Category Archives: Broken in the USA

guns & gas

The Price of Medication

The Price of Medication

I have posted numerous times about the cost of RX in our country. Recently my lovely spouse passed along a link to an article that rekindled my ire on this topic. See the intro below:

“Why a patient paid a $285 copay for a $40 drug

Health Aug 19, 2018 11:42 AM EDT

Two years ago Gretchen Liu, 78, had a transient ischemic attack — which experts sometimes call a “mini stroke” — while on a trip to China. After she recovered and returned home to San Francisco, her doctor prescribed a generic medication called telmisartan to help manage her blood pressure.                                                                                                                                          Liu and her husband Z. Ming Ma, a retired physicist, are insured through an Anthem Medicare plan. Ma ordered the telmisartan through Express Scripts, the company that manages pharmacy benefits for Anthem and also provides a mail-order service.

The copay for a 90-day supply was $285, which seemed high to Ma.

“I couldn’t understand it — it’s a generic,” said Ma. “But it was a serious situation, so I just got it.”                                                                                                                                                                     A month later, Ma and his wife were about to leave on another trip, and Ma needed to stock up on her medication. Because 90 days hadn’t yet passed, Anthem wouldn’t cover it. So during a trip to his local Costco, Ma asked the pharmacist how much it would cost if he got the prescription there and paid out of pocket.                                                                                                 The pharmacist told him it would cost about $40                                                                                    “I was very shocked,” said Ma. “I had no idea if I asked to pay cash, they’d give me a different price.”                                                                                                                                                           Ma’s experience of finding a copay higher than the cost of the drug wasn’t that unusual. Insurance copays are higher than the cost of the drug about 25 percent of the time, according to a study published in March by the University of Southern California’s Schaeffer Center for Health Policy and Economics.                                                                                                                  USC researchers analyzed 9.5 million prescriptions filled during the first half of 2013. They compared the copay amount to what the pharmacy was reimbursed for the medication and found in the cases where the copay was higher, the overpayments averaged $7.69, totaling $135 million that year.

USC economist Karen Van Nuys, a lead author of the study, had her own story of overpayment. She discovered she could buy a one-year supply of her generic heart medication for $35 out of pocket instead of $120 using her health insurance.”

I act as guardian for my mother who has both Medicare & Tricare coverage. I just received a detailed account of my mother’s medications for RX this year. There is an “*” on each line item. The note at the bottom of the statement reads as follows: “You can use home delivery from the TRICARE Mail Order Pharmacy for this medication and receive a 90 day supply for less than the 30 day supply co-pay from a retail pharmacy. Shipping is free……..”

I am shocked by this. As a tax payer you should be also. Obviously planned overpayments to pharmacies (with possible collusion by insurance companies) is horrible and in my view constitutes both fraud and an additional “tax” to consumers. However, keep in mind that these are examples were the Co-pay is higher than the retail value of the drug. This is not merely an “overpayment” but outright theft. The attempt at explanations, in my view, are ludicrous. I encourage you to form your own view by reading the entire article at: https://www.pbs.org/newshour/health/why-a-patient-paid-a-285-copay-for-a-40-drug

 

 

Americaneeze

Americaneeze

I think we often forget that we have a “borrowed” language. Over time our use of English has evolved and probably not for the better. I am the first to admit that my language skills are lacking. Anyone reading this and other postings can testify to that fact. I’ve always been a bit better with numbers.

I am a reader and always have at least one book in process. Despite my exposure to great word smiths my writing talent is stagnant. I am in awe of published authors.

However, there are a couple of commonly used phrases that make my skin crawl and both involve “dangling” participles:

“Where are you from?” Not only the participle “dangle” but what does this really mean? Where do you live or where were you born or where were you just before where you are now or…….. How about “Where are you living?” of “Where is your home?”

“Where are you at?” What is it with the use of “at”. Why is it needed? Wouldn’t “Where are you” suffice?

