Monday, April 15, 2013

Alienating the Left

Recently I posted another article about Levaquin Lady. Some readers took offense with the following statement from the article:

Levaquin Boy was feeling sorry for his mom at home. She was discharged early because of new hospital rules regarding reimbursement which are a direct result of major changes in healthcare, but I wouldn't want to point any fingers at the culprit because there's just soooo many readers of this blog out there that are quite happy with the way things are going healthcare-wise. Someone might say "Socialist Libtards," but I won't.

One comment states:

I used to think that your blog was semi-amusing, and I started reading it because it is on Dr. Grumpy's recommended list. The increasing number of bitter, insulting political comments have changed my opinion. It's your blog, your choice, but I'm not sure why you'd want to alienate left-leaning readers.

Semi-amusing? Woo hoo! Thank you! That's a big step up from my family members who don't find it amusing at all! But I have to ask: where have you been the past thirty years? The media in general, but primarily newspapers, television, and Hollywood, has been on an anti-conservative bent FOR YEARS. From digs on Dan Quayle to George W. Bush to John McCain, it's a never-ending saga of "bitter, insulting political comments." Every week on Saturday Night Live we're treated to some sort of dig on conservatives. I laugh at something when it is funny whether it is a dig at a liberal or a conservative. I laughed when they made fun of Dan Quayle. He said some wild crazy things and the media went out of their way to publicize it and make fun of it. TODAY you're hard pressed to hear about the stupid things that Joe Biden says all the time even though he says A LOT of stupid things. Just the other day Biden was telling people to use a shotgun instead of an assault rifle because it won't put holes in the wall. Really?

The irony is that my statement about the healthcare reforms in this blog article points out the fact that the new healthcare policy actually has a negative effect on the patient and is really all about money, not the patient. To me this would be something that a liberal would suggest as a conservative reform, not vice versa. Part of the healthcare reform (that Nancy Pelosi instructed the congress to vote for "so we can see what's in it") directly affects the reimbursement that hospitals receive for Medicare patients. One small part of that reimbursement is that the patient must be discharged according to the healthcare bill's predetermined chart, NOT based on when the individual patient should be discharged according to their own needs. OTHERWISE, the hospital does NOT get paid, at all. I'm sorry people don't seem to understand this simple concept, but ALL businesses operate on profit. No profit = no incentive to produce. Unless the hospital can make a profit, they're not going to stay in business.

Every patient is different and for all the Levaquin that Levaquin Lady has had in the past, kicking her out of the hospital too soon was a really bad idea. And here's another aspect you probably don't know about. When a patient is discharged according to this predetermined schedule, the new directives also dictate that IF the patient returns to the hospital within a certain amount of time with the same ailment, the hospital will not be reimbursed for EITHER visit. The healthcare directive is forcing hospitals to discharge patients early then if they come back due to complications being discharged early... tough luck, no reimbursement for you. Tell me, HOW is this beneficial? It's NOT, except to stick hospitals with having to spread the cost of these patients onto other patients' bills.

Over the next decade you will see massive changes in how care is provided based on this bill. Hospitals WILL close. Have you noticed how urgent care centers are popping up everywhere? That's because they know this. This is the future of healthcare. Doctors will stop taking Medicaid and Medicare patients because they won't be able to get paid for seeing these patients. Some doctors are already declaring bankruptcy. Read this article. Again, let me remind you, all businesses operate on profit. No profit = no incentive to produce.

You're kind of silly. The corporate blockheads are making your work life miserable because of their greed, yet you want healthcare completely in their hands? Not sure if I'm left or right, but I'd love to know what you think is the answer here.

I'm not silly. I am on the battle line seeing what's really happening as its happening. Nothing I said indicated that I want corporations to run healthcare, but I certainly don't think government should be involved in it either. One thing I know for sure: Socialism is not the answer. If you can tell me ONE example of anywhere in the world where socialism has worked, I'll reconsider. You can't. Look at history.

 Janine said...
I have to agree with the other two posters. Clearly you hate the thought that the gov't might try to provide health insurance to those unable to afford it any other way, but I don't understand why. I also don't understand why you think it will make your life worse, since your problem seems to be that you hate the company you work for. 

I don't hate the thought that the government might try to provide health insurance to those UNABLE to afford it any other way. What I see on a daily basis is massive abuse of the Medicaid system by people who ARE able to pay but are taking advantage of the system. Here's an EXAMPLE of how the you know the system is broken and is exactly what I'm talking about, and NO it isn't an isolated incident. Abuse of Medicaid happens all the time. There is a growing, pervasive ENTITLEMENT attitude out there of YOU owe ME and it just has to stop. This abuse is widespread and it costs us all money.

