LIFE IN THE AGE OF BUSH-- HEALTH CARE

Maybe it's because my friends are all getting older, but I keep hearing more and more of them talking about the problems they face in navigating the health care system. Come to think of it, it isn't just my own generation. A neighbor of mine is only 18 and the sytem drained every penny he had before tossing him-- utterly untreated-- onto the mercy of a generous doctor he stumbled on who saved the use of his hand. The generous orthopedic surgeon happens to be a music lover and couldn't accept that this talented guitar player would lose his ability to play just because of the dogmatic right wing ideology that has utterly wrecked the American health care system. I'll never forget Rep. Brad Miller (D-NC) telling me how overwhelmed so many people are with just dealing with the sheer hatefulness of the system.

And the system couldn't be more hateful if it were specifically designed by Kafka to be hateful. Estimates go as high as 40% of each health care dollar spent going to wasteful and needless bureaucracy and the creation of profits centers around those functions which actually impede the efficient delivery of health care. The system wasn't designed by Kafka. Nor was it even designed by Congress per se. It was designed by the very people who stood the most to gain, profit-wise, by structuring it the way it is now. In other words, the HMOs and pharmaceutical companies bribed our elected legislators with tens of millions of dollars, and our legislators abdicated to them the right to design and structure a system that would screw consumers and doctors. Today my old college friend and sometimes DWT writer, Helen Klein, agreed to share her recent experiences inside the hateful system. She's outlined a synopsis of her recent experience with health care/prescription drug companies, one that I suspect more than a few DWT readers will easily relate to. Helen:

Needless to say it is a negative one, generating much frustration (and cash). Even those of us who are solid middle class citizens with supposedly excellent health coverage are now confronting a disaster. We are teetering on the edge of an abyss and the middle class will soon be pulled down into it if something is not done and soon. The out of pocket expenses are increasing drastically. Boy I wish I lived in Europe or Canada right now!

I have Lyme Disease, a nasty tick borne disease resulting in many different symptoms. Early detection (based on the bull's eye rash, stiff neck and fever) and an immediate proper course of treatment usually do the trick. Living in Westchester, where there is a virtual epidemic of Lyme (though not recognized as such), I have had it three times over the past twenty years, as did my husband and both my sons. We were all treated quickly and everyone was fine. Many people, however, don't display the early symptoms or are not treated properly when they initially become sick. When this is the case, the disease morphs into another stage, with symptoms such as tingling and numbness in your legs and arms, joint pain, headaches, vision problems and others too numerous to list. At this stage, Lyme requires more intensive and extensive treatment. There is much disagreement, however, among medical professionals about this. "Lyme literate" doctors are in a tough situation right now. Furthermore, diagnosis is difficult, as the blood tests are not that reliable, which muddies the waters and gives health insurance companies an out. Treatment of this later stage of Lyme Disease is lengthy and expensive. Many health insurance companies will not pay for intravenous antibiotics or some of the pill antibiotics.

I was treated for chronic Lyme last year, initially with intraveneous medication and then with pills. The Lyme went into remission and I was a very happy camper! I was fine for about eight months. Unfortunately, last summer it returned. I was treated in the fall with pills, then went on to IV treatment again. All of the medication was covered by my insurance plan, so I was only paying the copay amounts (which were not insubstantial, e.g., $300/month copay for the IV medication). I am now entering my third month of IV. All of a sudden, the pills I have been taking inconjunction with the IV are no longer covered by my health insurance company. I had been paying a $10 copay for 30 pills that were generic, no problem. Now I was told I had to pay for them myself. I am guessing that I will need to take these pills for another three to six months.

So-- I asked my local pharmacist, a very nice man, how much 30 pills would cost. He said, "Oh, it's really expensive, about $500." I was in shock! I thought that the generic pills would be cheap. Based on talk among my fellow IVers (we sit together every morning while we drip-- that's another interesting story!), I decided to shop around. The pharmacist at CVS informed me it would cost over a little over $200, which did not sound too bad. I called BJ's and Sam's Club, both wholesale stores with pharmacies, and was told it was over $260. So I went back to CVS to buy the pills but I was then told it was $539 and that the previous amount was a mistake. I freaked out! This is a lot of money for me to have to lay out every month just for some generic pills! I then went on line for Canadian prescriptions, as one IVer had bought medication this way until he got better health coverage. One quote was $400, so I gave this up. Finally, I called COSTCO, another wholesale store, and was told $107! Needless to say, I ran right over there and bought the pills.

The saga continues. Last weekend I needed a refill. I called COSTCO and went to pick up the prescription-- but now it was $289!! I asked the pharmacist what happened and he told me that the prices from different drug companies change and that this was the cheapest price he could give me at the moment (he was a very nice guy and seemed to feel badly about this). I decided to shop around again. The next morning, another fellow IVer suggested a local pharmacy, which had sold the pills to someone for $120. I went over there and guess what? She told me it would be $89!! I filled the prescription immediately! Strike while the iron is hot! When I spoke to other IVers the next morning, one said that he had filled the same prescription there two weeks ago and he had paid $150.

So what the hell is going on? How can prices for a generic mediction range from $89 to $539 and vary so much from one day to the next even at the same place?? WE ARE GETTING RIPPED OFF, FOLKS!! The drug companies are yanking our chains! And what can we do about it? Right now, nothing. I am stuck buying these pills for a while and will have to keep shopping around!! If I am really lucky, my Lyme will go into remission for a long time. My fingers are crossed!

-Helen Klein


UPDATE: VOTERS KNOW SOMETHING IS WRONG BUT FEEL CONFUSED ABOUT HEALTH CARE

It always bothers me that Democratic candidates can't explain the problems with the health care system in a way that would rid the Congress of another 100 or so Republican and Blue Dog shills for HMOs and Big Pharma. Voters sense there is something terribly wrong; they're looking for leadership. Good luck in finding any!

Residents of the greater Miami area point to cost as their biggest healthcare concern and find information about the cost and other aspects of health care coverage to be complex and confusing. They are paying close attention to presidential candidates on health care and want more information from the candidates about the bottom line cost for them and for the country. They say the top health care priorities for the candidates should be to provide health insurance to all children, improve prescription drug coverage, and control rising health care costs.

I hope Democratic candidates will remind these consumers/voters how their representatives voted on the health insurance for children legislation (SCHIP) that kept coming up this past session.

Reactionary Republican Lincoln Díaz-Balart, for example, was a leader in GOP efforts to derail health care for children, which passed with bipartisan support and was then vetoed by Bush. Congress almost overrode the veto but Díaz-Balart refused to budge and the bill wasn't enacted. Now he's too busy campaigning for McCain to bother with the wishes of his constituents. But his constituents have a choice this year. The much-admirerd former Hialeah Mayor Raul Martinez, is running against him-- and he's on the right side of every issue that matters to most people in South Florida.