Archive for the ‘health care’ Category

The Long Farewell: Just shoot me now

October 26, 2017

So, at age 73 I am facing problems I thought wouldn’t be an issue for another 10 years. Multiple Myeloma is relatively rare — 0.8% of all new cancer cases worldwide. Being rare, it is also expensive. How expensive? One of my meds is the thalidomide cousin Lenalidomide. The raw price for enough pills for a single 14-day dose cycle is $8,700.

The cost problem arises from the fact that, although the drug has a generic name, the manufacturer, Celgene, has a monopoly on its production (as Revlimid), and can charge what they want. As far as the last 20% of price hikes is concerned, Celgene said in a statement that pricing decisions reflect a therapy’s value. i.e. what the market will bear.

My treatment will involve at least six cycles, or $52,000. However, that’s before insurance coverage kicks in. The trouble is, it’s hard to figure out the insurance copay. Here’s my ongoing Revlimid saga

23 Oct:

Letter from WA Rx Svcs approving the drug. To be supplied by Walgreens Specialty Drugs

24 Oct:

  1. Call from Walgreens saying there was a $175 copay. I was surprised, because we have three layers of coverage: Uniform, Medicare, Tricare. Called them back. They said Medicare doesn’t cover it, and they don’t have a contract with Tricare. Suggested I call the manufacturer and ask for a co-pay card.
  2. Called Celgene patient support. They are out for a two day beach party. Got a patient support specialists name and left a voice mail. They swore blind they’d call back on the 25th.
  3. Checked the Tricare site. They say they cover Revlimid with a $24 co-pay. They also said they have a contract with Walgreens.
  4. Called Walgreens back. They are Walgreens Specialty Drugs, not Walgeens Retail Drugs. Revlimid would be available at a $24 co-pay if the retail stores had access to them, but retail doesn’t have access to Revlimid. This is starting to sound like a Monty Python skit.
  5. Called Rockwood Cancer Center. They are busy. Left a voicemail.
  6. Called Uniform. They said it has to be filled through Wallgreens
  7. Called Wallgreens. Paid. They’ll get it to me tomorrow.
  8. Called Rockwood. Canceled voicemail. Set up appointment for Thursday
  9. Off to local Rockwood for blood draw, because the system hasn’t got enough of it out of me yet.

25 Oct:

Revlimid shipment came today — a sign-for FedEx shipment that left the manufacturer in Portland, Oregon, yesterday, and travelled to Spokane via Nashville, TN. One $8,700 bottle with 14 pills and a biohazard sticker.

26 Oct:

No callback from Celgene yet, and further research indicates that “co-pay cards” are only for those without some form of government insurance. Which is totally understandable.

Went to the clinic and started my chemo, but that’s another story.


Drugs, particularly speciality drugs, are not treated like other medical expenses. For most stuff, my work insurance picks up most of it, and what they don’t get Medicare gets, and what they don’t get, Tricare covers. With drugs, everything is in these individual silos, and WA Uniform works with a different set of providers than Tricare does, and what you pay is based on your point of entry into the system.

So, our point of entry is Uniform Insurance, and they only deal with Walgreens, and they want a $175 co-pay. The issue isn’t the money, as such, after all, others have it much worse. The issue is, we didn’t find out about the actual cost and the actual provider until it was ordered, and I don’t see any easy way we could have found out.

The next question is, what will happen when I lose employer insurance after I retire next year? Am I going to have to spend days on the phone again? Does the fabled Tricare $24 co-pay really exist? There’s an outfit called Accredo, that evidently has a contract with Tricare, so that might work out. Unless, you know, it’s Accredo Retail.



un-Health IT

April 12, 2012

I went in to get a blood test today. I’m a pretty healthy guy all told (when I had my mustering-out physical, the doctor thought part of my records must be missing, my career health record folder was so slim), and I’m usually only in for an annual physical. That’s what this was in preparation for.

Since my last visit, actually since last month, the clinic had gone to a new IT system — new provider, cloud based, the usual. What was irksome was that none of my medical insurance data had come across (I didn’t think to ask about my actual records), so they had to re-enter all of the data from my employer’s plan, my Medicare, and my Tricare coverage. Produce the cards. Scan them in. Re-enter things like emergency contact number. Wait for the servers, somewhere out in ‘the cloud’, to respond.