Also you overlook a very real problem in this country. For 15 years I was self-employed and bought my own health insurance. Then the recession hit, my income plummeted yet my health insurance had risen to $800/mo. I had no choice but to drop it (along with a host of other "necessary" things like collision on my car, healthy food, etc.). For 5 years I lived in fear of becoming really ill. No matter what might be wrong, I had to hope it would heal on its own because no doctor would even see me without insurance--and the ER is much too expensive for non-emergent issues. It's a horrible feeling to have to live with such fear. Recently I was able to again get health insurance for a price I could afford because I still spend NO MONEY on anything that isn't critical to existence, like food. No restaurants, newspapers, vacations, or unnecessary trips in the car. NOTHING. But I can afford health insurance again. Maybe your utter lack of compassion has something to do with the fact that while you don't like your job, it has always included some health insurance so you don't know what it's like to live in fear of dying of something easily curable just because no doctor will see you?

I am sorry for your situation but as you describe it you're one of a very few number of people using the system for the help it was designed for. You didn't abuse it and I don't mind a portion of my taxes going to people who truly need it and appreciate it. What I see is widespread abuse by people who take advantage of Medicaid and Medicare's lack of any ability to verify each patient situation. Too many people know that they can get help at no cost or virtually no cost just on a signature. And they DO take advantage of it.

I was self-employed for 20 years myself. I bought my own health insurance when I could afford it. I didn't always have health insurance and I paid out of pocket for the doctor/hospital cost for the birth of both of my children. I never thought that my healthcare was a "right" like life, liberty, and the pursuit of happiness, because it is not. I have a right to life, but I didn't (and still don't) expect my healthcare to be paid for by everyone else. That's the thing you have to realize... when people say THE GOVERNMENT is paying for Medicaid, that's not really true. Taxes from OTHER people are paying for Medicaid. I have no "right" to expect someone else to pay for my healthcare any more than I have the "right" to go to my next door neighbor and demand that he give me a gallon of gas out of his car because I'm short this week.

Maybe your utter lack of compassion has something to do with the fact that while you don't like your job, it has always included some health insurance so you don't know what it's like to live in fear of dying of something easily curable just because no doctor will see you?

As I said, I was self-employed too. I lived in fear too. I can sympathize with your situation because I lived it myself. BUT I didn't expect someone else to pay for my healthcare. I honestly am just appalled at this philosophy. It really makes no sense to me. Further, it is very ironic that you accused me of having an "utter lack of compassion" when I was lamenting the fact that Levaquin Lady was discharged BEFORE she should have been. I was showing one weakness in Obamacare that directly affects the patient and the hospital.  

And that's another thing: While I have health insurance, I don't have drug insurance because I only take one, inexpensive drug (synthetic/generic thyroid). But my local pharmacy chain charges me $30 for a month's supply, while WalMart charges me $4. So is WalMart subsidizing the other $26 in the hopes that I'll buy more than $26 worth of stuff while waiting for the prescription or is the chain ripping off those of us without insurance? What does it cost to make a thyroid pill? Something is seriously wrong with the way we do healthcare in this country and if there is any way that Omamacare will correct it, I'm all for it.

I don't know your community, of course. In mine, all the major pharmacies match the Walmart $4/month price for a bunch of medication, even if it is below cost. What's more, every pharmacy matches the other pharmacies' list. Each pharmacy has a different list, so in essence the actual list of medications available for $4 for a month supply is much larger than any one list. In some states they just give you an Amoxicillin Rx at no cost just to get you in the door.

Again, I don't know your specific pharmacy that's charging $30 for a month supply. But if we look at it under the idea that NO profit = no incentive to produce, it would make sense. Walmart is huge, the largest retailer in the world. And with that you get a huge, huge quantity discount. In retail, the more you buy, the cheaper the price. That's just the way it works. A small community pharmacy has to pay more for Levothyroxine (generic Synthroid) than Walmart. It's just a fact. A small community pharmacy has to pay more per square foot for rent. They have to buy their own insurance at a premium price (which you are aware of... you said you were self-employed). So EVERYTHING costs more for the small pharmacy as compared to Walmart. Do I think it justifies them charging $30 for a Levothyroxine Rx? I don't know. But I'm sure the manager/pharmacist there is simply trying to make a profit to feed his family based on income needed per number of prescriptions filled. What I can tell you is that you will get faster and better pharmacy service than at the giant Walmart where you're just an Rx number.

