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Tilting at Windmills

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January 16, 2006
By: Kevin Drum

REPUBLICANS ON DRUGS....On the subject of Republicans treating legislation as mere vehicles for doling out favors to corporate special interests, one of Josh Marshall's readers offers up some comments about the Medicare prescription drug bill:

Arbitrary drug classes like benzodiazepenes and barbiturates are specifically excluded from coverage. Congress left no clue as to the legislative intent of the exclusion. Someone seems to have decided that these two drug classes are incompatible with some Biblical teaching. Or maybe the competing drug classes are much more profitable for someone's campaign contributors (as both benzodiazepines and barbiturates are cheap and produced as generics, unlike their likely treatment alternatives). As a result the nation's psychiatrists are going batshit right now, trying to figure out what to do with patients on drug regimens for things like seizures.

I don't know if this was the worst bill ever written, but it's certainly in the top ten. I'd actually be willing to cut the funding for prescription drugs in half if only they'd let actual policy experts design the implementation of the damn thing. Of course, since Republicans don't have anybody who cares about policy in this area, that would mean handing it over to Democrats.

Say....

Kevin Drum 9:52 PM Permalink | Trackbacks | Comments (110)

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Biblical teaching

going batshit

Huh? I'll make a wild guess and say that they were excluded because they are drugs that commonly find their way to the black market.

Posted by: onetwothree on January 16, 2006 at 9:59 PM | PERMALINK

Cal,
I have gotten two messages from you today that are, to say the least, puzzling. As you have more important people than this dufus to email, I assume that your address book has been corrupted.
Yes, this is one of the all time badly written bills of American history, excepting the one that tried to define the value of pi as 3.0 instead of 3.1416....
However I think the rethugs will have to implode with the power of a super nova before the demodumbs return to power. So sad.

Posted by: dilbert dogbert on January 16, 2006 at 9:59 PM | PERMALINK

i get to say it for the second time today!

i've been urging dems, since this awful bill passed, to loudly call for its recission, on the grounds that it's too expensive and too inept.

by playing against type, the dems would position themselves well for the tax-hike struggle to come; meanwhile, by showing that we stand for government programs that accomplish something as compared to those lobbyist cronies over there on the other side of the aisle, we make an important point to what i consider to be the crucial swing vote in 2006: honest conservatives alarmed at bush-ism but culturally resistant to voting democratic.

Posted by: howard on January 16, 2006 at 10:00 PM | PERMALINK

"Many people will wake up and discover that the Medicare bill is a
cruel hoax
," Sen. Hillary Rodham Clinton, D-New York, told reporters. "It does not provide the kind of benefits that they had hoped for, and it will lead to the undermining of Medicare traditionally."

Posted by: Den on January 16, 2006 at 10:11 PM | PERMALINK

This is a story that will be played out locally. Every nightly bulletin, every local paper will have its own Area Senior affected by this clusterfuck. It'll be covered by beat reporting, as a human interest story.

In short, the GOP isn't going to be able to squash this one.

Posted by: ahem on January 16, 2006 at 10:26 PM | PERMALINK

I'd also rank that Telecommications Act of 1996 right up there as one of the all time worst bills ever to pass through Congress.

Posted by: eagleye on January 16, 2006 at 10:31 PM | PERMALINK

So how would Kerry's policy of universal healthcare be handled better?

'cos it say no to nothing?

Then how would it not cost much, much more?

Posted by: McAristotle on January 16, 2006 at 10:32 PM | PERMALINK

I remember reading an article about the Clinton administration's prescription drug program. Wanting to be a little more accurate, I did a quick Google search. Clinton's program was supposed to cost about $150 billion over ten years, compared to the $700 billion over ten years the Bush administration program will supposedly cost. And this program, from the brief readings I've done, it was a fairly simple program designed to be phased out after certain expenses and incomes. So, we have a better program that costs less, a lot less.

As my mom often says when she opens bills, "WHAT THE HELL?!?!?" I have to stop researching this stuff. It's making me so depressed.


http://clinton4.nara.gov/WH/New/html/20000313_1.html

Posted by: Brian on January 16, 2006 at 10:34 PM | PERMALINK

onetwothree,

If they were really concerned about blackmarket drugs, they would have excluded Oxycontin. Kevin's explanation is much more plausible. There was nobody lobbying for generic benzodiazepenes and barbiturates. Benzodiazepenes specifically are commonly used responsibly and effectively for insomnia (in competition with blockbuster drugs Ambien, Lunesta, and others), and restless leg syndrome (in competition with newer brand treatment alternatives). I fear a lot of patients will experience bad withdrawal syndromes if they cannot afford to continue these medications.

Posted by: Raj on January 16, 2006 at 10:36 PM | PERMALINK

Given the rapid exponential growth of health care costs that 150b/10y in 1995 vs 700b/10y in 2005 might not be quite what it sounds.

Heh, "Restless leg syndrome". Those commercials always make me laugh.

Ruling out cheap generics so people can only buy expensive patent protected medicines is just the essence of republican commitment to the free market though.

Posted by: jefff on January 16, 2006 at 10:42 PM | PERMALINK

damn, trotting out Kerry at this point is fucking lame. you got nothin.

Posted by: dipfuckfucker on January 16, 2006 at 10:42 PM | PERMALINK

Once all the kinks in the new Medicare Drug program are ironed out, you will be surprised by the magnitude of improvement that it will make in the life of our senior citizens.

Posted by: tbrosz on January 16, 2006 at 10:53 PM | PERMALINK

Who wants to bet on the percentage of "excess deaths" of this Republican-Medicare disaster? 5%? 10%?
Forcing the poor, addled and fragile into a private insurance program that denies them or charges them exorbitant fees for necessary drugs is cruel.
Medicare Part D is a killer. D for Death. It will kill both the elderly and Medicare.
Intentional?

Posted by: pogo on January 16, 2006 at 11:00 PM | PERMALINK

So how would Kerry's policy of universal healthcare be handled better?

'cos it say no to nothing?

Then how would it not cost much, much more?
Posted by: McAristotle on January 16, 2006 at 10:32 PM | PERMALINK

Let's just set this straw man on fire right now.

Since Kerry's policy was not up for a vote, and was not the law that was passed, it doesn't fucking matter.

