Experienced physicians know that patients who don't fill their prescriptions or don't take their medicines as prescribed (often because they can't afford them), are the ones who show up sick in the office or hospital for expensive emergency care and may go on to expensive extended nursing home stays. Now, that clinical experience is confirmed: Study Finds Savings From Medicare's Drug Plan Extend Beyond Cost of Meds.
Your actions can make a difference (see the recent reader's inquiry/comment to my blog about generic prices). Read the NIH report and send a copy of it to your Congressperson's office: urge your Congressperson to champion action which preserves access to Part D medicines through Medicare. Otherwise, as the prices of branded and generic Part D drugs rise, making those medicines unaffordable, America's Medicare health costs will rise.
Every politician counts heads: the number of voters who communicate with Congresspeople will affect the outcome.
The message is clear: Part D medicines save the United States money. Even more important, they keep seniors out of emergency rooms, hospitals and nursing homes, preserving their independence and quality of life.
Added July 27, 2011, 7:52 pm. Information on how the Federal Government and the pharmaceutical companies carry out their mutual functions. Click here.
Wednesday, July 27, 2011
Monday, July 25, 2011
Medicare and Retirees - Watch Out for Rising Generic Prices
I have noticed an increase of $1.00 to about $10.00 in the cost of generics I use. Perhaps you have had similar experiences, wonder why and ask yourselves how this will affect your financial security.
The pharmaceutical business is just another free enterprise business which places profits at the top of its accomplishment list when it reports to shareholders and seeks financial support from bankers and investment sources. Brand name drug manufacturers may have subsidiaries which produce generics, and as their patent franchises (i.e., Lipitor and Plavix) expire, you can expect those subsidiaries (or competing generic companies) to be producing generic versions of the branded drugs and to reflect their free-enterprise priorities in doing so. The insurance business, another free-enterprise (subject to some regulation) operation, generates profits by contracting to pay less for the drugs sold to you then your premiums reflect. The difference between their revenues (premiums, copays, rebates, etc.) and their costs (less rebates, etc.) for the drugs they cover pays the big bucks to their executives and more modest returns to individual shareholders.
When the price of a generic increases by a dollar, you, the purchaser, must have $100 in your bank account (at current interest rates) to generate the interest to cover your extra dollar in cost. If you fill 30 generic prescriptions a year you must have thousands of dollars in your bank account to have your interest cover your extra costs. The "minor" increase in generic prices will soon eat away your savings and assets because with the current rate of generic price acceleration that I have seen, you will have to be well-off to generate the return on investment sufficient to pay for the inflation in your drug charges. Obama's health reform plan may control the long-term doughnut whole growth that we have seen in the last two years but seniors and retirees need to pay attention to a political environment where formidable anti-health care reform pressures are being exerted by the party in opposition.
The "minor" increase in generic costs will have a major effect on Medicare-covered Americans and retirees. Make your insurance plan, including Medicare Part D, choice carefully. Shop carefully. And let your Congress people know that you understand what is going on and you expect them to respond to constituent's needs, and not let "minor" generic price increases bankrupt this voting population.
The pharmaceutical business is just another free enterprise business which places profits at the top of its accomplishment list when it reports to shareholders and seeks financial support from bankers and investment sources. Brand name drug manufacturers may have subsidiaries which produce generics, and as their patent franchises (i.e., Lipitor and Plavix) expire, you can expect those subsidiaries (or competing generic companies) to be producing generic versions of the branded drugs and to reflect their free-enterprise priorities in doing so. The insurance business, another free-enterprise (subject to some regulation) operation, generates profits by contracting to pay less for the drugs sold to you then your premiums reflect. The difference between their revenues (premiums, copays, rebates, etc.) and their costs (less rebates, etc.) for the drugs they cover pays the big bucks to their executives and more modest returns to individual shareholders.
When the price of a generic increases by a dollar, you, the purchaser, must have $100 in your bank account (at current interest rates) to generate the interest to cover your extra dollar in cost. If you fill 30 generic prescriptions a year you must have thousands of dollars in your bank account to have your interest cover your extra costs. The "minor" increase in generic prices will soon eat away your savings and assets because with the current rate of generic price acceleration that I have seen, you will have to be well-off to generate the return on investment sufficient to pay for the inflation in your drug charges. Obama's health reform plan may control the long-term doughnut whole growth that we have seen in the last two years but seniors and retirees need to pay attention to a political environment where formidable anti-health care reform pressures are being exerted by the party in opposition.
