A Forty Dollar Pill and a Donut Hole…

40 Dollar Pill and a Donut Hole

Warning… This is both an update and a rant.

 I made a major change in my life last February, leaving my straight job with the full intention that I would now be able to  pursue with a vengeance, the artistic endeavors which I had been relegating to second class citizenship for lo those twenty plus years in cubicle captivity. As I strolled out of the building for the last time, already relieved of my security pass, never to return again without first getting a “visitors pass”, I breathed a deep sigh of relief and walked into the bright sunshine of my perceived new future. (Visions of sugarplums danced in my head.)

 A week or so later, it was already apparent that my envisioned freedom and stellar increase in productivity was going to be placed on hold. First there was the matter of Cobra Dental, Medicare and Social Security paperwork. Surprisingly, these assorted messes took two months to sort out. Then came the task of selecting a trustworthy fund administrator and rolling over my parsimonious IRA. For days I found myself reciting a line I once heard in a cops and robbers show on TV, “I’m surrounded by fools and assassins.” (I have since found a firm that provides real comfort, competence and expertise.)

 Shortly after all that appeared to be settling down, my car decided to grab my attention. Clutch, clutch fork, throw out bearing, transmission, rear differential, brakes, passenger door locks, battery, alternator, serpentine fan belt and a frame repair kept me car less or enroute to Quincy for about two months straight. But that wasn’t all. The Director of the Gallery for which I am board president suddenly took seriously ill and it became necessary for me and Dotty to put on our conductors hats to insure that the trains continued to run and run on time. I’ve also spent an incredible amount of time and energy on housing issues; a big story that deserves its own space. Alas, the desired results were not accomplished.

 These annoyances however, were minor and just a warm-up for what came next. 11/18/09 I went to Brigham and Women’s L1 for “routine” CT scan of my lungs. Actually the word “routine” as applied to medical issues is always an oxymoron. Two days later I received a call from the doctor to let me know that a small nodule had been noticed. The long and short of that is we decided to treat it as though it were a fungus (I’ve had an Aspergillus fungus before which necessitated removal of the tip of my upper right lobe) as opposed to something more ominous. A strong and well proven antifungal, V_FEND was prescribed for me. I went to fill the prescription and was introduced to one of the new realities of Medicare and supplemental drug coverage plans.

 The pill that holds the future of my left lung in its hands, costs $40 per dose. I found that astonishing but was quickly told that there are actually more flagrantly expensive pills for other illnesses. Nonetheless, one refill of this prescription (2 pills @day) costs a total of 2,400. (I understand development costs, etc. but I still cannot condone a pill costing 33,000 a year per person as fair compensation.) Now, under the current health care system, after you have received 2,880 of coverage from Medicare and any ancillary drug coverage program, you fall into the Medicare Coverage Gap, also known as the “Medicare Donut Hole”. At that point you must pay the next 4,550 of drug expenses out-of-pocket. After that, magically your coverage resumes; until next year that is. I won’t try to address the twisted terminology or the ersatz logic foisted on the public. Those who are absolutely indigent have some crisis social services to lean on. The financially well resourced will take a little extra out of savings, etc. with negligible harm. The “middle class” however are simply relieved of a chunk of their savings or retirement funds yearly.

 Even casual observation leads to the realization that everyone knows that the newly retired are in charge of the largest amount of discretionary funds they will ever command in their lives unless one wins the lottery. Shamelessly and without a twinge of guilt, the bandits in button down shirts scheme and connive to transfer those funds from the retiree’s nest egg to theirs. The Feds tax it, Medicare schemes against it; no state or government agency, bank, finance or insurance company seems to have the honest interest of these citizens at heart.

