“It’ll take two-thirds of both Houses and three-fourths of the States to approve an amendment saying that two straight parents are better than one straight parent which is still greater than two gay parents which is equal to a guy screwing a turtle.”
John Stewart, again calling it as he sees it:
Thank you, Wikipedia, for giving me shivers…
“The Hummingbird Hawk-moth (Macroglossum stellatarum) is a species of hawk moth with a long proboscis, and is capable of hovering in place, making an audible humming noise. These two features make it look remarkably like a hummingbird when it feeds on flowers. They fly during the day, especially in bright sunshine.”
The article neglects to mention that this particular insect gives me the heebie-jeebies.
Bright Eyes :: I’m Wide Awake, It’s Morning :: Another Travellin’ Song
Well I’m changing all my strings
I’m gonna write another travelin’ song
about all the billion highways
and the cities at the break of dawn
Well I guess the best that I can do now
is pretend that I’ve done nothing wrong
and to dream about a train
that’s gonna take me back where I belong
Well now the ocean speaks and spits
and I can hear it from the interstate
and I’m screamin’ at my brother on a cellphone
he is far away
And I’m saying nothing in the past or future
ever will feel like today
until we’re parking in an alley
just hoping that our shit is safe
So I go back and forth forever
All my thoughts they come in pairs
Oh I will, I won’t, I doubt, I don’t,
I’m not surprised but I never feel quite prepared
Now I’m hunched over a typewriter
I guess you call that “paintin’ in a cave”
And there’s a word I can’t remember
and a feeling I cannot escape
And now my ashtray’s overflowing
I’m still staring at a clean white page
Oh and morning’s at my window
she is sending me to bed again
Well I dream the dark on the horizon
I dream the desert where the dead lay down
I dream a prostituted child touching an old man in a fast food crown
Oh yeah, I dreamt this ship was sinkin’ there was people screaming all around
And I awoke to my alarm clock it was a pop song it was playin’ loud
So I will find my fears and face them
or I will cower like a dog
I will kick and scream or kneel and plead
I will fight like hell to hide that I am giving up
Skip/Skim this if you’re not particularly interested in why I’m so jaded about health care.
Or just click here to see the shit hit the fan.
OK… here it is. I’ve been thinking about this a lot since Part D became effective.
Here’s how Part D currently works, in its most basic form:
The patient pays a monthly premium set by the DHS. This year it’s $34. (n.b.: The monthly premium does not count towards the $2,250 of initial spending.)
The coverage is broken down into four phases:
On a side note, I’m wondering if Part D coverage has enticed people to take more prescriptions. I did a lot of searching for people on which plan to get based on the total amount it would cost people, and a lot of people—had they continued using the same drugs they took last year—would not enter the doughnut hole at all. But a lot of people seemed to have increased their spending now that they think they have insurance to cover drugs, forgetting that they only get $2,000 worth of initial coverage after the deductible.
Once the total spending equals $3,600-that is, once the patient has spend an additional $2,850 on drugs-they enter phase four which is called “catastrophic coverage”. They couldn’t have picked a better name. For many seniors spending almost $3,000 dollars (in addition to their monthly premium) is a catastrophe! The complicated part is that the first twenty-two-fifty includes what the plan pays, but in order to get out of the doughnut hole (or “coverage gap” as it’s also called—perhaps it should be called the “crevasse” or “chasm” to give it a name that sounds as perilous as it is) only out-of-pocket spending is counted. They call this TrOOP, I guess to make it sound more fun like a boy scout troop. That means it breaks down like this:
Initial deductible of $250 + $500 in copayments + $2,850 in the chasm = $3,600
The caveat is that only drugs that are covered by the plan count towards the $2,850 that enrolees are required to spend. This means that if you opt to buy a drug that isn’t covered by the plan—say for example your doctor prescribes the expensive Cox-2 inhibitor Celebrex (which costs anywhere from $100 to $500 a month) but it’s not covered by your plan and you decide to get it anyway, this doesn’t count towards anything and you’ll continue to pay full price year round no matter what. Also certain drugs were legislatively excluded: vitamins, over-the-counter drugs, barbiturates (phenobarbital-sometimes used for seizures) and Benzodiazepines (also used for seizures, sleep, and anxiety) are not covered at all. It should be noted that the barbiturates and benzos are for the most part ridiculously cheap—Temazepam (a fairly common sleeping pill) costs about $25 a month whereas Ambien (a newer, brand-name sleeping pill that’s covered by most plans) costs $125 a month. Ambien is perhaps, pharmacologically speaking, a better medicine—but the benefit on the patient’s and the government’s checkbook (in my opinion) outweighs the benefit of the newer drug.