The "minor" increase in generic costs will have a major effect on Medicare-covered Americans and retirees. Make your insurance plan, including Medicare Part D, choice carefully. Shop carefully. And let your Congress people know that you understand what is going on and you expect them to respond to constituent's needs, and not let "minor" generic price increases bankrupt this voting population.
Sunday, July 24, 2011
The Debt Ceiling, The Civil War and Health Care
When the Tea Party, the Republicans, the Democrats and our nation's leaders take political positions based on their articulated fundamental principles, they demonstrate that they have learned nothing from American history.
Our Civil War, fought on the basis of deeply held non-negotiable principles, scarred our country and its families, leaving the South with a deep sense of tragedy from which it has never fully recovered. Fundamental beliefs cannot be negotiated and cannot be compromised. Individuals and parties, unable to walk away from their articulated fundamental beliefs, cannot move the political process forward.
Today, we have a debt ceiling impasse based, not on common sense and the need to solve our problem, but on "fundamental beliefs" which are not to be compromised - which, for the Democrats, means an attachment to social policies which ameliorate perceived societal wrongs and needs (including changes to our health care system) - and for Republicans, become tightly glued to beliefs about the unfairness of taxation, redistribution of America's resources, and "private" enterprise.
I hope that politicians make the political process work. Failure to move compromise forward will have serious national consequences, at a time when many American families are already touched by a national sense of tragedy.
Our Civil War, fought on the basis of deeply held non-negotiable principles, scarred our country and its families, leaving the South with a deep sense of tragedy from which it has never fully recovered. Fundamental beliefs cannot be negotiated and cannot be compromised. Individuals and parties, unable to walk away from their articulated fundamental beliefs, cannot move the political process forward.
Today, we have a debt ceiling impasse based, not on common sense and the need to solve our problem, but on "fundamental beliefs" which are not to be compromised - which, for the Democrats, means an attachment to social policies which ameliorate perceived societal wrongs and needs (including changes to our health care system) - and for Republicans, become tightly glued to beliefs about the unfairness of taxation, redistribution of America's resources, and "private" enterprise.
I hope that politicians make the political process work. Failure to move compromise forward will have serious national consequences, at a time when many American families are already touched by a national sense of tragedy.
Wednesday, July 20, 2011
ALMOST PERFECT
I accompanied a person to the doctor, today, and was impressed with what I saw. First, the staff and the doctor had hard copies of the records, x-rays, reports and materials (from other doctors) he needed. Second, he took a history relevant to the patient's complaint and even prompted for information he thought the patient might have and with a little effort, could produce. Then the doctor actually physically examined the patient. He was comfortable with his examining technique and quality and, as a physician, I felt assured that he was demonstrating not only his interest in the patient, but own competence and integrity. And then he spent a few minutes talking to the patient, reviewing scans and x-rays with the patient, and demonstrating why and how he came to a medical diagnosis, the meaning of that diagnosis, the prognosis and treatment. The visit was everything that a visit should have been.
Unfortunately, if you are a new Medicare patient, this doctor will not be able to see you. He has closed his practice to new Medicare patients.
Unfortunately, if you are a new Medicare patient, this doctor will not be able to see you. He has closed his practice to new Medicare patients.
Wednesday, July 13, 2011
What Does The Budget Impasse Predict For Health Care?
Prior to the early 1980's, health insurance was a side business of insurance companies. It is what they had to provide to big employers in order to get their other insurance business which was highly profitable. Then came inflation and things changed. As interest rates climbed and the health insurance business became profitable, among other reasons, because it allowed the insurers to profit from the "float," the insurers suddenly realized that they had hit an inflation gold mine.
One evening, at a dinner, Justice Arthur Goldberg (who told me that he served on the board of a prominent nation-wide health system) asked me what I thought of President Carter. He really wasn't waiting for my answer - and proceeded to tell me that he thought that Carter was lacking in capacity because he allowed interest rates to climb to more than 22% and that was destructive to our country.
I recall one group of physicians who - in the high interest early 1980s found itself paying more than 14% interest rates on loans it needed to continue its practice - and were only available - you guessed it, from insurers!
The danger of the impasse in the budget process, and the Republican refusal to raise the US debt limit, is that the uncertainty surrounding the outcome will force interest rates to rise, again rewarding insurers who manipulate their floats, slow down payment to hospitals, physicians and other providers, and reduce access by patients to what may be desperately needed life-saving services.
So, when the national debt ceiling adjustment is blocked by one party, is one consideration of that party the benefit which will accrue to the insurers who fill its campaign coffers? Is it the strategic ability of that party to further damage our health system. Or is it, as it should be, the well being of the United States of America and its citizens?