Also: Just to let you know up front, this thread isn't going to be hijacked into a tangent digressive argument. At least not by me, and I encourage all other bloggers on the thread not to fall for the bait either.

Posted by: jcricket on January 16, 2006 at 11:04 PM | PERMALINK

Clearly this is a bad bill, for many reasons, though this example seems less and more than what it appears on its face - I suspect the reason barbituates, valium and halcyon etc are off the list is something about habit forming, addictive substances that doctors should be less eager to prescribe... but this underlines how legislation shouldn't be used to affect social policy.

In the run-up to this bill, the Wall Street Journal ran an article on drug costs that higlighted the plight of some heavy drug taking seniors - i.e., heart condition, diabetes, a whole gamut. Tucked away in one list for one lady was the fact that an interaction between her blood pressure medication and something else caused depression... so her doctor had added a mood elevator to the mix. Which is to say, as I it suddenly dawned on me, rather than investigate if perhaps other medications or a different treatment regimen might be more effective, this lady was just getting more and more pills. No wonder, perhaps, that she was depressed.

One of the problems with the drug plan that everyone overlooks is just that - perhaps pills are not entirely the answer. So while, yes, I sympathize with psychiatrists who need to treat serious cases with barbituates and benzodiazepams, I think the worst thing this bill does is legislate something really questionable - that everything can be better through pills and chemistry. More sleeping pills and happy pills and trnaquilizers? Heck yeah! What's wrong with that? I suspect we've crossed a line with this thing that we really can't undo, a notion that health care is best which prescribes most. And we'll be dealing with unintended consequences off of that one for years.

Posted by: weboy on January 16, 2006 at 11:05 PM | PERMALINK

dilbert dogbert on January 16, 2006 at 9:59 PM:

have gotten two messages from you today that are, to say the least, puzzling. As you have more important people than this dufus to email, I assume that your address book has been corrupted.

Okay, so it's not just me receiving mail from Kev...it's probably a virus of some sort; don't open any attachments (.hqx file in my case).

McAristotle on January 16, 2006 at 10:32 PM:

So how would Kerry's policy of universal healthcare be handled better?

For starters, it wouldn't be handled by Dubya. That automatically doubles its chance of success.

I wondered how long before the "We-can't-implement-a-medicare-prescription-drug-benefit-so-universal-healtcare-is-out-of-the-question" bullshit got trotted out...Thanks for not disappointing me, McA...I can always count on you for the latest in irrelevant RNC talking points...

Posted by: grape_crush on January 16, 2006 at 11:10 PM | PERMALINK

Some of these drugs are on the Beers List, which may account for some of the exclusions if they were written by someone without a lot of medical background.

A bill to correct the exclusion came up last summer (H.R. 3151). If you can find out what happened to that, it might tell you more about the motivations on this issue.

Posted by: tbrosz on January 16, 2006 at 11:10 PM | PERMALINK

Yes, benzo's and barbituates do make it to the black market. But so do Prozac and Zoloft and any number of pain medications.

Remember a few years ago, the "problem" was that insurance companies only wanted to pay for the "old" drugs? Now, suddenly, they are in bed with big pharma? It's enough to make one shake the head in incredulity.

Benzo's are the class of drugs that includes Ativan, Valium, and Xanax. The benzo's are the singularly most effective class of drugs to combat anxiety disorders. Barbituates includes phenobarbitol, the main ingredient in Donnatol, the most effective and cheapest treatment for irritable bowel syndrome.

The thing to remember is that most drugs have some potential for abuse, especially maintenance drugs.

Posted by: Global Citizen on January 16, 2006 at 11:17 PM | PERMALINK

The good news is that a month of Ativan is only about ten bucks with or without insurance coverage.

Posted by: Global Citizen on January 16, 2006 at 11:26 PM | PERMALINK

One of the problems with the drug plan that everyone overlooks is just that - perhaps pills are not entirely the answer.

Actually, for old people, the issue is that without drugs, they would require much, much more expensive surgery. So while I understand the skepticism over the prescription of a number of different drugs, the truth is that in the case of senior citizens, these drugs are all that stand between them and much more costly and risky surgical procedures.

Posted by: Constantine on January 16, 2006 at 11:29 PM | PERMALINK

BTW, given the information we actually have on this issue, there is absolutely nothing to justify Kevin's opening line, or speculations about "Biblical teachings." It's possible somebody screwed up writing the bill, but this is hardly something brand new in Washington, and if it needs correction, the Congress should correct it.

I didn't think we needed to add this to our Medicare load in the first place, and I wouldn't have supported it no matter which party pushed it.

Posted by: tbrosz on January 16, 2006 at 11:33 PM | PERMALINK

Taking a lot of pills is part of the tradeoff that happens when one lives past the age of fifty.

Posted by: Global Citizen on January 16, 2006 at 11:34 PM | PERMALINK

i have no intention of entering into discussion with the nitwit mcaristotle, but gang, let's get our own facts right.

Kerry didn't run on universal healthcare.

Kerry ran on a government catastrophic insurance program, an idea that many honest conservative economists approved of. By nationalizing the relatively rare but expensive issue of catastophic medical costs, the kerry program would have made the currently untenable private health insurance tied to your job model able to function for a while longer. In addition, kerry ran the numbers and had an income source to cover it: allowing the bush tax cuts on the upper 2% of income earners to lapse.

as for the clinton (or clinton-gore) prescription drug bill, one thing it depended upon was government negotations to set prices, a practice specifically excluded in the pharmaceutical industry bill that bush/delay passed. But more to the point, Clinton waited years to even consider such a thing - until our financial house was in order and we could afford it.

Posted by: howard on January 16, 2006 at 11:37 PM | PERMALINK

Well what are the viable alternatives.

Posted by: Brian on January 16, 2006 at 11:47 PM | PERMALINK

BTW, given the information we actually have on this issue, there is absolutely nothing to justify Kevin's opening line, or speculations about "Biblical teachings."

Of course there is - Kevin is just being a complete left-wing hack. And in his hackishness, it's his job to throw in every irrelevant insult against Republicans he can think of.

Posted by: Al on January 16, 2006 at 11:57 PM | PERMALINK

Jeez, Kevin, I'd like to post a reply to Terry Ott down on the impeachment thread, and you won't let me?