What this adds up to is this:
$250 deductible⇒$500 of copays + $1,500 paid by the plan⇒$2,850 chasm⇒5% after the catastrophe + $408 in premiums
If you’ve made it this far, you now have an understanding of the agony this caused for seniors and their families last year and will cause again this year as people renew their plans. Imagine being 70 years old and on your own trying to figure this shit out. I think I’d rather stop taking pills, decide I’ve had a good fucking life and die already, and let my kids inherit whatever money I’ve got left instead of giving it to the government and the fucking insurance companies.
The other component that makes this a little bit better for enrolees and a very sweet deal for the insurance companies is this:
Anyone can offer a plan that fits these basic requirements. Additionally a company can offer variations on this theme as long as is averages out to be about the same as the basic coverage.
For example, the Humana PDP Standard Plan operates pretty close the the model above: The monthly premium is $24, there’s a $250 deductible (it should be noted that the first $250 worth of generic medication in this phase is provided at no copay but brand names are charged 100%) and after that the next $2,000 is split 75/25 by the enrolee and the plan. Additionally, Humana offers a discount on all medication during the coverage chasm, which is a blessing and a curse: you pay less in the gap, but you get out of it slower. After the gap you pay 5% of everything.
By way of contrast, the Humana PDP Complete plan offers the following coverage: The monthly premium is $65, but there is no coverage gap. You pay extra each month for coverage “in the gap” (or a bridge over the chasm, as it were) and there is no deductible. You pay $7 for a month’s supply of generic drugs, $30 for preferred brand name medications, and $60 for non-preferred brands, and 25% for some special drugs that don’t have generics and are particularly costly. In my opinion this is the best plan for a lot of people as it offers very comprehensive coverage with the least amount of worry and cost.
The “preferred” category is another complication of this: each PDP has come up with a formulary (which is a fancy word for “list”) in which some drugs are preferred and others are not.
How formularies work: The plan draws up a list of every marketed prescription drug, listed by therapeutic class. Then the plan divides these drugs into “tiers” all of which have different copays. The first tier is almost exclusively generic drugs, in the second tier are brand name drugs that the plan has negotiated with manufacturers to get discounts on and the third tier are those drugs which have preferred drugs in the same category but they could not negotiate a discounted price on—it should be noted that these “discounts” are not given to pharmacies or patients but are provided to the plan in the form of kickbacks by the drug companies for listing their medication over another company’s medication in the same category. Let me give you an example:
In the “Gastrointestinal” category there are numerous medications. Let’s focus on a particular class: the Proton Pump Inhibitors. The first tier would be the only currently available generic:omeprazole. This would be $7 on Humana Complete. After that let’s say that Humana has negotiated a $50 kickback per prescription with the drug company Wyeth on their Protonix. You’d pay $30 a month per prescription, Humana would pay another $60 (on average) to the pharmacy, and they’d get $50 back from Wyeth, making their cost only $10 per prescription. Then there are three other products (Nexium, Prevacid, Aciphex) that if you wanted them (say omeprazole and Protonix just didn’t work very well for you) you’d have to shell out $60 for, and Humana would pay the $40 difference. Also keep in mind that you’d be paying about $100 a month in the coverage gap for any of these medications, as generic omeprazole is still around $100 a month. The top tier is only explained by bringing up some drugs that are called orphans or drugs that are particularly expensive. Let’s say for example you needed to use the drug Kineret for your rheumatoid arthritis. This is a very special injection you use every day and costs $1,500 every month. You’d pay $375 a month for it if you had Humana.
So the formulary kinda allows everyone to catch a break, while really the drug and insurance companies get the best deal and patients end up getting a run around. Especially since doctors don’t like to be told which drugs they can and cannot prescribe: they didn’t go to med school so they could figure all of this shit out. Pharmacists, but the way, didn’t go to pharmacy school so they could figure all this shit out either. I know the most about it because I’m the “third party expert” and it’s my job to know about all this shit. Guess who gets paid the least… So when you show up with your prescription for Nexium (which you’ve seen advertised on TV and dutifully begged your doctor to write for even though you probably just need a bottle of Rolaids—and which the doctor is more than happy to write for because the drug rep just stopped by yesterday and bought him lunch) you’re told that it’s gonna be $60 unless you can get the doctor to write for the either the $30 tier 2 drug or the $7 tier 1 drug. This in turn wasted my time, your time, and the doctors fucking time.
So once you’ve gone and figured out which plan to get and which drugs to get, you’re still gonna spend about $5,000 a year on this shit. Now imagine you make about $20,000 a year from your pension and social security. That leaves you $15,000 a year to pay for food and other medical bills-such as doctor’s visits, the part B premium (don’t get me started on that!!) plus whatever additional insurance you’ve purchased to fill in the shit hole gaps in part B, plus the cost of gas, plus the cost of heating and powering you home (which you hopefully own by now) as well as candy for the grandkids and dog food while you’re in the coverage chasm. So you can see that all of this Part D nonsense doesn’t really help anyone but the drug and insurance companies, who get about $5,000 from you and another $5,000 from the government.