One evening, at a dinner, Justice Arthur Goldberg (who told me that he served on the board of a prominent nation-wide health system) asked me what I thought of President Carter. He really wasn't waiting for my answer - and proceeded to tell me that he thought that Carter was lacking in capacity because he allowed interest rates to climb to more than 22% and that was destructive to our country.
I recall one group of physicians who - in the high interest early 1980s found itself paying more than 14% interest rates on loans it needed to continue its practice - and were only available - you guessed it, from insurers!
The danger of the impasse in the budget process, and the Republican refusal to raise the US debt limit, is that the uncertainty surrounding the outcome will force interest rates to rise, again rewarding insurers who manipulate their floats, slow down payment to hospitals, physicians and other providers, and reduce access by patients to what may be desperately needed life-saving services.
So, when the national debt ceiling adjustment is blocked by one party, is one consideration of that party the benefit which will accrue to the insurers who fill its campaign coffers? Is it the strategic ability of that party to further damage our health system. Or is it, as it should be, the well being of the United States of America and its citizens?
Tuesday, July 12, 2011
The July Turnover Issue
I was fortunate to have my medical training at a time when the diagnosis of cardiac disease was dramatically improved by x-ray (angiographic) and laboratory techniques (cardiac catheterization) and to have been exposed to superb clinicians, including Maimonides Hospital's (Brooklyn) extraordinary clinician, Dr. William Dressler, the cardiology staff, led by Drs. Harrison and Hancock, at Stanford Medical Center (Palo Alto) and Stanford's cardiac surgery team, led by Norman Shumway, M.D. So, when I needed a cardiac diagnostic procedure and surgery I was faced with making a choice: a community cardiologist or a University Medical Center cardiologist. And then decide between a reputable community cardiac surgeon and team or surgery at the nearby University.
It was early July. Having served as a clinical faculty member myself at Stanford, Chief of Staff of a large local hospital and a member of a large hospital system board of trustees, I had enough experience and information to make the decision. I balanced the choice of a community hospital staffed by physicians and nurses who did complicated procedures well every day and the choice of going to a university medical center where I would be facing experienced faculty and a new crop of interns, residents and fellows. I stayed local and have never regretted that decision.
For information that might affect your decision in similar circumstances, see the Medline article and its related article which provides even more information. Be sure to discuss this issue with your trusted personal physician as you make your decision.
It was early July. Having served as a clinical faculty member myself at Stanford, Chief of Staff of a large local hospital and a member of a large hospital system board of trustees, I had enough experience and information to make the decision. I balanced the choice of a community hospital staffed by physicians and nurses who did complicated procedures well every day and the choice of going to a university medical center where I would be facing experienced faculty and a new crop of interns, residents and fellows. I stayed local and have never regretted that decision.
For information that might affect your decision in similar circumstances, see the Medline article and its related article which provides even more information. Be sure to discuss this issue with your trusted personal physician as you make your decision.
Friday, July 8, 2011
Complaint Day
Years ago, when the San Jose, California area had GM and Ford automobile assembly plants, I would see patients who told me that they hated their auto assembly jobs. They said that they hated the work and the systems in which they were working. They hated having to spend their lives installing the right front tire on every vehicle that came down the assembly line. They hated their dehumanization (my interpretation, not their word), inability to make decisions and bring about change. They hated the imposed industrial metrics which governed their work and lives.
Now, I receive complaints about medical care from a variety of people throughout the country. Their themes reflect their perceptions that the people who provide their medical care have issues similar to the auto workers I described. I interpreted their experiences differently from the way they interpreted them. The common theme for them was failure to receive care, interest, attention and proper treatment. My interpretation focuses on two issues, business arrangements and professionalism which I believe underlie many of these complaints.
When a physician sends a patient off without taking an adequate history, without performing an appropriate physical examination, and without offering an evidence-based diagnosis and treatment plan, that physician is unprofessional and has not fulfilled his or her responsibility to the profession, to the people who have established a governmental licensing authority providing a franchise for that doctor to provide professional care, but most of all, to the patient who, with a mixture of anxiety and trust, has come to that physician for professional intelligence, wisdom, insight and understanding. Patients are defenseless against the professional's "brush off," lack of concern, lack of skill and lack of interest or distractedness. Unfortunately, for those physicians - and most of all for their patients - what should be an intellectually challenging and engaging work has become a 9-5 job.