Wow.

If I'd ever trolled LGF, I guess this is what it would feel like when they banned me in after one comment.

I guess this is why I don't generally spend any time here. What a shame - I used to love your blog. I thought you rocked.

Posted by: tena on January 17, 2006 at 12:00 AM | PERMALINK

I've had to deal with helping a lot of my older relatives get a plan. It is a mess. My dad (who just got a bone marrow stem cell transplant a week ago) still hasn't gotten his prescription card and the pharmacy is only giving him 3 days supplies of drugs after a bunch of arm twisting. The insurer appears to be completely non-responsive on drugs that require prior approval. Foot dragging = patient covering drug themself??

The worst thing about this bill (as you are pointing out) is it puts the insurance providers in charge of drug choice. There are a lot of variables that doctors take into account when prescribing an antibiotic, immunosupressant, or other drug. For instance -- if a patient shows signs of kidney damage a doctor would like to prescribe a drug that has the fewest kidney side effects which is not necessarily the one within that category that is covered by the insurer.

I'm guessing you are going to see a lot of people taking the wrong drugs. This will result in folks dying from side effects and bacteria and viruses becoming immune to the most commonly insured drugs.

Whoever is in charge (dem or repub) should put medical professionals in charge of writing a prescription plan and not drug companies.

Posted by: B on January 17, 2006 at 12:00 AM | PERMALINK

And, really, is it THAT difficult to figure out why BARBITUATES are excluded? How about medical marijuana? Is that covered too? I fully expect that, as soon as barbituates are covered, Kevin is going to be complaining that the program is bad because it doesn't cover marijuana either.

Posted by: Al on January 17, 2006 at 12:01 AM | PERMALINK

howard for President!

And for the humor impaired: "Biblical teaching" is a droll sideswipe at that fact that the Repubs are now a wholly-owned subsidiary of the Christian fundamentalists. It's a joke. It's not meant to be taken literally. Good Lord, people.

Posted by: craigie on January 17, 2006 at 12:06 AM | PERMALINK

B:

I agree wholeheartedly. The doctors or medical practitioners who have full knowledge of a patient's medical history should have the final decision about which prescription is best and safest for that individual.

Howard somewhere upthread has the best remedy for this embarassment of a law: chuck it out the window and start again.

Posted by: jcricket on January 17, 2006 at 12:07 AM | PERMALINK

Medicare Part D has it all: the law was enacted amid lies, corruption, and intimidation and had little purpose other than the Rethuglican desire to appease seniors. Then, despite their obvious desire to buy the senior vote, they botched the program. Truly transcendental incompetence.

Rethuglicans love to pretend they are standing tall but when seniors wanted a drug benefit, Rethugs dropped their pants, bent over and let Big Pharma have its way.

Posted by: dwight on January 17, 2006 at 12:08 AM | PERMALINK

I'd actually be willing to cut the funding for prescription drugs in half if only they'd let actual policy experts design the implementation of the damn thing.

Let's also remember that the Democrat plan cost MORE THAN TWICE AS MUCH.

Democrats never, EVER want to spend less on anything (other than defense or national security). More spending is a requirement.

Hell, let's also remember that the Democrats never passed their own bill - EVEN WHEN THEY CONTROLLED CONGRESS.

Let's face it - Democrats DON'T CARE about prescription drugs; they care about the campaign issue only. It was only when Republicans controlled Congress and the Presidency that people who actually care about prescription drugs for seniors - us Republicans - could actually pass a bill.

Posted by: Al on January 17, 2006 at 12:09 AM | PERMALINK

tbrosz: Once all the kinks in the new Medicare Drug program are ironed out, you will be surprised by the magnitude of improvement that it will make in the life of our senior citizens.

Once all the kinks in the new Medicare Drug program are ironed out, our senior citizens will be dead.

Posted by: brooksfoe on January 17, 2006 at 12:10 AM | PERMALINK

And for the humor impaired: "Biblical teaching" is a droll sideswipe at that fact that the Repubs are now a wholly-owned subsidiary of the Christian fundamentalists. It's a joke. It's not meant to be taken literally.

Yup, just a pure, out-and-out trollish insult by Kevin. Good of you to acknowledge that.

Posted by: Al on January 17, 2006 at 12:11 AM | PERMALINK

And, really, is it THAT difficult to figure out why BARBITUATES are excluded? - Al

You are a moron. Are you aware that your tax money is currently going to buy morphine? Codeine? Ignoramus.

Posted by: brooksfoe on January 17, 2006 at 12:12 AM | PERMALINK

Are you aware that your tax money is currently going to buy morphine? Codeine?

So that makes it OK to spend more money on things like barbituates? Sheesh.

Posted by: Al on January 17, 2006 at 12:15 AM | PERMALINK

And, incidentally, Al's comment about it not being so hard to figure out why barbituates are banned is exactly what makes the possibility that "biblical teachings" are responsible for the ban - perfectly reasonable.

Just as it's not necessary to investigate why US foreign aid is prohibited from going to fund methadone programs, despite their scientifically proven effectiveness at reducing death, ill health, and crime by heroin addicts, as well as relatively high rates of drug rehabilitation, compared to other methods. No need to research this question. It's biblical teachings.

Anywhere you find something inexplicable in legislation, something that can't be understood rationally, the answer tends to be...biblical teachings.

Posted by: brooksfoe on January 17, 2006 at 12:17 AM | PERMALINK

So that makes it OK to spend more money on things like barbituates?

Wow, you really are that stupid, aren't you?

Did you know that your tax dollars are also funding hospitals that actually prescribe STEROIDS to their patients?

Did you know that the Pentagon buys vast quantities of highly intoxicating and addictive GLUE?

Posted by: brooksfoe on January 17, 2006 at 12:21 AM | PERMALINK

Bizarre Al Faker: Al is dead. Why do you keep on impersonating him? Have you still found no girl willing to kiss you?