I recently transferred a couple of prescriptions from Walmart to my pharmacy. I was astounded at one of the labels on the bottle: "Please give us 48 hours advance notice for your refill." Really? 48 hours? I barely get 10 minutes advance notice at my pharmacy. Years ago I did a rotation at CostCo. Every single person that had to wait ten minutes JUST TO DROP OFF their prescription was absolutely shocked to hear that it was going to take 90 minutes to fill their prescription. And it did take 90 minutes with TWO pharmacists, NINE technicians, and me the intern to fill the prescriptions, because it was just that busy. Did we have time to really delve into the particulars of each patient? No. This was a pump-it-out factory of prescriptions.

Let's analyze the Levothyroxine issue for a moment. I don't have exact numbers, but we can estimate. Suppose your local pharmacy has one technician and one pharmacist. Let's further assume from start to finish it takes five minutes to fill your Levothyroxine prescription:

Technician, $10/hour, 5 mins = $0.83
Pharmacist, $52/hour, 5 mins = $4.33
bottle = $0.15
cap = $0.05
label = $0.20
product = $1.26
electricity, phone, rent, insurance... all fixed costs but would be part of the equation too. Let's say electricity is $300 per month, $100 for phone, rent is $2,000, insurance is $500. I'm pulling these numbers out of thin air but this is just for fun. Let's further say that your local pharmacy does 600 prescriptions a week or 31,200 prescriptions a year.  So for every prescription, the fixed cost is about $.90 per Rx. We haven't even addressed any other staff for the pharmacy, promotion, advertising, even the bag to insert the Rx, etc.

So far I've got $7.72 as just the COST for processing your prescription. Remember, the pharmacy HAS to make a profit or he/she wouldn't be able to stay in business. If the pharmacy does a lot less than 600 prescriptions a week, obviously the cost is going to go up and the mark up has to be higher. So what's the trade off? Why is your prescription $30 instead of $4? Part of it is simply the cost of doing business. But why does your pharmacy continue to stay in business? Because he or she sells something that Walmart can't... that's genuine, personalized customer service. You're only on one med. But if you were on several meds its a good bet that even when the computer picks up on an interaction at Walmart they will bypass it and you'll not be counseled at the register. But not an your local pharmacy. Maybe 90 minutes isn't unreasonable to you, nor is having to let the pharmacy know 48 hours ahead of time. Maybe $30 is unreasonable for one Levothyroxine prescription... but when you look at it, really look at the numbers involved you can see that it is much more than that. Your local pharmacy will never be able to compete with giant Walmart ON PRICE alone. If that's the only thing that's important to you, then you'll never understand the value of an educated and seasoned pharmacist.


Anonymous said...

"Unless the hospital can make a profit, they're not going to stay in business."

Just for discussion's sake, should hospitals really be included in the same class of businesses as, say, cars, clothes or cell phones? I can get by w/o a new car, new clothes or a new cell phone. I can do w/o new if need be, or do w/o entirely if need be. Should a person really have to do w/o lifesaving medical treatment whose requirement could not have been foreseen? You knew you'd have to pay cash for your kids' births, so you probably starting saving up before they were even born. What if they had been preemies and needed a million dollars of NICU care? Everyday there are people who are in medical situations that could not have been planned for, through no fault of their own. Are they really supposed to "do without"?

Now, don't mistake my question for saying there isn't serious abuse in public assistance. I definitely think it should be more strictly regulated than it currently is. But it doesn't mean it doesn't have a place.

Anonymous said...

Why should anyone have to worry about everything you've written here...when the almighty government will take care of everything for them and make all the bad stuff go away?

Excellent response. Kudos to you.

And, keep working your ass off for Levaquin lady because Lord knows she isn't going to be taking care of herself anytime soon.

Anonymous said...

Yes, hospitals do need to make a profit otherwise they cannot keep their doors open. I.E. can't operate in the red indefinitely. The employees don't work for free and bills need to be paid (mortgage, taxes, utilities, special waste disposal for hazardous waste and anything with patient information on it, etc)

Even non-profit hospitals need to bring in more money than they spend - to upgrade equipment, new technology,training folks on those new technologies, redoing the electrical wiring, etc. - the non-profits just need to put the profit back into the company.