Factors shaping the health care profession which affect providers, patients and payers, include the "businessification" of medical care. What was once a single-practitioner or small group practice, marked by strong identification with the quantity and quality of care provided to patients and pride in shared practice skills, now will often be a large multi-location multi-specialty group, operated or controlled by non-physicians, with standards for practice essentially set by highly-paid non-medical administrators and business personnel enforce those standards through highly paid and carefully placed (and controlled) medical administrators (i.e., directors and department chairpersons) . The financial bottom line offsets the real quality of care (not the advertised quality of care). The choice of ancillary staff, productivity per doctor, cost per square foot of space, equipment, range of services, and scheduling have been removed from physicians' decision-making. Marketing-oriented questionnaires substitute as measurements of quality. Return on investment, rather than life-changing high-quality of care, is the measure of effectiveness and efficiency. Your health care has moved into the industrial metrics and control era. It's not the government's fault. It's our fault.
Quality of care can be measured, but why should anyone bother? If an insurer has a new group of patients every year, why invest in care which may initially cost more, but save their competitors money when, in later years, they inherit the patients on the basis of their "low" insurance premium bid. If the physician's pay and recognition depends more on the amount of revenue generated than the actual quality of care he or she has provided to non-high-profile patients, the physicians become ground down, their professionalism suffers and they have neither time nor interest in dealing with your complex medical issues in a 10 minute time slot.
We know what happened to GM and Ford and previous GM and to the sad owners of their industrial-metric produced cars. What is going to happen to you and your family under the industrial approach to health care?
Now, I receive complaints about medical care from a variety of people throughout the country. Their themes reflect their perceptions that the people who provide their medical care have issues similar to the auto workers I described. I interpreted their experiences differently from the way they interpreted them. The common theme for them was failure to receive care, interest, attention and proper treatment. My interpretation focuses on two issues, business arrangements and professionalism which I believe underlie many of these complaints.
When a physician sends a patient off without taking an adequate history, without performing an appropriate physical examination, and without offering an evidence-based diagnosis and treatment plan, that physician is unprofessional and has not fulfilled his or her responsibility to the profession, to the people who have established a governmental licensing authority providing a franchise for that doctor to provide professional care, but most of all, to the patient who, with a mixture of anxiety and trust, has come to that physician for professional intelligence, wisdom, insight and understanding. Patients are defenseless against the professional's "brush off," lack of concern, lack of skill and lack of interest or distractedness. Unfortunately, for those physicians - and most of all for their patients - what should be an intellectually challenging and engaging work has become a 9-5 job.
Factors shaping the health care profession which affect providers, patients and payers, include the "businessification" of medical care. What was once a single-practitioner or small group practice, marked by strong identification with the quantity and quality of care provided to patients and pride in shared practice skills, now will often be a large multi-location multi-specialty group, operated or controlled by non-physicians, with standards for practice essentially set by highly-paid non-medical administrators and business personnel enforce those standards through highly paid and carefully placed (and controlled) medical administrators (i.e., directors and department chairpersons) . The financial bottom line offsets the real quality of care (not the advertised quality of care). The choice of ancillary staff, productivity per doctor, cost per square foot of space, equipment, range of services, and scheduling have been removed from physicians' decision-making. Marketing-oriented questionnaires substitute as measurements of quality. Return on investment, rather than life-changing high-quality of care, is the measure of effectiveness and efficiency. Your health care has moved into the industrial metrics and control era. It's not the government's fault. It's our fault.
Quality of care can be measured, but why should anyone bother? If an insurer has a new group of patients every year, why invest in care which may initially cost more, but save their competitors money when, in later years, they inherit the patients on the basis of their "low" insurance premium bid. If the physician's pay and recognition depends more on the amount of revenue generated than the actual quality of care he or she has provided to non-high-profile patients, the physicians become ground down, their professionalism suffers and they have neither time nor interest in dealing with your complex medical issues in a 10 minute time slot.
We know what happened to GM and Ford and previous GM and to the sad owners of their industrial-metric produced cars. What is going to happen to you and your family under the industrial approach to health care?
Tuesday, July 5, 2011
Harold and the Band
Years ago, when I performed "pre-hire" physical exams at 7:30 Monday mornings, musicians were easy to spot. At one point during the exam I would hold a mechanical (tic toc) watch near patients' ears and ask what they ("they" were mostly men) heard.. Then I would rub my fingers together near their ears and repeat the question. If they didn't hear anything, my next questions were (1) are you a musician?and (2) did you have a gig this weekend? Invariably the answer was "yes" to both. Musicians were easy to spot because they were hearing impaired as a result of their work.