As time passes Americaneeze evolves. I have tremendous admiration for the language employed by our founding fathers. They had the ability to effectively and concisely convey thoughts and actions. The following is an excerpt from President Washington’s farewell address and concerned the dangers of the two-party system. (I sited this in an earlier post and it is well worth repeating)

“The alternate domination of one faction over another, sharpened by the spirit of revenge, natural to party dissension, which in different ages and countries has perpetrated the most horrid enormities, is itself a frightful despotism. But this leads at length to a more formal and permanent despotism. The disorders and miseries, which result, gradually incline the minds of men to seek security and repose in the absolute power of an individual; and sooner or later the chief of some prevailing faction, more able or more fortunate than his competitors, turns this disposition to the purposes of his own elevation, on the ruins of Public Liberty

Without looking forward to an extremity of this kind, (which nevertheless ought not to be entirely out of sight,) the common and continual mischiefs of the spirit of party are sufficient to make it the interest and duty of a wise people to discourage and restrain it.

It serves always to distract the Public Councils, and enfeeble the Public Administration. It agitates the Community with ill-founded jealousies and false alarms; kindles the animosity of one part against another, foments occasionally riot and insurrection. It opens the door to foreign influence and corruption, which find a facilitated access to the government itself through the channels of party passions. Thus, the policy and the will of one country are subjected to the policy and will of another.

There is an opinion, that parties in free countries are useful checks upon the administration of the Government, and serve to keep alive the spirit of Liberty. This within certain limits is probably true; and in Governments of a Monarchical cast, Patriotism may look with indulgence, if not with favor, upon the spirit of party. But in those of the popular character, in Governments purely elective, it is a spirit not to be encouraged. From their natural tendency, it is certain there will always be enough of that spirit for every salutary purpose. And, there being constant danger of excess, the effort ought to be, by force of public opinion, to mitigate and assuage it. A fire not to be quenched, it demands a uniform vigilance to prevent its bursting into a flame, lest, instead of warming, it should consume.”

Polarization and solutions

Polarization and solutions

Not long ago I posted my thoughts on polarization. Since then I have had the opportunity to discuss my view with others and also receive some interesting feedback.

One of my friends tends to agree with my position and is taking steps to implement a remedy. His view is that if persons with opposing viewpoints first can agree to have “civil” discussion on issues then we can begin to make progress toward a solution. If we are willing to take this first step then reaching a common ground is possible.

This gentleman is putting his money behind this idea. He has been working with and contributing financially to a university in support of a trial program. The idea is to take a controversial topic and invite students with opposing viewpoints to discuss potential solutions through a series of meets. He reports that the results have been encouraging. Exit interviews have revealed that the majority have come out of the meetings with a revised point of view and appreciation for the opposing position. He also reports that several common ground suggestions for resolution have been proposed.

I started thinking about this in my own life experience. I have another friend who I always considered holding political views quite far apart from mine. However, as I grew to know him better we were able to have quite civil discussions on numerous topics. While we will probably never agree on specific “income security” programs, we do agree that all should involve some degree of “contribution” (in the form of work or community service) and should have effective violator safeguards with penalties. We agree that SS disability is does not contain these safeguards and is out of control. Despite my position being a bit to left of my friend in many respects I was surprised to learn that I was more conservative on fiscal matters. We could agree on the need to reduce deficit spending and that spending on both healthcare and advanced education is out of control. However, we were not in agreement on the priority that should be assigned to these issues. Regardless, if asked, we could easily agree to common ground solutions to many of our issues.

The bottom line is that we, as tax payers, need to elect representatives that are solution oriented. I consider the trend to polarization to be anti-patriotic. It should be considered criminal. Senators, congressmen & the press that facilitate polarization should not be supported. The coming election is your chance to display your patriotism. Buck the trend of voting the party line. Vote for a person that is willing to work through solutions with all parties.