Thursday, February 21, 2019

Who's in Charge of Your Health? It Might not Be Your Doctor


Who is prescribing your medications? Is it your doctor, or is it a panel comprised of pharmaceutical companies in concert with your insurance company?

There is a family that this writer is very close to. I have known them before they first married, watched them go though the good and the bad. I have, witnessed them bring two beautiful daughters and a son into the world. We are talking Wheaties box stuff here. The American dream, conservative in politics and life in general. Not the Cleavers, but a rock solid example of American values.

We all know that with the good, well, there's always some "issues" that come with this deal of "living life on life's terms." In this family's case it has been health issues.

Mom suffers from fibromyalgia which results in constant muscle and bone pain, throw in a good dose of an anxiety disorder and problems with sleep. Her laundry list of prescription drugs are: Soma, (muscle relaxant), Vicodin, (used only when in extreme pain}, Klonopin, (anxiety) and Trazodone (sleeping).

The oldest daughter, thirteen years old, was blessed at birth with ADHD, Anxiety attacks, and Bi-Polar Disorder. She must ingest daily doses of three different drugs, Strattera, Abilify, and Zoloft.

Dad has high cholesterol and is stuck with the drug Lipitor for life. But here's the kicker, Dad also very recently took a new job, more money, more perks, "moving on up," the Jefferson's would say... Sounds great right! Well, everything was just peachy until he recently discovered his new prescription co-pays basically jumped from $10 a shot per prescription to a whopping $50 per script. Blue Cross, not exactly a shinning star in the medical field, was charging about $80 a month for all their meds. The new company, United Health, will charge them about $400 a month for the same medications. In addition, the family pays an additional $361.00 per month for their basic health plan. This of course, is just the employee's contribution, the employer will pay way more on it's end.

It is easy to fault the couple for some of this new dilemma. Shouldn't they have done the some research on the "new" insurance prior to making this new found "commitment"? In hindsight, of course they should have. Didn't happen, facts are, the barn door is open and the horse is out in the pasture, and mom and dad are trying to make some sense out of the new predicament that they have found thier family in.

A call was made to the new protectors of all things "health" for this typical American family of five.
The response given is so stunning, I am both shocked and amazed that the "representative" of United Health would actually utter the words he did, as he explained his company's policy on "prescription co-pays."

When asked why the "co-pays" were so high, it was explained that this company operated on a "THREE TIER" basis. Certain drugs were listed with a $10 co-pay, others were listed with a $25 co-pay. The third tier was the $50 buck co-pay, and unfortunately, every single one of this family's prescriptions were categorized in the third tier.

All?, asked the mother. All, responded the spokesman. Then the unbelievable was uttered. This representative of the insurance company suggested some "replacements" for the prescribed drugs that would fall under the lower tiers. Mom, quickly responded, "but that was not what was prescribed by my daughter's doctor." The "representative", replied, "Well, I just wanted you to know what was available on a more economical tier."

The mother then asked the "Question of all Questions."... "And just who makes these decisions on what medicines are allocated to each specific tier?"......Either the "representative" had recently been given a injection of some sort of truth serum or he felt no shame in responding: "Oh, every once in a while, members of the pharmaceutical companies meet with members of the insurance company and those decisions are made." Don't you find that amazing, your trusted insurance company has no problem suggesting a cheaper medicine might be just as good as what your doctor, who after a detailed diagnoses, prescribed? Especially a prescription that deals with something so volatile as ADHD and Bi-Polar Syndrome. That is F***ing scary.

Ah, but I am not done yet. As an experiment, I suggested that the young lady, take a couple of prescriptions, along with her AAA card, (Yes, the Automobile Club will get you a substantial discount on prescriptions), and go to Von's and tell them you have NO, as in None, insurance and see what the charges would be. To everyone's amazement, the prescription for Vicodin was $14.00, and the prescription for Soma was $32.00. That results in a savings of $54.00 by NOT using her insurance. That is nuts!

However, if you a one of the many uninsured Californians that suffer from a bi-polar disorder and your doctor prescribes the medication Abilify, it will only cost you about $600 for 30 days of sanity.

Does any of this make any sense to anyone? If so, please, let me in on the secret. Tossing all fears of a socialized America aside, I shall vote for a presidential candidate that will give us "Universal Healthcare."...It should be America's number one priority.