Posted by: word on January 17, 2006 at 12:22 AM | PERMALINK

And, really, is it THAT difficult to figure out why BARBITUATES are excluded? How about medical marijuana? Is that covered too? I fully expect that, as soon as barbituates are covered, Kevin is going to be complaining that the program is bad because it doesn't cover marijuana either.
Posted by: Al

are you a doctor, you dipshit pissant??? can you list the indications for barbituate prescriptions? because I am a doctor, and I'm fond of pimping stupid little fucks who think they know it all. ... so google it, you little cumstain, as there will be a test.

jesus fucking christ ... years of undergrad, med school, and residency just to have ignorant pussies like al tell me what meds I should be writing for.

Posted by: Nads on January 17, 2006 at 12:28 AM | PERMALINK

'Republicans on Drugs', is that like 'White Punks on Dope'?

Posted by: Dick Durata on January 17, 2006 at 12:29 AM | PERMALINK

Wait - with Al's help, I finally understand the governing philosophy behind the Bush Administration's Part 4 program.

JUST SAY NO TO DRUGS

Posted by: brooksfoe on January 17, 2006 at 12:32 AM | PERMALINK

is that like 'White Punks on Dope'?

And a baby's arm holding an apple.

Posted by: craigie on January 17, 2006 at 12:34 AM | PERMALINK

Once all the kinks in the new Medicare Drug program are ironed out, our senior citizens will be dead.

I didn't write that, and I don't think the elderly will necessarily be better off under this program than under the previous ways over seventy percent of them got their drugs paid for just fine, thanks.

As far as private and public solutions go for this problem, I'm getting very tired of the "neither fish nor fowl" approach to medical care in this country.

Either someone who has a real idea of what market principles are all about (and that includes almost no modern Democrats and damn few modern Republicans) needs to set out a real path to bring the moderating effect of market forces back into medical care, or someone else has to push the cart all the way up the hill and set up a consistent socialized medicine program.

What we've got now is a bleeding, flopping chimera of state and private systems which gives us all the bureaucratic crap inherent in government programs and none of the low prices and innovation inherent in private ones.

Naturally, I would like to see it move toward the free market, but at this point, pushing it to either goal line would probably give us something better than what we've got now.

Posted by: tbrosz on January 17, 2006 at 12:35 AM | PERMALINK

Sorry, that first line should have been italicized.

Posted by: tbrosz on January 17, 2006 at 12:53 AM | PERMALINK

Nice to hear that from you, tbrosz, except that you've got that last section a bit backwards. There are no countries in the world with more private-oriented health insurance than the US and lower prices. The only comparably privatized health insurance system in a (post-)industrial country is Switzerland's, and it's the second most expensive system in the world, after the US's.

So the sentence should read "all the bureaucratic crap inherent in private programs and none of the low prices inherent in government ones." As for "innovation", I haven't seen much of that coming out of the private health insurance sector - except for innovative ways to deny people coverage, of course.

Posted by: brooksfoe on January 17, 2006 at 12:56 AM | PERMALINK

As a New Orleanian who hopes to turn 68 in a couple of months, all I can say is Medicare, meet Katrina.

Posted by: Brian Boru on January 17, 2006 at 1:03 AM | PERMALINK

Wow Kevin, I've been too busy to read your blog for the past few weeks, but going over the posts of today and yesterday, you're kicking ASS. Keep it up. You're almost starting to make up for your mendacious wishywashiness over the past 6-12 months or so.

Posted by: osama_been_forgotten on January 17, 2006 at 1:07 AM | PERMALINK

Of course, since Republicans don't have anybody who cares about policy in this area...

In this area. I defy anyone of you to name a single area of social/political/economic life in which this set of Republicans actually cares about policy.

Posted by: mrjauk on January 17, 2006 at 1:09 AM | PERMALINK

The GOP noise machine will drown out any disturbence this bill causes. My mother in law thinks the WMD is in Syria and that the Dems pushed this bill through congress to help big Phara. Ain't that a hoot. I irony is, she survived the Halocaust.

Point is, Dem can't drown out the GOP noise machine.

There is going to be "terroists" in the news this week sometime.

Posted by: the fake fake al on January 17, 2006 at 1:16 AM | PERMALINK

Trolls galore.

Al spews a lot of nonsense - a conclusion that, as Al might say, is self-evident.

tbrosz deludes himself that "free" markets result
in socialy acceptable distribution of medical insurance. Unfortunately, incentives in insurance markets often lead to non-ideal allocation of resources - skewed more towards paying claims adjusters to avoid insuring people who need insurance and less towards paying for actual patient care.

The market is a great force, but is not, and never has been, the be all and end all of sound econonomic policy.

Posted by: tbrosz on January 17, 2006 at 1:17 AM | PERMALINK

Arbitrary drug classes like benzodiazepenes and barbiturates are specifically excluded from coverage.

If a batshit psychiatrist wants to prescribe one of those for you or someone you love I recommend that you find a better psychiatrist.

Posted by: contentious on January 17, 2006 at 1:20 AM | PERMALINK

tbrosz deludes himself

...and fake tbrosz outs himself. This is one of the weirdest posts of all time, dude.

Posted by: brooksfoe on January 17, 2006 at 1:24 AM | PERMALINK

Republicans on Drugs.

White Punks on Dope.

Killer Chimps on Crack.

Posted by: t-t-t-trolls r us on January 17, 2006 at 1:25 AM | PERMALINK

Benzodiazepenes specifically are commonly used responsibly and effectively for insomnia (in competition with blockbuster drugs Ambien, Lunesta, and others), and restless leg syndrome (in competition with newer brand treatment alternatives). I fear a lot of patients will experience bad withdrawal syndromes if they cannot afford to continue these medications.

Prescribing benzodiazepenes for insomnia is a terrible idea; people become addicted and have no long term improvement in sleep quality. Professor Dan Kripke of UCSD Psychiatry has published frequently on this topic, and you can find his papers by doing a Medline search. Newer hyponotics are potentially less problematical and more effective.

Posted by: contentious on January 17, 2006 at 1:26 AM | PERMALINK

If a batshit psychiatrist wants to prescribe one of those for you or someone you love I recommend that you find a better psychiatrist.
Posted by: contentious

are you a doctor? ... Not for nothing, but I do enjoy reminding you right wing ass monkeys that I am better educated than you ... and probably have a better idea than you of when brabituates are indicated.

Posted by: Nads on January 17, 2006 at 1:28 AM | PERMALINK

but this underlines how legislation shouldn't be used to affect social policy

Legislation affects how tax money is spent.

