Standard Mischief

The Scene: K-mart-Sears, or Sears-K-mart, or whatever that store is down the street that sells everything from kitchen stoves to snack food, and has redecorated to add a “internet cafe” – sans any coffee – and to remove the pizza! pizza! cheezy snack bar. Your host, Standard Mischief, walks in. He’s on a mission. He walks up to the pharmacy counter and waits politely. He has timed this just right, it’s early in the morning and there are no other customers. A pharmacist is taking a personal call on the phone.

Standard Mischief: “I’m not in a hurry, I was just looking for a price check.”

Pharmacist: “What can I help you with?”

SM: “Well, I was looking for some prices on proton pump inhibitors.”

Pharmacist: “Well, what is your co-pay?”

SM: “No, no. I’m paying cash. I’m looking for a price on Nexium, once per day, 20 milligrams, 30 day supply”.

Pharmacist: “If you are paying cash, you definitely do not want that. I think you should try this” He pulls out a package of Prilosec OTC.

SM: “Yes, but that’s over-the-counter, I can price check that myself.”

Pharmacist: “With Nexium, you will pay through the nose.”

SM: “I was willing to bet that’s the case, but I wanted to get a check on the full range of options before I go into the Doctor’s office. You see, he only gives me fifteen minutes of his time and I need to have my ducks in a row. Also, I only get those fifteen minutes if I’m lucky and one of those drug company sales reps isn’t trying to take up some of my time.”

Pharmacist: “It’s very expensive.”

SM: “Is it really that hard to look up? I thought you had a computer? Don’t you do that all day long?”

Pharmacist: (begrudgingly) “Well, let’s see. The 30-day supply is $175.”

SM: “Thank you very much, I suppose I’ve taken up far too much of your time to get any more prices, I appreciate it.”

Standard Mischief exits stage left. On the way out, he price checks OTC ranitdine (Zantac), and picks up one bottle of brand name saline nasal spray. It’s a pricey $3.29 for something that is essentially sterile salt water, but he needs it and it’s far, far cheaper that that still-under-patent prescription steroid nasal spray he used to use, and it isn’t habit-forming like the OTC stuff he was using before that. Oddly enough, here at K-sears, the generic brand saline is actually more expensive. He decides to stock up on the cheap generic stuff next time he sees a sale.

–

Scene two: Our hero walks up to the pharmacy counter inside Shoppers Food Warehouse. It’s still early, so there’s only the Pharmacist on duty. He’s putting that four to six year degree to good use by counting out pills from a bulk package and sticking labels on little vials. Upon seeing a customer, he immediately puts down his busy-work. Standard Mischief smiles. Good service is such a rarity nowadays.

SM: “Hi, I’m looking for a quote on Nexium.”

Pharmacist: “Well, what strength do you need?”

SM: “20 mg, let’s say once a day and a 30-day supply if that’s a convenient way for you.”

Pharmacist: “Well, that’s $154.95. But we’ll price match any competing store in the greater Bowie area.

SM: “Oh, that’s interesting, do you do that with all your prescriptions?”

Pharmacist: “Yes, oh, and let me see what the price is on the other strength.

SM: “Ah, that should be 40 mg, right?”

Pharmacist: “Yes. (pause) Well, the other strength is the exact same price.”

SM: “That’s interesting, and if I remember correctly that’s a capsule, not a pill, so I could not use my pill splitter, right?”

Pharmacist: “That’s correct.”

SM: “Could I get one more please? Say Prevacid at 30mg, once per day?” Obviously, that research with his copy of 2001 Current Medical Diagnosis and Treatment was paying off. “I of course need to talk to my doctor first, but I wanted to check first.”

Pharmacist: “Sure, no problem. OK, that’s going to be $163.95 for 30 days.”

SM: “Thanks for your help today.”

–

I originally was going to gather a few prices on common heartburn or acid reflux drugs and make a chart, but I decided that this exchange, all of it true, was a far better example. I’ve cleaned up the dialogue a bit, but that’s it. From this short exchange anyone can draw out a number of important points.

By price shopping only two stores, I’ve manages to save a hypothetical $20.05. That’s only considering the fact that I was shopping for one drug. Furthermore, the Pharmacist at the second store offered to match prices. Clearly even the most left-leaning soul on the planet can see the Free Marketâ„¢ at play here, doing exactly what it is suppose to do.

Although it was tough slogging to get an actual price from the first Pharmacist, he wasn’t trying to push snake oil on me. According to this Wikipedia entry, AstraZeneca, the manufacture of Nexium, used to push Prilosec as their star acid-reflux drug. According to this other page:

“…So she’s among the many who hail the miracle powers of the original Purple Pill, Prilosec. That drug stripped misery from the lives of millions and became the world’s best-selling prescription drug – and the number one medication prescribed for seniors – taking in $6 billion a year. Prilosec is so good, and patients so attached to it, that doctors jokingly call it “purple crack.”