This is stupid. This is wasteful. This borders on criminal. Any company who cannot engineer a simple data transfer from one system to another shouldn’t be in business, and they certainly shouldn’t be in the health IT business. I didn’t think to ask what of my actual health records didn’t come over. Do they still know what drugs I am allergic to, or will they find out through trial and error?

I have said it before, and I’ll undoubtedly say it again. I lived my whole life, man and boy, in the military health care system. It worked, and it worked well. It is a government-run single payer system. Was it perfect? No. But, I’d take it in a heartbeat over the crapped up system we have today.

Veterans Day

November 11, 2009

I hadn’t planned on writing anything for this day. Most of what comes out is too treacly-sweet for me. But there have been a couple of reports worth passing on:

First, former 4-star and current ambassador to Afghanistan has expressed reservations about troop buildups, given the current Afghan leadership. He probably wouldn’t agree with anything but item 5, but I’ll reiterate what I’ve said before:
1. No compelling national interest – AFPAK is not where terrorist operational planning is done, and there are other places available.
2. Our presence is not helping. The tribes see us as just the latest in a long line of invaders.
3. Our presence is making things worse. There was no active taliban threat in PK until there was a US presence in AF.
4. No reasonable chance of winning at a price this country is willing to pay. We’re talking decades of conflict here.
5. We are propping up a regime that is corrupt from top to bottom — Karzai, the ministries, the army, the police. This has never worked.

If you want to support our troops, and not the old men who are sending them off to die, then support the idea of not committing them to hopeless causes.

Second, there are two reports on the streets on how we are treating our discharged veterans. In a word, shabby. In two words, like crap. Last year, over 2,000 vets, under the age of 65, died because they didn’t have health insurance. And another report says that vets are twice as likely to be among the homeless.

If you want to support our troops, support legislation that will provide adequate health care for all Americans, and will prevent honorable and courageous people from being thrown out on the streets. The fight isn’t just for veterans, it’s for us all.

Health Care and the UK's NHS

August 28, 2009

A friend of mine in the UK just emailed me. Here’s a snippet of what he had to say:

I am currently listening to news coverage of the debate taking place over there in the US about health care. There are some politicians citing the National Health Service as being an insidious service which rations out health care. I could not believe my ears when I heard the arguments against the NHS. How much insurance cover would I have needed in the US for the following treatments:- a partial laminectomy, the removal of the gall bladder, treatment(35 shots of radiotherapy) for prostate cancer, three months of Chemotherapy prior to the removal of the bladder and prostate,the resultant hospital treatment, all together about four weeks including five days on Intensive Care wards, and continued monitoring in the way of CAT and MRI scans and X-rays and not to mention numerous back-up consultations, and, most recently, consultations prior to my lung biopsy, during which fluid was drawn from the lung for analysis, the biopsy and resultant treatment including 48 hours on a High Dependency Unit, and, finally admission and treatment, including another CAT scan,for the blood clot in the lung. Oh, and don’t forget all the drugs I have been on over the years, and am still on. Total cost to yours truly, not a penny!! I think I know which system I prefer!

None of the arguments so far put forward agains health care reform ring true, except those that inadvertantly admit to being self-serving. They are either scare stories, that is to say, lies, or they are grounded in something other than a concern about health care. For example, those who say they oppose it on cost grounds are the same ones who voted for enough spending to change a budget surplus into a record level deficit. Those who oppose it on the basis that government can’t do things well are the same ones who fight to retain Medicare (but are careful to ensure that Medicare can’t use its full bargaining power). The only truth-sayers are those who fear that it would hurt the insurance industry (which is making big campaign contributions) and those who are opposing it because it’s the Democrats and Obama who are pushing for it.

And of course, that’s the point. The goal of the opposition is to defeat Obama and the Democrats. Health care is just a tool. When you hear the arguments, remember that. And think of my poor, downtrodden British friend.

An open letter to our Senators and Representatives

July 4, 2009

I have never written to my elected representatives before. I can only make that claim once, and the fact that I am doing so now should give you an indication of how important I consider this to be. I am writing about the current discussion on how to improve health care in this country. My position can be stated in one sentence: it is vital that any legislation passed include provisions for a public health option, and I am willing to accept increased taxes to achieve that goal.