This is where the shit hits the fan.
Let’s say there are about 40 million people on Medicare Part D. Each of them are going to spend about $10,000 total this year on prescription drug costs. This is including all the factors of copays, deductibles, out of pocket spending, and what the plan covers(which is what the government pays). I am going to spell this out for you so it has what might be the biggest impact:
ten thousand times forty million equals four hundred billion
Let me put that another way: that’s the number 4 followed by 11 zeros.
Which is $400,000,000,000.
Which is more than the gross national product of Belgium.
Yes. You read that right. The drug and insurance companies are going to make
FOUR HUNDRED BILLION DOLLARS
this year just on people who signed up for Medicare Part D.
And all of that money comes from us.
That works out to be about $1,333 for every man, woman, and child in the United States. I can think of a few things I’d do with $1,333 and it’s sure not “give it to Pfizer.”
Who do we have to thank for this huge windfall? Who’s the thank for the largest, most expensive entitlement in history? Mostly the drug/insruance lobbyists who worked hard writing the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. That’s right. This law was not written by people in congress but rather by a group of industry lobbyists that specifically tailored it to their advantage.
You can also thank your senators and representatives. They’re the ones who voted to give away four hundred billion dollars of our money. Unfortunately the political climate at the time made it impossible for anyone to vote against this bill; most senior citizens were affected by high drug prices, most seniors and their supportive organizations ostensibly led the call for coverage for seniors, most senior citizens vote. And besides, who could vote against Medicare? Against “drug coverage for seniors”? All anyone would have to do to defeat an incumbent come election time is repeat over and over again “He voted against drug coverage for seniors!” But seniors need their drugs! They’ll die without them!
And I think that’s the point we may well be missing. As much as we hate to admit it, as much as it hurts all of us to lose our parents and grandparents, old people are supposed to die, not keep hanging on so they can keep eating dog food and filling up big pharma’s pockets.
Now we come to more of my opinions. Working in “the industry” I’ve seen how a lot of drugs are miraculous. Take Kineret, as I mentioned above. This drug has dramatically improved the lives of many people both old and young with rheumatoid arthritis. That’s where this industry does do some good. Where is hurts us is that people aren’t dying at 60 or 70 they’re dying at 90. That’s another 20 years, which I believe is both a blessing and a curse to humanity. Those 20 years can often be spent with family and friends and enjoying a newfound quality of life thanks to several medications that treat the things that often go wrong as we age. But there is a price to be paid for those twenty years, and right now and it works out to a number so big I have to use exponents: 8 × 1012 dollars. When the numbers get that big even a superlative like “a whole hell of a lot” doesn’t even work. And all that money goes to fund a two industries: the drug plans and the drug companies. It doesn’t build houses or educate people or feed people or even get little kids insurance: it just goes out of our pockets and into less than 100 companies—companies that spend five to ten times more on advertising (to get you to buy the drugs they already make) than they do on research and development (to discover new drugs to sell you, which is also their excuse for high drug prices).
Four. Hundred. Billion. Dollars.
I think that’s enough for now.
Aaron is going to Ottawa this weekend, so for lack of anything else to do I thought I might catch the Casey Stratton shows over on the other side of the state this weekend… Alas I don’t have the money. I estimate $70 in gas plus money for the shows.
This whole bein’ poor thing sucks. If only I didn’t have to spend so god damned much on health insurance every week. I’m paying out $2,000 a year just for coverage, and it’s to the point that even if I ever had to to use it, I wouldn’t be able to afford the 15% coinsurance of a hospital visit or even just my $30 office visit copay plus prescription copays. And I work in a pharmacy! You’d think affordable healthcare would be a priority for us, but of course not. They are only concerned with profit lately. They are cutting hours out of the pharmacy. It used to be our focus was on patient care and there was a lot of hours for pharmacists and techs to make sure we all did a good job and everyone got the information they needed, but now they are taking time away and the pharmacist barely has time to check the prescriptions, let alone make sure patients receive proper counselling for stuff.
I’d really like to work for an independent who focused more on disease management and counselling but I think I would end up taking a pay cut. I would feel a little bit better about my job if our focus was less on script counts, profit and inventory costs. But so goes the healthcare system in America; we aren’t so much concerned anymore with making patients well we are concerned with getting their money.