But that was then, and this is now, and the world’s former best selling prescription drug suffered a timely fate, it’s patent expired. AstraZeneca didn’t let it’s most profitable drug slip away so easily, however:

The main patent on Prilosec expired more than a year ago. Under normal circumstances, that would have triggered the arrival of a generic version on the market, followed by a host of generic rivals. With so much low-cost competition, we would all be enjoying lower drug costs. But that didn’t happen. Through lawsuits, the makers of Prilosec have managed to keep the generics at bay while unleashing a half-a-billion-dollar marketing blitz to move people off Prilosec and onto Nexium, their costly, patent-protected new Purple Pill, which even their own studies show to be barely more effective than the original.

The article that I’m linking to is somewhat dated. but after Prilosec’s patent expired, AstraZeneca pensioned to move the drug over to OTC. Perhaps at one time, over the counter drugs were a class of medication that was supposed to be safe enough for just laypeople to be able to dose themselves on, but nowadays it’s all about the marketing. There’s tremendous pressure on doctors to write scrip for prescription drugs, instead of telling patents to try something OTC. By moving Prilosec to OTC, I’m sure that they also managed to cut into the projected profits of the manufactures of generic Prilosec.

It also seems that Nexium really isn’t all that more effective that the now cheaper Prilosec:

Dr. Doug Levine, AstraZeneca’s executive director for gastrointestinal clinical research, says Nexium represents a clear improvement over Prilosec. But in most of the company’s trials, the effects of 40 milligrams of Nexium were compared against 20 milligrams of Prilosec. In the two instances where they were compared at equal strength, only one showed a statistical difference, and that was a 3 percent shorter healing time.

So as long as some other entity was picking up the majority of the cost of Nexium, The first Pharmacist was more than happy to sell it to me. That brings me to our next point: Almost no one price shops for pharmaceuticals. Is it any wonder that drug prices are sky high? If your prescription cost you a $20 co-pay, are you really going to shop around or are you going to go to the pharmacy that’s most convenient to you? Furthermore, if OTC Prilosec is priced at $19.29 for a 30 day supply (darn right I price-checked it), but the prescription purple pill is just a $20 co-pay  with the majority of the actual cost taken up by your insurance provider, which one are you going to choose? Now is it clear why pharmaceuticals prices are out of control?

You will also notice that I was price shopping for saline spray. I’ll tell you the truth, after I started paying the full real price for medicine, and that very real cash was coming out of my pocket, I was more than willing to try other therapies to get some relief. I know this will not work for everyone, but the simple saline spray once or twice a day works better for me than an expensive steroid spray like Flonase, Nasacort or Nasonex. By doing a better job at keeping my sinuses clear, I’ve drastically reduced the number of times I have had to seek professional care for an antibiotic scrip to fight off a sinus infection, saving both myself a co-pay and also saving my insurance company from having to come up with the balance of the doctor’s payment.

Update: There’s just one more point I need to make, It’s a pain in the ass to price prescriptions drugs. I’m convince that this is the case because there’s no market forces demanding prices (short of seedy no-prescription-needed gray-market ‘net pharmacies, none of which I’m willing to quote in my blog). Why should there be, when all drugs cost the same, the price of your co-pay. Most times a good doctor will have a feel for what’s expensive, but if I’m going in expecting to get a certain kind of scrip, I try very hard to control my out-of-pocket costs myself. This means bugging pharmacists, unless I can find another online pharmacy with open prices (sadly,an old online source I use to use is now defunct).

About the Author: Standard Mischief is the pseudonym of a person without any “piled higher and deeper” letters behind his name. He is in no way qualified to dispense medical advice, and is in fact explicitly not doing so. He has classified this blog post into the “not intended to diagnose, treat, cure or prevent any disease” blog category for that very reason. Please seek medical advice before acting on any non-advice contained in this blog. While you are waiting in the waiting room, please ponder living in a world where this type of incantation – meant to try to ward off a frivolous lawsuit – would not be needed. Think of a world where our legal system, suppose to be “of, by, and for the people”, would dismiss such suits with prejudice before even incurring a single billable hour by a several hundred dollar per hour lawyer.

Again, over at Lean Left. digglahhh Says:

Not to mention that elective surgery fields are siphoning off more and more of our most talented medical students.

Why have to worry about chasing down payments from begrudging insurance companies and bureaucracies when you can make what is basically straight cash to, as Kanye West would say,”throw some D’s on that bitch.”

