool of recipients large enough to matter--but let's take a look at what it does to government in general in the country.

Fifty states will have to create fifty new bureaucracies. Now who can say among you out there that that will be a good thing? I live here in the fiscally challenged state of New York, a state that a month ago almost couldn't pay its bills, despite having property taxes 79% above the national average and being the second most taxed state in the union.

This law will give us another bureaucracy, and more administration waste. Which means more taxes to pay for it. Ah, what a wonderful idea!

I guess they took the idea from private insurance. We have over ten thousand different prescription plans in the U.S. administered by thousands of different companies. Thousands of administrators wasting billions of dollars. It's almost like we are trying our best to come up with a plan to make insurance the most expensive in the world...which it is already.

It could have been so different, so easy, so manageable and efficient. Medicare for all. One insurance, one administrator, one phone number, one formulary, one set of rules. And it would save hundreds of billions of dollars.

Maybe we should all ask for a refund.