As an elected official at the national level, you, more than anyone (and on this day, more than any other) should be aware of a major reason that the US Constitution was written the way it was. To put it in modern language, the founders wanted to make it difficult to game the system. For decades now, private insurance companies, whose goal is profit maximization, have demonstrated an ability to game the system to maintain those profits, and a willingness to do so at the expense of their customers. Far from being a competitive market, health care today is characterized by few buyers colluding with few sellers, none of who represent the population, either sick or well. The most important thing a public option would do is create a countervailing power, with a different objective, that will help keep the insurance companies and hospital chains honest.

I come from a military family, and a military career. I lived in Europe and Asia for six years, and I got to see how other systems worked. Recently I have been assisting an aged mother-in-law with her medical bills. She has a decent health care package as a result of her late husband’s years of work. Her own decades of work, by the way, proved fruitless – the victim of corporate mergers and destruction of retirement medical plans, well before the current meltdown. Her bills are a labyrinth of bureaucracy, apparently designed to discourage the elderly and infirm, and those who need it most. I have seen and been the beneficiary of a ‘public’ health care system since birth, and I can say without reservation that, despite it’s many flaws, it is far better than what most Americans have now.

I recognize that all systems have to ration medical treatment. Today, in the US, we do it by employment status, by socioeconomic standing, by luck, and by bureaucratic frustration. A private health industry is an important way to offer higher end treatments to those who can pay. A public option has to establish a rational method of rationing, but will have the example of the many different methods used around the world as a starting point. For example, it has been pointed out that in the Canadian system, everyone gets prompt, efficient emergency care, with moderate waits for elective surgery. High end treatment is constrained by limited numbers of specialists, not by government bureaucracy. The current US system provides an overabundance of specialists, with a shortage of General Practitioners. A private insurance system with a strong public option is the best way to go.

I also recognize that providing even minimal coverage for everyone will cost money (although not as much as the public plan critics have claimed, and there is a reasonable chance it will save money, overall). Even if it does cost more, it will be worth it, for two reasons. First, a public option will remove the uncertainty and frustration associated with today’s non-transferable employer-funded (if you have a job) system, a system that is designed to deliver profits, not health care. Second, it will be worth it because it is the right thing to do. I am offended by the fact that I live in a country that allows the poor and the unlucky to die in order to maintain insurance company profits. I am appalled that so much of my contribution to health care is wasted in a corporate bureaucracy designed to limit support for my needs. Under the current system, health care costs continue to rise, and more of every patient’s valuable time is spent digging through paperwork. These costs are at least as burdensome as higher taxes. If taxes go up, and the system becomes more reliable and available, then the extra tax is worth it.

Recently, conservative columnist George F. Will admitted that a public option would be cheaper because of the negotiating power of the government, and because it is not driven by a profit motive. He then complained that this was unfair to the insurance industry. I am not opposed to the insurance industry, and I certainly am not opposed to businesses making a profit. I am opposed to businesses profiting from the suffering of their customers. The whole point of a public option is to use the power of the government, and its mandate to provide for the common good, to…provide for the common good.

In conclusion, I urge you, our Senators and Representatives, to support a public option in the upcoming health care legislation. I know there are compelling political reasons and pressures against such support. But, the point of health legislation is to protect the health of Americans, all Americans, rich or poor, employed or (increasingly) unemployed. It is too important to be held hostage to special interest groups and politics as usual. This is your chance to rise above politics, to rise above being a politician, to become a statesman.

Health Care and Taxes

March 15, 2009

Just finished assembling my aged mother-in-law’s taxes. Her health is OK, for a mid-90’s cancer survivor. What depresses me every year is how convoluted, nay Byzantine, our health system is. She’s lucky. Her retirement plan covers most of her costs, but the sheer number of bits and pieces of bills and reports and is just horrifying, and the original costs, before plan coverage, is beyond horror. She lived and worked at a time when it was still possible to be employed at the same firm for years, and so has good coverage.* Today’s part-time, downsized, RIF’d, no-benefits workforce is out of luck, and living on the edge of the abyss. Anyone who isn’t for a single-payer system, and universal coverage, simply does not, cannot, or will not understand the situation for millions of Americans. I’d be willing to pay a whole lot more in taxes to avoid her situation.

*Correction. Her retirement plan/health care got killed when BofA took over SeaFirst. Her husband had excellent coverage through GE, which still protects her.