Anonymous said...

Differing opinions are great. Insults and bored generalizations tend to make people shut down and not be interested in what you have to say, even if what you say has merit.

I'm able to express my political views without resulting to name-calling.

Shame so many on all sides miss that concept.

Steph said...

"I have a right to life, but I didn't (and still don't) expect my healthcare to be paid for by everyone else."

Sometimes your live depends on medical treatments you can't afford- Given your profession you surely are aware of that.

I live in Germany and we have mandatory health insurance.
The premiums for healthcare are defined by your income and you have a fixed sum of yearly copay also depending on your income.

What is so wrong with the principle of solidarity ?
I count myself very very lucky to live in a country that provides a high standard of healthcare affordable to everyone.

Janine said...

You're right that too many people believe their assistance is free, electing not to care that it is paid for by taxpayers. And I'm sure there are tons of abuses connected with disability, medicaid and all the other government programs. But that just means that we need to root out abuses more diligently and perhaps find a way to make it clear to people on assistance that their assistance isn't free (maybe expecting them to pay some of it back by doing volunteer work?).

And, OK, I don't at all understand the hospital issue you raised. Why force a hospital to discharge someone prematurely and then punish them for doing that by forcing them to take the patient back without reimbursement. I wish someone would explain the thinking behind this because it makes no sense to me.

But still, these are side issues. The real issues are: Why is healthcare so expensive? What costs keep driving it up? And what prevents us as a country from simply insuring everyone? I doubt there is any simple answer to either question.

Some problems are surely obvious: If local pharmacy cannot compete with WalMart, then the free market says local pharmacy should go out of business. Draconian, maybe, but that's the free market. (Just by the way, the "local pharmacy" that charges me $30 for synthroid is a national chain, not a privately owned store. Clearly not on a par with Walmart in size, but still hardly a ma-and-pa operation. So your financial analysis skewed high.)

Why do hospitals compete for patients the way retail stores do? Is that necessary? Does every hospital have to have the newest, most expensive machines, even though they don't have the traffic to justify the cost? What's wrong with there being regional centers that offer specialized medicine and let small, local hospitals avoid those kind of expenses? (Yeah, I know. Hospitals believe patients won't go there if they don't have the latest and greatest facilities. But I doubt it's really true.) And if that means some hospitals go out of business, well it's the free-market again.

And what's wrong with clinics? I think they're a great thing! Why go to a hospital if all you need is a flu shot, an x-ray or an antibiotic--and you can't wait two weeks for your own doctor to fit you in? The clinic is cheaper and quicker than the ER (and maybe that's another problem with hospitals).

Why isn't government using its buying power to buy drugs at cheaper powers? It already uses its paying power to set prices.

As the person from Germany pointed out, if EVERYONE pays into the healthcare system, the costs are distributed over a much wider group.

And if I may applaud what Anon at 5:12am said: Every day there will be people who find themselves in need of healthcare that they could not have anticipated and could never pay for without insurance (and in some cases, can't pay for even with insurance). Do we want to revert to the kind of society that throws old people in the woods to let them die, or abandons children with birth defects? Or even says, too bad you've broken a leg: you have no insurance so we won't help you. There will always be abuses, but they should NOT be the justification for not taking care of one another. We just need to do more to root out abuses and do more to provide all of society with the basic things needed to stay alive. I don't think that's too much to hope for nor do I believe we can't afford it.

Anonymous said...

What offends me the most in this whole dialog is the use of the word "libtard". I find it insensitive and insulting to use any form of the word "retarded" as a derogatory term. Mental retardation is not a joke and to characterize someone one dislikes as a "tard" is repugnant. That word belongs in the dustbin of history along with the "n" word and other pejoratives that are based on a characteristics that an individual has no ability to control.

DreamingTree said...

I consider myself to be a moderate. When I watch shows like SNL, I laugh at skits that poke fun at politicians on both sides. The problem I have with some of your comments is that they aren't funny. Instead, they come across as insulting and mean spirited.

I'm a health care professional, so I get your frustration. The system is broken, and we need real solutions, and real compromise. The current practice of insulting the other side just prolongs the problems.

Finally, fill your blog with whatever type post you choose. My opinion is just opinion. As I pointed out before, I started reading your blog after seeing the link on Dr. Grumpy's blog. I like his humor, and I like many of the blogs he links to. Many of your posts are funny, but there are times I'm turned away - usually because of political insults. Simple feedback that you can take or leave.