"The United States is the only wealthy, industrialized nation that does not provide universal health care." (Wikipedia)

About the Writer

Steven Lane is a writer for BrooWaha. For more information, visit the writer's website.
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9 comments on Who's in Charge of Your Health? It Might not Be Your Doctor

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By Kerry on December 30, 2007 at 04:55 pm
Well written expose. For a civilized country, we sure have some uncivilized ways when we let the drug companies dictate when there are so many organic methods available.
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By Rose Mountain on December 31, 2007 at 04:57 pm
Steven great article, and I'm glad your friends found cheaper drugs, too many heartbreaking stories like that in America. I'm not sure of your politics, but I'm curious why you wrote that conservative politics are the American ideal? Your story agrees on the point that corporate greed harms the wellbeing of people, which is exactly what Democrats & liberals have always been fighting to expose and stop. More examples, Democrats & Liberals & Moderate Republicans have also had to fight for decades to fund public education for school children in Congress and even the California Legislature 20 years ago. They fought for worker's rights, trade unions, environmental safety, and the Environmental Protection Agency (EPA),the Food and Drug Administration (FDA), social justice, civil rights for all people,etc Now, most of these are considered mainstream ideals, however the corporations killed the labor unions for workers, and education in America is funded less than all industrialized countries, and less than the US military. And so far the corporations are still winning the fight to be able to pollute our environment which is now known to cause disease in people, etc etc I'm glad you wrote this article to expose the drug companies, and tell people of the solutions for cheaper drugs. Thanks
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By Steven Lane on December 31, 2007 at 10:17 pm
Rose, Thanks for your comments. As to my politics, I would have to say I am a bit of a left leaning Democrat. I have no problem disclosing that fact, but I do try to keep "balance" in my writing. I wrote the following, describing the couple that the article focused on: "The American dream, conservative in politics and life in general. Not the Cleavers, but a rock solid example of American values." I wrote it that way because, I believe that is the manner in which they, (the couple), would portray themselves. This issue affects everyone in the political spectrum. I don't think right-wing republicans want to be treated as idiots anymore than I do. What these insurance and pharmaceutical companies are doing should constitute treating all Americans as "equal-opportunity buffoons."
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By shellbelle on January 02, 2008 at 12:20 am
Thank you for this article. I am uninsured. Recently, I had an infection that was so painful, I caved and went in search of medical help. I ended up with prescriptions for an antibiotic, and a painkiller. With my AAA discount (so grateful for that!) -- the antibiotic prescribed was $180. The Vicodin was $10. The drug you need to save your life, $180. The one that just makes you more comfortable, $10. That was depressing. Especially when I realized that, hypothetically, with the apparent re-sale value of Vicodin being what it is, one could sell the Vicodin and really help pay for the antibiotic. The system is broken. Capitalism is a fine system. For most things, it's great. But as long as we have a profit-motivated healthcare system, making money for corporations will always take precedence over taking care of people's health. We need a new solution. I agree with you on the "Universal Healthcare" priority.
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By Steven Lane on January 02, 2008 at 12:36 am
Shell-Belle, next time give the Simi Valley Free Clinic a call, they are listed. They have a doctor a couple of times a week and I have heard they will help on prescriptions, maybe some samples. I know they do "labs" when needed. They ask for a $20 donation but it's not mandatory. It is crazy that something that is addictive is $10 bucks and will never fix a thing other than pain. I AM NOT bad talking Vicodin, when my back was messed up, I would have gone ballistic, if I didn't have them on hand but I had enough sense to put them down when I no longer needed them. Thanks for the comment
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By wolviela on January 02, 2008 at 09:53 am
Ironically I work for a hospital, non-clinical part, but I can't believe the crappy health plan I have!!!! However, when I landed in the hospital in India a few months back and had to stay there for 2 days, the bill came out to $250 TOTAL. This included a doctor, a private a/c room and all the drugs I needed to get better. Now can someone tell me how a 3rd world country can't provide not only that healthcare servce, but excellent bedside manner to some one who can barely understand their language, yet the U.S. the land of opportunity, shafts it's public in the health department?
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By Steven Blake on January 02, 2008 at 10:58 am
Great points Steven, I recently have had a simular experience and felt it should be brought to light. Bravo
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By Ivan Homeless on January 02, 2008 at 03:36 pm
The pharmaceutical industry, FDA and AMA is a nightmare triad, I have had to pay huge amounts for psych meds, sometimes I think psych meds are the worst because so many are off-label scripts. Thank you for this well written article.
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By 'Mean' Mike Duffau on January 02, 2008 at 04:53 pm
health is a huge issue nowadays. its getting too expensive. it seems like theyre out to rob us rather than helping us. money doesnt cure sickness or diseases. good stuff here, champ!
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