The (un)ethical spillover from the American medical model infects, and promotes the infection of other spheres of our culture. How can we expect our citizenry to have a healthy view of health in general when our mechanisms to ensure it are in such disrepair, and ill-conceived at root?

Oh my yes! Why, D-503 is stealing his services from the One State! Square root of negative one!

I’ve stolen the above title from tgirsch over at Lean Left. That and the statement that both Canada-style and USA-style health care has serious flaws are the only bits worth repeating. I was hoping that he’d also make one of his typical smarmy statements about the “free market”, but alas that was not the case. Truth is that both systems need a IV transfusion of a little free market to break out if their anemic slog.

tgirsch rightly spanks this WSJ article though. Although the author David Gratzer does come out strongly for the USA system, he does fail to note any shortcomings, and he drops the ball when it’s his turn to propose some solutions. Hmmm, maybe if you buy his book you’ll get those answers. (Yup, he’s writing in the WSJ to plug his new book) Hopefully, I’ll be picking up that ball and running with it.

I’m planning on a few posts over the next few days. I’ve had them kicking around in my head for a while, I suppose this quote it what spurred me to get started on them:

tgirsch Says:

[For the record, I don’t support adopting a strictly Canadian-style health care system. Instead, we should survey the top health care systems in the world and selectively pick the best aspects of them to build a world-class health care system for everyone, not just the well-to-do...

Sounds pretty good offhand, however he goes on:

...Unlike Canada, I’d also allow private practitioners to provide pay-out-of-pocket care to those who are willing and able to do so, noting that doing so does not exempt you from paying your share toward the larger system. Think of this like education, where putting your kids in private school, home schooling them, or simply not having any kids are all perfectly legal options, but they do not exempt you from chipping in to pay for the school system.]

Now despite the fact that he’s willing to travel the world to sample the very best ideas in health care, in the very next sentence he’s already got what he thinks is the perfect solution, one which would undoubtedly be the rose-colored glasses he’d view every other solution through. What bothers me most, however, is the knee-jerk assumption that more government regulation and control are what’s needed, not less.

Now I’m not going to claim that our national public school system is utterly broken, because it isn’t [1], but the reason why is because there really isn’t a national public school system. Oh sure there’s the federal boondoggle that is the school lunch program and the No Child Left Behind crap, but by and large the public schools are controlled locally, and funded with largely local funds to boot. This one fact that there’s a lot of control locally Is what I believe prevents public education to be the typical federal bloat-aucracy that I would expect it to be. His analogy breaks down here because I’m assuming his idea is that if you resided in Maryland and were vacationing in Tennessee and for some reason needed emergency care, his idea would be that the local health care system would not turn you away, or charge you cash prices because you were not funding the local emergency care network with your property taxes. That kinda thing does happen every day with our public school system. Every once in a while they catch a congress-critter trying to enroll his/her offspring in Montgomery County Maryland schools, instead of the District of Columbia’s public school system, even though the representative in question resides in the District (that’s because DC’s schools are horribly broken, compared to some of the local suburbs).

A better analogy might be our public retirement system, also called Social Security. Here, everyone pays in to the system according to their income, (except for a certain white religious minority), and everyone dips into the same retirement pool when they are eligible to receive payments. Except that if your income is still too high, you get taxed on those benefits at a higher rate. Except that we’ve let our congress-critters (Republicans and Democrats alike) steal the Social Security trust fund, transferring it by decree into the general fund, and leaving the Social Security Administration with a pocket full of IOUs not worth the paper that they are printed on. Except we’ve allowed ourselves to be saddled with a de facto citizens ID card, originally not intended for identification purposes at all, yet now has transformed itself into an essential ID number, without which one can not function today in society. Except that very same ID number has been used and abused as a way to violate the privacy of citizens by public and private parties for decades.

So now that I’ve trashed tgirsch’s proposed system (and by extension, Canadian style health care, HillaryCare, single-payer health care, socialized medicine, universal health care, and any other related name from the euphemism treadmill for the same socialist crap), where are my solutions? Well for that, you’ll have to wait until my next few blog posts. To preview, the problem with US style health care is that there’s little incentive to control costs. More on this later.

[1] I will interject here that I’m a strong advocate of vouchers, and abolishing public schools altogether, letting the private schools compete with each other and cater to the educational wishes of their customers.

Yep, is seems to be true, Jacqueline Mackie Paisley Passey seems to have cut way back on the blogging. Seems that the dreaded “Real Life” syndrome (in this case a new job) has intruded on to the scene.