Posted by: contentious on January 17, 2006 at 1:29 AM | PERMALINK

Those who advocate free markets for health care must be on some sort of drugs, as their worship of the invisible hand for this purpose shows that they have understanding of neither free markets nor health care.

Posted by: lib on January 17, 2006 at 1:31 AM | PERMALINK

It's a joke. It's not meant to be taken literally.

With KD, how can one tell?

Posted by: contentious on January 17, 2006 at 1:32 AM | PERMALINK

No surprise here about the Med D nightmare.

It is everything I expected and then some.

Personally I saw my retiree coverage on drugs go from $56 a month last year for three asthma drugs, to $282 a month this year. of course if I refused this I would them also lose my health insurance coverage. The 720 billion in our tax money the gov gave corps to "maintain" their coverage?...there was a little catch...the corps didn't have to "maintain" their old program, they just had to make it "as good" as Med-D in order to get the gov hand out. So goodie,goodie...free money and up their employee cost by 400% by making their coverage "equal" to Med D.

Then there is this elderly disabled lady I have been providing help and transportation to for several years who was receiving free drugs from one of the drug companies programs because she is disabled and low income. No more. Now she has to enroll in a Med D program and pay the fee and maybe or maybe not get reimbursed, assuming she has the cash up front to even buy what she needs.
I read the letter she got from Glaxo,Kline saying the could not provide the free drugs any longer because under their program she had to "not have access" to any other program. But..voila!..now with Med-D all these poor folks do have access...they just don't have the monthy fees to the insurers or the $3100 for their drug cost, which is what your cost will be if you spend up to but not beyond $5000 a year for prescriptions.

You can buy the same drugs and more covered in the Med D in Mexico for the same price and if you spend less than $5000 a year, less than what you will pay for Med-D drugs including your monthly premium.

Posted by: CoCo Channel on January 17, 2006 at 1:33 AM | PERMALINK

Prescribing benzodiazepenes for insomnia is a terrible idea; people become addicted and have no long term improvement in sleep quality. Professor Dan Kripke of UCSD Psychiatry has published frequently on this topic, and you can find his papers by doing a Medline search. Newer hyponotics are potentially less problematical and more effective.
Posted by: contentious

are you fucking retarded ... kripke's SOLE contribution to insomnia research regarding benzos is an article IN FAVOR of benzo use and a favorable safety profile:

"Clinical safety of flurazepam and midazolam during 14-day use in chronic insomniacs."
J Clin Psychopharmacol. 1990 Aug;10

Posted by: Nads on January 17, 2006 at 1:39 AM | PERMALINK

Once all the kinks in the new Medicare Drug program are ironed out, our senior citizens will be dead.

By November, the GOP hopes.

This isn't going to be drowned out, because local health stories write themselves. Lots of Granny Mabels across America, in districts where the GOP incumbent voted for the bill in that crooked vote.

This was always designed as a colossal payoff to Big Pharma and Big Insurance. Faceless, soulless entities. Granny Mabel will be talking on the local news, or to the local paper, and so will her pharmacist.

Not even the toxic slick of Drumtrolls can deal with that. BushCo would have done better to have sent Jack Abramoff's goons to rob those senior citizens' homes in the dead of night; there really is no difference.

Posted by: ahem on January 17, 2006 at 2:05 AM | PERMALINK

"Newer hyponotics are potentially less problematical and more effective."

Posted by: contentious on January 17, 2006 at 1:26 AM | PERMALINK

In my experience, the less problematic medicines like Rozerem, are also less effective. Ambien was supposedly the greatest thing since sliced bread when it came out even though it is similar to clonazepam in efficacy and side effects and like bzds had never been proven safe for long term use. Now that Ambien-CR is out, suddenly the incidence of people that don't really get a full night sleep with just Ambien is very high. But of course, Lunesta is the only one that is really not addicting and "proven safe" for long-term use. It's too bad that the pharmaceutical companies are funding more and more of the research, and it really is hard to find true head to head comparisons to help us doctors choose the best medications for patients. And I agree all of these medicines should be prescribed only for short term use on an as needed basis only after trying improved sleep hygeine and other non-medicinal remedies.

Posted by: Raj on January 17, 2006 at 2:17 AM | PERMALINK

All these troll comments about profligate Dems sure are a real fucking hoot, when you stop and remind yourself that the Republicans who wrote this piece of garbage and shoved it up our collective asses at 3AM made sure that it specifically prohibited Medicare from seeking volume discounts from pharmaceutical companies.

In other words, they're more than happy to waste your tax dollars, as long as it rewards their political allies instead of actually helping sick people.

BushCo also gagged the analyst whose job it was to project the actual costs of the program. Strange behavior for an administration that's proud of all the money it's planning to save taxpayers.

Better trolls NOW.

Posted by: Lionel Hutz, attorney-at-law on January 17, 2006 at 2:17 AM | PERMALINK

GOP: your tax dollars at play.

Posted by: brooksfoe on January 17, 2006 at 2:51 AM | PERMALINK

By the way, how in the world do liberals expect to have universal healthcare without healthcare companies making money?

Make doctors, nurses and researchers work at gunpoint?

Posted by: McAristotle on January 17, 2006 at 4:39 AM | PERMALINK

You can buy the same drugs and more covered in the Med D in Mexico for the same price and if you spend less than $5000 a year, less than what you will pay for Med-D drugs including your monthly premium.

Posted by: CoCo Channel on January 17, 2006 at 1:33 AM | PERMALINK

Actually, anything is cheaper overseas wrt to medical care. There's some debate about whether the lower years of training to become a doctor in other countries actually makes a difference in health care.

I'd suggest making use of medical tourism in your health system somehow. Perhaps you should consider immunizing insurance companies who specifically offer medical tourism insurance for non-emergency procedures immunity from being sued in the US (but allowing the foreign lawsuit)

http://www.medical-tourism.us/


Posted by: McA on January 17, 2006 at 4:43 AM | PERMALINK

tbrosz?

I lost track of who the fake is.
Anyway, medical care is the best example of why a free market cannot provide the lowest possible price --unequal access to information. Medical care has the largest information gap between provider and consumer. The consumer is at an appalling disadvantage. The obvious result is that the freer the market for medical care the higher the cost to the consumer. Insurance is not much better.
Bend over indeed!

