Monday, February 25, 2013

My "Attitude" on Medicaid

A recent blog post on my frustration with upper management elicited the following comment:

"I get the sense from your posts that you pretty much have no tolerance for anyone on Medicaid. I have to think not all of them are scammers. And no, I'm not on Medicaid or any other form of public assistance. I pay more than my fair share of taxes, too. I know there are some people out there mooching off of the rest of us, but I still don't understand your attitude. You can't tell me you aren't mistreating some of the innocent people out there with your attitude." (emphasis added)

This comment really threw me. I'm basically accused of mistreating people because my attitude expressed toward the people who are clearly abusing the system that come to my pharmacy. That's a stretch. But since the author doesn't understand my attitude, let me tell you where it comes from:

A few years ago people were grateful for the state-funded program and embarrassed to pull out their Medicaid card. And some were on the program temporarily and when they found work, they went off the program. They were grateful for the temporary help. I myself have family members who were on state-funded Medicaid until their situation changed, so I personally know how fortunes can change and people desperately need help. And when they're back on their feet, the go off the system. That's how the system is supposed to work and I don't have a problem with that.

MY issues with Medicaid comes from the fact that I'm in the trenches seeing abuse and misuse every single day. UNFORTUNATELY, there are too many people that stay on the program, year after year, making no attempt to change their situation. Another aspect about Medicaid has changed. Many people currently on the program have an attitude that is completely different from those who used the system temporarily. Many people on Medicaid are, quite frankly, real asses about it. They not only DEMAND that their Rx be filled immediately, they have an attitude that it OWED to them. They are the worst segment of our population... people on the dole who feel like the government owes them a living, free housing, free medication, and you better get it for me right now.

Some of the abuses I've seen: Patients with BMW keys on Medicaid picking up prescriptions. YES, they own the car. Patients with seriously expensive cell phones and bluetooth connectors hanging on their ears on Medicaid picking up prescriptions. Patients that go year after year without work, not even trying to find a job. Other patients that go month after month, at our expense, with what appears to be no hope of getting off their narc medications. And doctors that make no effort to wean patients off pain medications. Oxycodone 30mg #300 every 30 days for some mysterious ailment and no attempt to find the source of the pain or attempt to wean them off. Here's a couple of examples:

I've written about Miss Loosey before. She's been taking advantage of Medicaid for the past five years. She openly admitted to me one time that she lied on the forms to get on Medicaid. A year before that she came in with an insurance card that was not hers; it was her sister's Humana insurance. She tried to tell me that it was "just an insurance mix up" and that I could process her medication under that card. Naturally the insurance rejected it because of the difference in the birth date. When I brought that up, she said they must have mailed her the wrong card. Of course, she never brought in the "right" card.

I have another patient who lives a good twenty miles away. Somehow he's convinced the Medicaid people that he needs a taxi ride to MY pharmacy every week to get his medications and a taxi ride back home. So the state (and my tax dollars) pay not only for his medication, but he gets a state-funded ride to come get it. His co-pay is $1.10. And time after time he doesn't have the $1.10 and we just give it to him. NOT ONLY THAT, some of his medication is not reimbursed entirely by our state. WE TAKE A LOSS every time he gets that medication filled and we have NO SAY about it. Most Medicaid reimbursements are minimal... meaning that even if we do make a profit on the prescription, it doesn't really cover the actual costs. It's barely a break even situation in most cases. And the more people that go on Medicaid, the less profit the pharmacy makes, and eventually that will affect tech hours and then pharmacist salaries. This socialist agenda is just out of hand and unless something stops it, it will affect my job.