 While investigating for possible help for myself I was told that my case was a little unusual. (I was ineligible for any help because I have my paltry IRA and draw upon it to pay my monthly expenses. This is counted as “income”. That it will be totally depleted in about six years was of little consequence.) Due to the high cost of the V_FEND prescription I hit the coverage gap very early in the year. Most Medicare recipients hit the “Donut Hole” around November. This means that each November and December, large numbers of Medicare dependent patients will need to cut back on their medicines or forgo food or perhaps presents for loved ones because of the high out of pocket cost of medicines they need. This in the time of year, the Holiday Season, when the weather is harsh, many are more likely to be depressed or have additional heating bills, etc. Ho, Ho, Ho! By the way, it is interesting that the most expensive drugs seem to be those related to breathing, heart, and other life threatening issues; those for which one will pay any amount in order to live.

It’s obvious that we need health care reform and even more so moral policing of all the agencies, businesses and providers of services for the population over 65. Otherwise we’re simply turning a blind eye to economic euthanasia.

3 Responses to “A Forty Dollar Pill and a Donut Hole…”

  1. January 26, 2010 at 9:21 pm

    Hey Arni C!

    Funny I had just been reading about the hoped for “assistance for seniors in the Medicare prescription coverage gap” in an article about the proposed health care overhaul, but I had no idea what that phrase meant. Now, courtesy of your entry, I know EXACTLY what it means. The current system is truly diabolical— something must be done, NOW! I am hoping the Democrats can find their missing spine, and I am hoping for the best for you, my friend.

    with love- – dz. –


  2. 2 CCR
    January 28, 2010 at 4:14 pm

    I just wanted to add my two cents here. For about 3.5 years I worked for a firm that manages clinical trials. What is that? Well… a clinical trial is a process designed to safely try a new drug on volunteer patients before sending it out to the market. My experience with the process was limited but I believe it is fairly typical and can be used as an example of how governments turn kind help into downright aggression. In my first month on the job I was shown how to create certain reports. Basically the population reacts to the drug or to the placebo and one is supposed to quantify their reactions and create a series of reports. Those reports are programmed individually, that is –I know you are young and don’t remember this- like old guys like me used to do in the seventies with COBOL when working for a bank or an insurance firm. Someone would ask you for a report on a certain account and the kind programmer would produce “the printout”. Well, that is how performance analysis is conducted by mandate of the Federal Government. I could see that a rather simple Oracle routine would have done the job of the 100+ people involved with the production of those reports. But guess what… it is not permitted to do it so. Now a floor full of “programmers” making 50K+ per year + overhead are just a tiny portion of the process, which I suspect it is as efficiently conducted as the foolishness I was force to perform to earn a living. Think about it a little bit and you will be susprised that a pill does not cost 2 million instead of 20 (Chinese borrowed) bucks.

    Brazil is able to do the same for a fraction of the cost. The funny thing is that the FDA was designed to make sure that no dangerous products reach the market. That is, to protect us. Just like Social Security and a bunch of other things were meant to protect us. These days I am happy if those good governmental intentions do not cause me any physical harm.

    I will end my unhappy diatribe asking that perhaps we would be better off if the government does not help us anymore. With the money saved we could live like kings… but… wait… don’t they Senators and Reps live like that?

    Who is paying it for them?

    Yeah… you guessed right.

    Be well my friend and don’t worry one bit. Everything will be just fine for you and Dotty.

  3. 3 PHB
    February 4, 2010 at 4:58 pm

    Hey Arni,
    Your do-nut hole essay (with photo) summarizes our barbaric health care system beautifully and succinctly. If you have the inclination, I’d encourage you to forward it to John Kerry, Scott Brown(yup, he really needs to hear/see it), Barak, The NY Times, Wash. Post, Journal of the American Medical Assn., New England Journal of Medicine, and just about anyone that comes to mind. This is the sort of exquisite depiction of real circumstances that can make a BIG DIFFERENCE.
    The terrorism that impacts upon most of us, daily, is denial of access to readily available health care (of all kinds including medications, nutrition, psychological/psychiatric care, time with physicians, preventative care, and education).

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January 2010

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All Photographic Images ©Arni Cheatham, Segami Images and Eyes and Ears, 2009. Unauthorized use and/or duplication of photographs without express and written permission from this blog’s author and/or owner is strictly prohibited.

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