Take cholesterol drugs for example: the statin category has produced some of the most profitable drugs the pharmaceutical industry has ever seen. And while they have helped patients live longer (and continue to eat cheeseburgers) they’ve also hooked the population on them. Stop taking the drugs and your cholesterol goes up, keep taking them and you’ll live longer with a lower incidence of cardiovascular disease. I used to think this was a good thing, but the more I look at it the purpose of these drugs isn’t to keep people alive so they have longer, fuller lives it’s to keep them alive so they (or their insurance and increasingly Medicare part D which is taxpayer-funded) continue to shell out $200 a month for their drugs.
I won’t even get into Medicare part D and how it’s just a government pay out to the insurance and pharmaceutical industries. A pay out of my tax dollars to fund a lucrative business that continues to produce drugs whose benefits may in fact not always necessarily outweigh their risks…
Crack kills
Originally uploaded by Paul Pellerito.
Seriously guy, pull up your pants.
Here’s my blog entry from 9/11/01:
What I did today was cry. I went to my creative writing class, and saw all of the flags flying at half-mast everywhere. Finally, driving to work on 28th st I was stopped at a red light and I saw one of the big ones we have around flying at half mast, a huge fluttering reminder that our country, our people, our very spirit of freedom had been attacked, forget about what I think about corporations and globalization, because everything that makes us a great nation was attacked along with everything that makes us bad. I bawled. I broke completely down, pounded the steering wheel and stared at that flag, the red-white-and-blue dancing in the wind, and I thought about the people who had jumped from the world trade center.
Duraflex II
Originally uploaded by Paul Pellerito.
If you can’t tell, I’ve been kind of down and out lately.
So Sunday I decided to do something about it. I gave myself two assignments for yesterday: one was that I had to stay out of my apartment for at least twelve hours and the other was to take 100 pictures.
I made it! And I feel much better about my day off, myself, and life in general vs. just being holed up in the apartment in front of a book or the computer or whatever.
So far I have 87 photos posted to flickr out of a total of 200 shots taken. I also ran though 2 sets of batteries, but that was well worth it—my rechargeables weren’t ready for today so I had to make due with e2 alkaline(the lithium ion ones are 10bux and the alkaline ones are 4 bux, so I got the alkalines even tho they last about half as long as the lithium ones, but twice as long as regular alkalines… good point of value at least).
But I digress. Those 200 shutter clicks got me out of the apartment and engaged in the world and most importantly I found something really cool. A Kodak Duaflex II from around 1950. I always wanted “one of those cameras you look down into to take the picture” but never understood it to be twin lens reflex. Something that is more than outmoded now, but the thing just looks great. Here I was snapping pictures with my relatively modern Cybershot and I found a fifty+ year old camera. AND it was only $10! I simply couldn’t argue with that price!
That was down in Schoolcraft, where I went to begin with because I didn’t really have any idea where to go but I knew that Portage doesn’t really yield that many interesting photo opportunities. I mean, there’s the big Arby’s sign and the knitting store’s sign but other than that there’s not much, unless I wanted to go trespassing around the lakes. So I rolled a four-sided die to determine if I was going to head North(1), East(2), South(3), or West(4). I rolled a 3, so I set out south.
Yes, I am indeed that much of a dork.
Once I finished up in Schoolcraft I headed back up to Rocket Star Cafe to upload some and get some coffee. I hung out there until dark and then went up to East Hall to finish my assignment.
So yeah, I had a pretty good day.
Link to flickr photoset.
I haven’t been blogging much since I’ve been living with headaches that wax and wane for a couple of weeks now. I can’t really figure out why, but probably from my stressful life—which isn’t really all that stressful, but I’m feeling pretty stretched taught lately. Hanging by a thread, as it were.
So lately it hurts to think, and it sucks to go to bed with a headache and wake up with one. Then it goes away for a little but comes right back. Tension/stress. It makes me miss migraines which were predictable and readily treatable with zolmitriptan but nothing really seems to ameliorate these.
Oh well, pain and suffering.
Regretfully, I’ve chosen not to move in with Jay. I love Jay and it would be great to have him and some other guys as roommates (especially Joe) but I can’t get the room that I want. Everyone wanted the room on the ground floor, but that was given to Adam, Joe got the biggest room upstairs, and Jay wants the “wood room” that’s done all in wood and is by far the most interesting room in the house. That’s also the room that I want, not the boring middle room. But Jay says that the middle room is the only room that’s open to rent, and I don’t want to rent a room I don’t want. I have until December to find another place or stay here, so I’m not in a hurry to find a place like Joe and Adam are. So I’m opting out.
I’m disappointed that I won’t be living with Jay and Joe, as it was sure to be a good time. And Joe is bummed and worried he won’t like his roommates and end up paying more than he anticipates. But It’s my call to look out for my own needs and wants.I guess it’s just not meant to be.
I close tonight with some frowny faces 
Here Lies Dust
Originally uploaded by Paul Pellerito.
Happy Birthday, Mom.
NEW! Download her memorial folder here. [820kb PDF file]