So no, I don't have a good attitude about Medicaid. I have little tolerance for people who are taking advantage of you and me and have an attitude about it. The abuses of Medicaid is yet ANOTHER sign how far down the socialist road we've gone. BUT to suggest that I'm mistreating innocent people... well that's unfounded by anything I've done or said. I work for a company which measures our performance mostly on script count. My company encourages people on Medicaid to come to the pharmacy because they want to sell them groceries. We're the S&H Green Stamps for the store. So I'm not really concerned about each script other than the fact that overall the system is obviously broken and employed people are paying for it. Maybe YOU'RE happy and ok with people mooching off of you. I am NOT, however. I earn my money, every freaking dime. Having others taking advantage of the system on my dime is not acceptable to me. You can give all your money to charity for all I care, but MY MONEY IS MY MONEY. Feeling that way doesn't affect the way I treat patients on Medicaid. I don't like it. I don't like people that take advantage of it. But if it is a valid Rx and I get a paid claim, I'm going to fill it. No one is being mistreated, except the pharmacists and techs who deal with these moochers every day.

SIDEBAR: All you liberal actors and actresses in Hollywood who are so quick to spout off your support for liberal socialist wealth redistribution... I'll be impressed when you give ALL your money to charity. Heck, I'll be still be impressed if you give all your money except for, let's say, $1 million. Keep a cool million for yourself to retire on. Give up all the rest and I'll take your "concerns" seriously. Oprah, are you hearing me?


Anonymous said...

Standing ovation for you.

In addition, perhaps said celebrities should have to spend 6 months as a pharmacy tech and 6 months in the ER as a tech. They might change their tune if they knew they were funding/subsidizing laziness. Oh wait, who am I kidding?!? When their salary takes a hit for taxes, they've still got enough leftover to pay the bills and then some. But me busting my ass to make it? Not so much.

Anonymous said...

I understood where the commenter was coming from, as I too have occasionally gotten that sense from your posts. However, other than an occasional raised eyebrow, or perhaps a short tone (understandable on a busy day), I wouldn't think it compromises your job.

This is your blog, and I read it as a place for you to vent. I may not agree with all of your positions, but they are understandable. I also feel there is a place for venting - and venting does not include allowing for other possibilities, it is to let off steam. Then one can sit back and say whoa and regain a clear head.

I see no real need for anyone to take your writings as more than what they are. There are so many tired lines out there that we don't need to make a fuss on a fun blog. Sure they take advantage of your money. Sure I pay your salary. Sure you shouldn't pay school taxes if you don't have kids. Sure! Everyone needs a chance to spit things out without having to qualify every sentence.

So Keep on Crazy RX man!

Nurse Nasty said...

I completely agree with every point you have made.

I once worked for a clinic where a couple of the doctors were very generous narcotic prescribers. Many patients were coming in on a bi-weekly or monthly basis, paying nothing for their office visit thanks to Medicaid, and walking out with anywhere between two and five different scripts for strong narcotics.

They would then take those prescriptions and have them filled for a whole dollar each, again thanks to Medicaid, sell them as street drugs and make more money from that than I did at work!

I'm sorry if I'm a little bitter about the subject but I would invite anyone to witness that kind of welfare abuse day in and day out... on top of putting up with all the bullshit a patient load consisting of 70% drug seekers has to offer... and not form a negative opinion about both the welfare system and prescribing regulations.

Anonymous said...

I used to agree with these arguments about people mooching off people who are working hard and paying taxes, but then I learned that 51% of the federal budget goes to the (in my opinion overly large, and in the opinion of several of the wonderful veterans I am fortunate enough to work with, rife with waste) military--something neither Democrats nor Republicans touch other than to increase, and there is actually tons of CORPORATE welfare (see for example, I overpaid so much in taxes on a small income (because I am an independent contractor but refused to place sneaky games with deductions like most people, which is what the system is set up for you to do) when I couldn't afford health care so many years, so I FINALLY got medicaid this morning just for my duration of time in graduate school (a school that offers no health plan), and I feel okay about it.

I'm more concerned about the many abuses in how our government is set up to allow corporations and those who work the system to maximize profits than those who couldn't otherwise afford healthcare taking advantage of a system that actually is one of the wonderful things I'm happy to pay taxes into...

My two cents.