Posted by: joe on January 17, 2006 at 4:45 AM | PERMALINK

McA troll,

At gunpoint?
You mean like the blackmail they pay to the malpractice insurers so that they can continue to make a living?

Posted by: joe on January 17, 2006 at 4:49 AM | PERMALINK

how in the world do liberals expect to have universal healthcare... Make doctors, nurses and researchers work at gunpoint?

Sure. This of course is what is done in Japan, Canada, Western Europe. The gunmen here in the hopsitals in Tokyo are quite something to behold - you should see the doctors quivering as they work and the gaggles of nurses working through their tears (apologies for the sexism implicit in this characterization). But works a wonder for the patients... ah McA, your silliness spans continents.

Posted by: snicker-snack on January 17, 2006 at 4:51 AM | PERMALINK

of course silly billy the answer is to take the private companies out of the equation.

Posted by: snicker-snack on January 17, 2006 at 4:53 AM | PERMALINK


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Posted by: 航班查询 on January 17, 2006 at 4:54 AM | PERMALINK

Substitute "protection money" for "blackmail" nevertheless, it's not much different than putting a gun to their heads.

And McPeabrain most of us realize that for most doctors no amount of money can compensate for the hidiously long hours and heartbreak that the job demands. The real reward is successfully helping people. As with education, if you're in it for the money you don't have any business getting into the profession in the first place.

Posted by: joe on January 17, 2006 at 5:00 AM | PERMALINK

You know folks, considering the timing and placement of the Chinese ad spam, I wonder if McAsshole is the party responcible since it tends to appear when he's getting thrashed.

Posted by: joe on January 17, 2006 at 5:04 AM | PERMALINK

What you also find in these plans are "Quantities limited" restrictions on many widely used, new medicines. Certain people can take only one type of hypertension medicine, for example, and have to take it every day, but have limited quantities covered. If they are going to cover a medicine, why should it not be a year's supply?

Posted by: bob h on January 17, 2006 at 8:00 AM | PERMALINK

Just as an aside, isn't it great how the Internet lets people in Malaysia offer their opinions here? Why, it's the great leveler! You keep telling us how it is, there, McAristotle. Don't let the fact that you are down there in MALAYSIA deter you. We welcome you here and want to know all about what you and other Malaysians think of America and our politics. Why, when I was a younger man, I didn't even have the benefit of Malaysian points of view about our congress and our healcare system. Now now though. Some say that free porn is the only benefit of the Internet. No one who posts here and reads little McAristotle says that!

Posted by: Pat on January 17, 2006 at 8:44 AM | PERMALINK

I fear a lot of patients will experience bad withdrawal syndromes if they cannot afford to continue these medications.

Hell, sudden withdrawal from these drugs can cause seizures and death in otherwise healthy people. My elderly father-in-law, who had already had two seizures before being put on an anti-seizure medication would almost certainly die from withdrawal. Even if he tapered off he would very likely die soon from another seizure.

Posted by: Tripp on January 17, 2006 at 9:52 AM | PERMALINK

weboy,

Your use of the terms 'mood elevators' and 'happy pills' tells me you are ignorant of what you speak. There are no such pills and using such emotionally chargerd terms simply muddles the debate.

Posted by: Tripp on January 17, 2006 at 10:01 AM | PERMALINK

The ban on barbituates certainly involves "Biblical teaching" and is aimed at Oregon.

It's law -- an intiaitive ap[prved by voters -- permitting physicial-assisted suicide offends the Christian Republicans.

The preferred prescription for this practice is barbituates.

Posted by: Russell aboard M/V Sunshine on January 17, 2006 at 10:27 AM | PERMALINK

If we could induce Billy Tauzin to come back from his side job, Billy would correct the problems - If only, government work paid better, Billy might return. We want Billy ala Chicago.
Billy cares about us - He tried to fight that damnable Max Baucas of Montana - That Dem is the one who forced this plan upon us. He outfought you Billy, but you are wiser now. Don't know exactly what your new line of work entails, but we really, really need you Billy.

And David Wu or Oregon - You sold us out - Yeah, you beat the Shah's daughter, but it was a Repug on Repug fight after your non-gainful sellout of the Seniors. Hang your head also, Wyden.

Posted by: stupid gitl on January 17, 2006 at 10:31 AM | PERMALINK

Replacing generic drugs with patented more expensive 'new' drugs is the main theme of the FDA and the drug industry. 30 years ago I was told by a pharmacy professor that if aspirin was discovered today they wouldn't let us use it. This same professor was adament that brand-name aspirin was better than generic aspirin, although she admitted there was no actual proof of this. (This was Joy Klein of Klein and Klein, for the antique medical professionals out there.)

Sharper readers will have noticed that there has been no epidemic of aspirin related fatalities, while aceteminophin (tyelenol), which actually does kill people every year, is widely sold with warning labels too small for anyone over the age of 25 to read.

Codeine- $10 for a month supply, oxycontin- $300 for a month supply. Morphine- 50 cents for a dose, Duramorph- $15 for a dose. Read and weep.

As for the Medicare drug bill, as one affected, I can say it is simply theft, taking from the very poorest to give to the very richest.

Ironically, our problems come from decades of government-protected monopolies that are totally unconcerned with the welfare of the patient.

There is no free enterprise and no pro-life in the real Republican party.

Posted by: serial catowner on January 17, 2006 at 10:39 AM | PERMALINK

the law was enacted amid lies, corruption, and intimidation and had little purpose other than the Rethuglican desire to appease seniors.

Nah, that was just the spin to garner votes. The real purpose, as with anything that DeLay and the boys would ram through Congress, was to transfer billions from the U.S. Treasury to favored corporate interests. The fact that they specifically prohibited negotiation on drug prices is a dead giveaway that their much touted "free market principles" had nothing to do with it.

tbrosz: Once all the kinks in the new Medicare Drug program are ironed out, you will be surprised by the magnitude of improvement that it will make in the life of our senior citizens.

brooksfoe: Once all the kinks in the new Medicare Drug program are ironed out, our senior citizens will be dead.

Or, translated into GOP: Once our senior citizens are dead, the kinks in the Medicare Drug program will be ironed out. Efficiency! (Not to mention the death of Medicare itself. Thanks, Grover!)