Although the quantity and quality of posts seemed to be declining, I suppose the comment discussion is what really kept me there. Still, I’d probably would have kept her blog in the “guilty pleasures” category regardless.

The part that ticks me off most is that she never blogged about her Health Savings Account (HSA) with a medical High Deductible Health Insurance plan that she had since post-college and probably right up to her new employment opportunity, if not held currently (I understand that her employers are libertarian leaning). She did, however, have quite a few posts about paying cash for excellent care in third world countries.

‘Tis a shame because I could use the ammo against those who want some kind of state run health care, or who confuse the Health Savings Accounts with the use-it-or-lose-it Medical Savings Accounts everyone is more familiar with.

Thankfully, in a post that had gone wildly off-topic, tgirsch doesn’t want to mandate that you participate, only that you are forced into supporting some sort of public health care boondoggle.

We’re veering off-topic now, but I wouldn’t support a Canadian-style Universal Health Care system where all services must be obtained from government providers. I would instead prefer a system where everyone is welcome to use (and, through taxation, help pay for) those providers and services, but could elect to go to a private practice at their own expense. Doing so would not exempt you from helping to pay for the government-run system, any more than sending your kid to private school (or not having kids at all) exempts you from helping to pay for the school system.

Yup, he want a system analogous to our *cough cough* World Famous Public School System. He might as well compare it to Social Security, where everyone (except one white religious minority) is forced to pay into a system that has had its operating surplus funneled right into the nation’s general fund while only having a pocket full of IOUs to show for it.

Oh and for the threat to privacy angle that appears after you have been taxed to the level that forces you into the public health care system?

Regarding personal records, you do what we do now with IRS records and the like: you prosecute the holy hell out of anybody who abuses access to that information. In any case, as Ted implies, your personal medical records are probably already in far more nefarious hands than those of the government.

I’m sorry, but please remind me who is now in jail for when the FBI overstepped their authority in using the perpetual patriot act? How ’bout the AT&T internet peering? When they pass laws like that mandating privacy, they frequently “forget” to add any penalties for breaking the laws, or if they do they ignore them. This is in stark contrast to the usual helmet or seatbelt laws chock full of fines and points.

Left on another blog, about a year ago by myself, after being ripped to shreds about my inexact, but apparently good enough grasp of the Canadian health care system:

…I can only guess that those who would support any kind of government controlled healthcare either think that medical privacy no longer matters, or that the moment we get socialized medicine in the USA, the horns will blow in the heavens; the United States will instantly turn into one of those enlightened European countries, except that it’s really freaking big, and has slightly less cool architecture; oh, and all the “fundies” will melt away like the Wicked Witch of the West.

Am I missing a third option? Please, do tell.

The response to that, oddly enough, was crickets chirping.

Yea, I’ll have to blog about this a bit more.

In what quite possibly may end up being my mantra, I’ll ask again. If Free Trade is good, isn’t it good for everyone, or is it only good when it directly benefits Corporations, LLC, and other types of corporate personhood thingys?

A few days ago, on May 8, the US Senate voted to add a “poison pill” amendment to a bill that would allow importation of drugs sold in other countries.

On a 49-40 vote, the Senate required the federal government to certify the safety and effectiveness of drugs before they can be imported, a requirement that health officials have said they cannot meet.

That’s a link to a story pulled off the AP. Unfortunately, they fail to explain further why the federal government can’t or won’t certify overseas drugs. The AP also fails because they don’t cite the name or bill number of the legislation.

My best guess is that it was S. 251, which – just for the record – comes in at a short 6,045 words.

If this is the proper bill, however, it does not have the text of the poison pill amendment. It’s been four days, Thomas.loc.gov is lagging.

The cited concerns, “safety” and “counterfeit” are pure FUD. I’m having a hard time understanding how the exact same drugs, frequently from the very same manufacturing facility, are somehow tainted just because the were packaged differently and then sold overseas. Are not the drugs available in “Australia, Canada, Israel, Japan, New Zealand, Switzerland, South Africa, Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxemburg, Netherlands, Portugal, Spain, Sweden, the United Kingdom, Iceland, Liechtenstein, and Norway” safe and effecitve? Or is someone making the case that the rest of the world is getting scree swept up from the floor of the manufacturing facilities? Also, seeing as we already have a problem with counterfeit drugs in this county, cheaper prices perhaps would remove some of the incentive to counterfeit drugs because that would be less profit to be made. It seems that simple countermeasures such as verifiable lot numbers should be able to take care of the problem. Pfizer is also implementing color-shifting logos as an additional countermeasure.

No, this amendment is just about allowing big pharma to be able to sell drugs at one price in one market and another price in a different market. It uses the resources of our government to protect the current business model.