Tuesday, June 25, 2013

Paula Deen and the American PC Pendulum


We Americans have a tendency towards extremism and while we share a strong national pride, we have not always had the most stellar history.

Slavery, the Civil War, the deaths of Lincoln, Martin Luther King, John and Robert Kennedy, and our propensity towards violence are not a shining example of "the land of the free and home of the brave."

Even when we self correct, we go too far.

Now, I am not familiar with the life of Paula Deen.  I have seen her a few times on the morning talk shows where she seemed like a cute southern grandmother who liked to cook with lots of butter and cream.  From what I understand, she is quite successful at plying her trade, so there will be no need to run out for additional Kleenex to mourn for her supposed financial setbacks.  

For the past few days, there have been countless of news hours dedicated to the fact that a 66 year old woman raised in the South admitted to having used the dreaded "N" word. Was it last week?  When she was twelve or fifteen?  The Food Network saw fit to cancel her cooking show and the media pundits have shaken their collective heads in obvious destain for her hideous sin of admission.  Suddenly, some woman who can make a good biscuit is the "Hitler of 2013."

 As usual, we have gone way too far.

The American obsession with Political Correctness has undoubtedly given us some important guidelines that have benefitted us in our workplaces, and hopefully have had an impact on sexual harassment. But, there is no doubt that they have also contributed to our social isolation and our inability to communicate or educate each other. We don't really know what to say to each other anymore. They certainly have not put an end to bullying in school or protected our children from gun violence.  In the hysteria of the Paula Deen incident, they will surely contribute to honing our deceptive skills and you can bet that no one will admit that they have  ever used a racial slur.

Ms. Deen is a product of the cultural and social history of the South.  In years past, this history included  the Klan, separate bathrooms and drinking fountains, riding on the back of the bus, and educational segregation, all things too unbelievable for most young Americans to even contemplate.  But, many of us of a certain age do remember.  It doesn't matter if you grew up in Mississippi or Long Island, prejudicial behavior was pervasive everywhere.

Sociologists remind us that all prejudice originates from fear.  Fear of our differences and fear of change.   Indeed, Ms. Deen has stated that one of her relatives committed suicide after the Civil War.  He could not fathom a world without slavery, which was his fear.

As a young woman in the nineteen sixties, I was part of the peace and love generation.  We embraced the ideas of equality for people of every color and for women's rights, which were still in the "back of the bus"stage.  But don't think for a moment that I could have dated an African American boy.  My parents were from a different generation and their fears ruled their lives as well.

It is 2013 now. While we have all been influenced by the social and political mores of our past, certainly Ms. Deen is old enough to have made her own choices in life.  As a young woman, influenced by her parents and social climate, she may indeed have used the "N" word.   I'm sure its part of a very distant past, and I would bet that her children were raised in a climate where the word was not part of the daily vocabulary.

Should we choose to fire every Southern, or for that matter Northern, individual over the age of 50 who has used "the word," at some point in their lives, America would be a third world country.

There is a point where our sensitivities become reminiscent of a lynching.  Isn't this the very thing our ancestors fought and died to avoid?




Saturday, June 22, 2013

Variations in Generic Prescription Drug Pricing - One More Factor in Our HealthCare Crisis


As if aging was not hideous enough, a trip past my glass kitchen cabinet where I now store a multitude of prescription drugs, is a constant reminder that I am no longer in the springtime of my existence.

Synthroid for my radiated thyroid, prescription Protonix for heartburn, high blood pressure pills, cholesterol meds, and most recently a bottle of Plavix from having an aortic aneurysm repair.  Oh, Joy and Happiness!

It could be much worse, I guess, and my recovery from the stent placement has proceeded to the point where I can almost, but not quite, cross my legs again - without wincing in pain.  What did make me wince, however, was the monthly out of pocket cost to swallow down the daily doses required to keep me upright.

All this pill popping was a relatively new phenomenon for me so despite my vast experience in managing a number of medical practices, I had no idea how much these colorful and varied shaped disease fighters cost.

My husband's medical plan requires that we pay up- front for our prescriptions.  We then mail the receipts and wait to be reimbursed at 80% of the cost.  The check always arrives in a timely manner, but until very recently, I was shelling out about three hundred a month to the lovely person behind the counter at my local CVS.  I pay less for my 2012 Honda lease - and it's much, much bigger.  One realizes why so many seniors have to make the choice between eating and taking their prescribed medications and I consider myself lucky that I could squeeze our budget to cover these costs without having to eat Ritz crackers for our evening meal.

I decided to investigate and was shocked to find that there was an overwhelming difference in the costs of prescription medication from place to place.  Not just a one or two dollar difference, mind you, but differences so staggering that there is really no reasonable explanation.

Plavix is now available as the generic Clopidogrel.  For thirty pills at CVS, the up-front cost was $157.49.  At Pathmark, the same prescription cost me $11.30.

The generic prescription Protonix was $89.00 at CVS.  Pathmark - $11.00 even.

How can this possibly make sense?   I sent an e-mail to CVS on Friday asking for an explanation and I can't imagine what they could tell me to account for the difference in pricing.   If the drugs cost them that much to purchase and so many patients pay only a co-pay of $15.00 or $20.00, how can CVS afford to stay in business ?   Do the uninsured or self pay patients make up the difference?

I can't claim to know what the insurance companies are reimbursing pharmacies for drugs covered under a co-pay plan, but if it is $157.49 for Clopidogrel, then how does Pathmark afford to stay in business. Do they supply the drug manufacturers with free food?  

There has been much discussion regarding the institution of federally controlled health care, but shouldn't there be some consistency in what patients are charged for services?  In medicine, we cannot charge our patients over and above the contracted reasonable and customary fees.  Shouldn't there be a reasonable fee for medications as well?