Posted by: R. Porrofatto on January 17, 2006 at 10:48 AM | PERMALINK

'Republicans on Drugs', is that like 'White Punks on Dope'? Posted by: Dick Durata on January 17, 2006 at 12:29 AM

No, it's more like 'White dopes on punk'.

Posted by: Dr. Morpheus on January 17, 2006 at 11:37 AM | PERMALINK

This nasty little comment perfectly illustrates why Americans get health policy wrong so much of the time, and why so many foreigners just don't like Americans anymore.

The poster slams (quoted below) someone for posting from Malaysia, totally ignoring the fact that we (mighty USA) might actually learn from someone's else's experience. Heck, just because every other industrustrialized country has socialized medicine - doesn't mean we anything. We're the US! Number 1! rah! rah! (Sarcasm intended)


"Just as an aside, isn't it great how the Internet lets people in Malaysia offer their opinions here? Why, it's the great leveler! You keep telling us how it is, there, McAristotle. Don't let the fact that you are down there in MALAYSIA deter you. We welcome you here and want to know all about what you and other Malaysians think of America and our politics. Why, when I was a younger man, I didn't even have the benefit of Malaysian points of view about our congress and our healcare system. Now now though. Some say that free porn is the only benefit of the Internet. No one who posts here and reads little McAristotle says that!"

Posted by: Samuel Knight on January 17, 2006 at 11:48 AM | PERMALINK

If you bothered to ever read any of McAristotle's posts you'd realize he's deserving of all the scorn heaped on him.

He's little more than a troll. Posting only to insult, derail the thread, and otherwise make a nusance of himself.

It would be an entirely different thing if he actually posted something insightful, even if it was from a conservative point of view. P. D. Ameldia (sorry if I mispelled his/her name) is one example of someone who posts good arguments from a conservative point of view and doesn't get dog-piled on.

Sorry, but McAristotle doesn't deserve the defense you gave for him.

Posted by: Dr. Morpheus on January 17, 2006 at 12:04 PM | PERMALINK

Dr M, Didn't mean it as a defense.

McA - showed the worst type of narrow-mindness.

Posted by: Samuel Knight on January 17, 2006 at 12:47 PM | PERMALINK

Dr. Morpheus, it's pb almeida, and he/she is an outstanding example of an honest conservative.

as for whichever tbrosz noted that what we've got now is the worst of both worlds - partly nationalized health care and partly a strange amalgam of market mechanisms - is absolutely right.

Posted by: howard on January 17, 2006 at 2:26 PM | PERMALINK

Actually there, Sam, I was trying to tweak McA for coming here every day and running down anyone who expresses concerns about real issues, such as affordable healthcare, human rights, or our values as Americans, when he comes from a country run by a corrupt military dictatorship that canes people for homosexuality and traffic violations. If he respected others' views here while disagreeing, I would too. And by the way, your jingoistic "rah-rah right wing America" parody is actually exactly what McA posts here.

Posted by: Pat on January 17, 2006 at 2:32 PM | PERMALINK

brooksfoe: Once all the kinks in the new Medicare Drug program are ironed out, our senior citizens will be dead.

social security solved.....


bush empathy on display....again?

Posted by: thisspaceavailable on January 17, 2006 at 2:32 PM | PERMALINK

'Republicans on Drugs', is that like 'White Punks on Dope'?

And a baby's arm holding an apple

You guys are my heros!

Posted by: E. Nonee Moose on January 17, 2006 at 2:32 PM | PERMALINK

serial catowner: Sharper readers will have noticed that there has been no epidemic of aspirin related fatalities,

Actually aspirin does kill, and it is contra-indicated for the treatment of fevers in children. It is contra-indicated in other cases also.

Posted by: contentious on January 17, 2006 at 2:55 PM | PERMALINK

Raj: And I agree all of these medicines should be prescribed only for short term use on an as needed basis only after trying improved sleep hygeine and other non-medicinal remedies.

That's better. Do you agree with the rant by Nads where he/she ignores almost all of Prof. Kripke's writings about sleeping pill use?

At one time, the most prevalent medication error in the US was the prescription of bensodiazapines for depression disdiagnosed as "anxiety".

Posted by: contentious on January 17, 2006 at 3:01 PM | PERMALINK

That's better. Do you agree with the rant by Nads where he/she ignores almost all of Prof. Kripke's writings about sleeping pill use?
Posted by: contentious

come now ... don't be a coy little pussy. I searched medline as requested and found ONE article supoporting the efficacy and safety of benzo's by this kripke cat. Not my fault the rest of his work seems not to have made it into peer review.

Posted by: Nads on January 17, 2006 at 4:21 PM | PERMALINK

It's funny how the Dems catch so much flak for supposedly not having much expertise on defense-related issues. (This despite having had a reasonably successful track record on defense matters during the Clinton Administration.)

OTOH, it's perfectly OK for the GOP to have little expertise in health issues (which is the biggest single chunk of the Federal budget, and is only going to get bigger), and ignore what expertise they've got while shoving major health care legislation through Congress.

Posted by: RT on January 17, 2006 at 4:39 PM | PERMALINK

I'm a union member in Chicago. Our union has negotiated with a well know prescription drug provider for a prescrition plan which costs $6.00 for name drugs and $0.00 for generics. We pay for that ourselves. If a group of 30,000 can negotiate that situation why is it impossible for the Govt, with a group of 45+M participants not do it? Someone tell me why this is not possible.

Posted by: MDR on January 17, 2006 at 5:32 PM | PERMALINK

Well I signed up for the drug program last December. They still haven't figured out what to do. Can't get in touch with medicare or the drug insurance program. When I went to get my meds this last week, my cost jumped by 2,000%. Checking the formulary, from last year to this, they increased the price of drugs dramatically. This is the biggest rip off in american history.

Posted by: Dennis on January 17, 2006 at 5:37 PM | PERMALINK

MDR, that's a simple question to answer: it's not possible beause the republican party doesn't want it to be possible.

Posted by: howard on January 17, 2006 at 5:59 PM | PERMALINK
The poster slams (quoted below) someone for posting from Malaysia, totally ignoring the fact that we (mighty USA) might actually learn from someone's else's experience.