My friend, Harold, was not a musician. He was a caterer, and like many in that occupation, he provided fine food and competent service at bar mitzvahs, weddings and other large events where music was part of the entertainment. But unlike most caterers, Harold had something special in his pocket, something which was unusual. He carried a pair of wire snips.
When the music, became painfully loud, Harold would speak to the band leader and ask that the volume be reduced. The band leader usually complied - for a while. But because the band leader and the musicians were all hearing impaired and didn't appreciate what the party goers were hearing, soon the volume would rise again and Harold would wince. Once again, he told me, he would leave the serving tables and slowly walk to the band leader and ask that the sound volume be reduced. Once again, there was fleeting compliance. The third time, Harold made no request. He took out his wire snips, cut the musicians' amplifier wiring and walk away to a suddenly quiet banquet hall. The next time that Harold and that band leader were hired for another event, Harold never had to take the snips out of his pocket.
How many events have my readers attended which were marked by painfully loud music? I recently attended one at which there was a large glass container of soft earplugs (thoughtfully provided by the hosts) which were effective at protecting against the loud music played by the DJ, but also made it impossible to hold a conversation. How many of the young DJs, musicians, and their audiences, have impaired hearing as a result of irrationally loud music. How many of these people will require $5000 hearing aids later in life because no adult will take action, as Harold did?
Hearing loss is an isolating expensive handicap. Some of it can be prevented. Do we care enough about our young people to take action to protect them?
My friend, Harold, was not a musician. He was a caterer, and like many in that occupation, he provided fine food and competent service at bar mitzvahs, weddings and other large events where music was part of the entertainment. But unlike most caterers, Harold had something special in his pocket, something which was unusual. He carried a pair of wire snips.
When the music, became painfully loud, Harold would speak to the band leader and ask that the volume be reduced. The band leader usually complied - for a while. But because the band leader and the musicians were all hearing impaired and didn't appreciate what the party goers were hearing, soon the volume would rise again and Harold would wince. Once again, he told me, he would leave the serving tables and slowly walk to the band leader and ask that the sound volume be reduced. Once again, there was fleeting compliance. The third time, Harold made no request. He took out his wire snips, cut the musicians' amplifier wiring and walk away to a suddenly quiet banquet hall. The next time that Harold and that band leader were hired for another event, Harold never had to take the snips out of his pocket.
How many events have my readers attended which were marked by painfully loud music? I recently attended one at which there was a large glass container of soft earplugs (thoughtfully provided by the hosts) which were effective at protecting against the loud music played by the DJ, but also made it impossible to hold a conversation. How many of the young DJs, musicians, and their audiences, have impaired hearing as a result of irrationally loud music. How many of these people will require $5000 hearing aids later in life because no adult will take action, as Harold did?
Hearing loss is an isolating expensive handicap. Some of it can be prevented. Do we care enough about our young people to take action to protect them?
Friday, July 1, 2011
Radical, Revolutionary, and American
America is a country in which the rights and welfare and health of all of its citizens have been paramount since its founding. We have significant responsibilities for ourselves, and to/for each other, and the attitude that some persons are not worthy of respect and health care is un-American, even when that attitude is manifested by a person elected or appointed to a federal office. Read on -
We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain inalienable rights, that among these are life, liberty and the pursuit of happiness.
......Declaration of Independence
We, the people of the United States, in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish a Constitution for the United States of America.
.....United States Constitution
In the future days which we seek to make secure, we look forward to a world founded upon four essential human freedoms: freedom of speech and expression, everywhere in the world; freedom of every person to worship God in his own way, everywhere in the world; freedom from want which will secure to every nation a healthy peacetime life for its inhabitants, everywhere in the world; freedom from fear, which means a world-wide reduction of armaments to such a point and in such a thorough fashion that no nation will be in a position to commit an act of physical agression against any neighbor, anywhere in the world.
.....Franklin Delano Roosevelt
We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain inalienable rights, that among these are life, liberty and the pursuit of happiness.
......Declaration of Independence
We, the people of the United States, in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish a Constitution for the United States of America.
.....United States Constitution
In the future days which we seek to make secure, we look forward to a world founded upon four essential human freedoms: freedom of speech and expression, everywhere in the world; freedom of every person to worship God in his own way, everywhere in the world; freedom from want which will secure to every nation a healthy peacetime life for its inhabitants, everywhere in the world; freedom from fear, which means a world-wide reduction of armaments to such a point and in such a thorough fashion that no nation will be in a position to commit an act of physical agression against any neighbor, anywhere in the world.
.....Franklin Delano Roosevelt
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