Was McAristotle posting something about his experience from which value could be derived, or just offering his unsupported opinion on how America should be run, like normal?

Because, I'd argue there is very little of use to be learned from the latter, and McAristotle does very little of the former here.

Whatever value he provides, its not in us learning from his experience, since that isn't generally put forward.

Posted by: cmdicely on January 17, 2006 at 8:00 PM | PERMALINK

The Medicare Drug Bill passed with the help of 5 or so Dems (so-called Centrist Dems, who said it was a bad bill, but we need bipartisanship). I know Baucus and Breaux were in there....

Dems need to stop kissing GOP ass. It never helps them....

Posted by: Not a DLC Bitch on January 17, 2006 at 10:16 PM | PERMALINK

Posted by: contentious on January 17, 2006 at 3:01 PM | PERMALINK

Nads makes a good point that this professors writings started in the peer-reviewed scientific realm, but then migrated to writing books that seem on first glance to play to the fears many people have about these medications. I have plenty of patients who do well on a low dose benzodiazepene every night. I also have patients that clearly suffer from depression and anxiety but can't tolerate the side effects of SSRIs (Prozac, etc.) and do much better on as needed benzodiazepenes. In an ideal world, these medicines would not be needed--I could just tell my patients to take a few weeks vacation in Hawaii every few months.

Posted by: Raj on January 18, 2006 at 2:01 AM | PERMALINK

Don't any of you policy wonks and partisans pay any attention to DENNIS who is telling you what actual seniors are actually experiencing. Neither Republicans nor Democrats give a good healthy dump about PEOPLE, about their constituents, about the people who cannot bribe them, basically.

If any of you bigmouths were actually IMPACTED by this, if you had to pay 2000% for meds that kept you alive or from being a total invalid, you would scream like a banshee regardless of your party affiliation, because this drug program HARMS the elderly, harms the poorest of them the most, and lines the pockets of Big Pharma AND the legislators who gave them the windfall.

Some day, unless you die sooner, you will be old, and the way the US economy is going you may well be poor. You may sicken and die because of rapacious and inhumane healthcare policy, instead of sitting on your well padded well off asses theorizing about it.

If I could curse each one of you 'theorizers' so that tomorrow you would wake stricken with age, illness and poverty and have to experience the REALITY of this bill under all your hot air, I would do it. I would stand by and watch you beg for medication and watch you die and I would feel...NOTHING.

Exactly what you feel for me and Dennis and people like us.

If and when the worm turns in this country, we the people will line you all up against a wall and shoot you. Check what has happened historically when ordinary people have had enough of an oligarchy/plutocracy. Bring on the tumbrels and the guillotine! LONG PAST TIME!

Damn the Dumbocrat spineless Quislings and damn the corrupt Rethuglicans both to the same ashcan of history.

Posted by: Mike on January 18, 2006 at 4:25 AM | PERMALINK

The Bad: my wife has MS; she needs a drug that costs (cheapest we can find) 1500/mo in order to stay functional and not end up in a wheelchair or worse. Not to mention the 300-500 worth of other drugs she take every month on top of that. We have to figure this "system" out and try to navigate it.

The Good: There's at least now the framework in place for a real drug benefit. if and when Dems (or someone who gives a crap) gains the necessary power, they can make some tweaks to this law and produce a REAL benefit. Like allowing medicare to negotiate drug prices w/ the pharmas. THAT'D help a lot!

The UGLY: non-disabled people who think they know what disabled people need when it comes to this stuff, and spout a bunch of market-based healthcare crapola. It's easy for you to pass judgement - just remember, you're non-disabled... YET.

Posted by: gordrann on January 18, 2006 at 4:58 AM | PERMALINK

MDR said:

>>If a group of 30,000 can negotiate that situation why is it impossible for the Govt, with a group of 45+M participants not do it? Someone tell me why this is not possible.>>>

Because the law is written specifically to not allow that. Because it was written by the ins. corps and pharmas. Because it's a huge giveaway to Bush bribers.

WHAT A SHOCK!

Posted by: gordrann on January 18, 2006 at 5:03 AM | PERMALINK

Oh Come On.
Anyone watching the evening news knows the Medicare Part D program and its implementation has been a disaster.

No price negotiation for drugs
No enrollments in plans
Low-income enrollees overcharged
HMO plans leave out drugs
No prescriptions filled without massive state intervention to shore up federal failure

All this happening with less than 10% enrollment
No wonder most seniors waited to see what would happen.

Time to take health care away from the HMO and pharma profiteers and their washington whores

Posted by: howie on January 18, 2006 at 9:03 AM | PERMALINK

I have not signed up IT don`t sound right tome Tier not putting a cap on the drug companies so when the prices go up are amounts for co pay going up? I wish the Dems could do more But theamerican people need do more .

Posted by: Romelee on January 18, 2006 at 12:45 PM | PERMALINK

I always knew bush & the republican congress were a bunch of screw-ups but w/this bill they started screwing me personally. I'm 1 of those disabled poor people that was forced into this insurance company clusterfuck. I have an interthecal medical device implanted in my abdomen that pumps a medication into my spine continuously, thing is, it needs 2 be refilled every month, which was never a problem b4 so i'm getting ready yesterday 2 go 2 this months refill when the office calls & tells me they have 2 reschedule cuz the plan they put me on is giving them the run around on approving the stuff that goes in it. yeah, real improvement.

Posted by: euthyfro on January 18, 2006 at 2:26 PM | PERMALINK

Raj, in case you come back: but then migrated to writing books that seem on first glance to play to the fears many people have about these medications.

Dr Kripke published a major peer-reviewed article based on about 1 million subjects showing that sleeping pill use shortens life span, when other things are taken into account.

If you have patients taking benzidiazapines every night, then that needs review.

Posted by: contentious on January 18, 2006 at 3:49 PM | PERMALINK

OK. I'll read the book instead of spending more time blogging. Read a little more of it tonight, and it is good to hear a counter to the pharm. reps. contentions and all the ads that hype the benefits and minimize the risks. Bottom line is you have to give the patients the facts, what is known and what is not, and your opinion based on your experience and other's on what's effective and safe.

Posted by: Raj on January 19, 2006 at 2:26 AM | PERMALINK

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