March 27, 2014

Food Fight at a Monster Truck Rally

"Mommy, what did you do during the 2008 Democratic Presidential Primary War?"

"Uh..I wrote shit online. Mostly about other shit that was being written."

"Why?"

"Because someone had to. It was not the corporate media's finest hour. Not their worst either. That was 2001-3, the &quot Oil) Drumbeat to War". Oh, and 2000, "Gore is a Liar". And 2004, "Exit Polls are Reliable in the Ukraine but Not in Ohio." Actually, what passes for a 'free press' in this country has been neither 'free' nor a 'press' in a long time. More like Pravda, if Pravda, represented four or five giant financial consortia rather than one country."

"What's a financial consortia, Mommy?"

"They're the ones who try to pick your party nominee, honey."

"I thought we did that, Mommy."

"Silly, rabbit. What do you think this is? A democracy?"

Read about why you thought Edwards was a Phony and Hillary was a Bitch and Obama was a Scary, Scary Black Muslim in this collection of essays by yours truly from 2007-2008 which I call "Food Fight at a Monster Truck Rally." It's FREE at Amazon for Kindle for the next five days, along with most of my fiction. Your democracy is not free. It takes lots of work.

http://www.amazon.com/Food-Fight-Monster-Truck-Rally-ebook/dp/B00J84V9NQ/ref=sr_1_2?ie=UTF8&qid=1395921977&sr=8-2&keywords=McCamy+Taylor

March 23, 2014

Life is a Crashing Plane, Peter Hammill's "Flight"

Warning! Long thread ahead! Travel at your own risk.

"No looking back on tomorrow...better think on today."

Peter Hammill from "Flight"/Black Box

If you choose to read this, please listen to the music at the following link simultaneously. And if you don't want to read this, please listen anyway. This song is about a million times better than what I am about to write.



Peter Hammill performs the song "Flight" from his album Black Box, this is a live solo version, Hammill doing vocals (duh) and accompanying himself on piano. Video is someone's compilation (not live).

Now, on to the topic, which is...

Mammon or muse?


"Mammon and Muse walk into a bar..."

Just kidding.

I have been listening to lots of Peter Hammill on You Tube recently. Which raises the question, where is the Peter Hammill Needs Money Police? You know, the folks who spend their time shutting down Internet bootleg? Apparently, Mr, Hammill is too busy writing, recording and performing to do it himself. Good for him. He survived his heart attack. May he live forever---meaning long enough---and keep writing and recording. Praise Gog.

And now, to the---no, not the, a ----as in one of many point(s), which is, how do we juggle the need to create art with the need to eat? This is an extremely loaded topic, right up with there with 1) Religion and 2) Politics on the list of Things Thou Shalt Not Talk About at the Thanksgiving Dinner Table Unless You Want a Food Fight.

I do not want to precipitate any food fights, so I am going to move this discussion to the far side of the Pacific Ocean. In Japan there is another term for mangaka. It is "richer than Croesus." Meaning that the people who create manga make a whole lot of money. Not like the US where DC and Marvel (now Disney) own your characters. That is why so many people create manga. So, consider two of the most successful mangaka, Rumiko Takahashi (Inuyasha) and Takehiko Inoue (Vagabond). It helps if you are familiar with their work. But if you are not, Rumiko's is sort of cutsie, shoujo-shonen-esque with so-so art, Takehiko's tends to be more mature, takes more risks, extremely inspired/technically competent art even by western standards. Now, Takehiko Inoue is on record as saying he does not care who posts his stuff on line and he even posts manga himself for free for fans (Buzzer Beater was an online manga). Rumiko Takahashi, on the other hand, has a rep as not tolerating any form of piracy--and that is saying a lot for a country that does not tolerate piracy. Keep in mind that both of them have more money than they will ever spend.

Where is this all going? The same place we are all going. No where. But, just to pass the time until we get there, I will step out on a limb and hazard a guess. I suspect that when Takehiko Inoue pens another chapter about swordsman Musashi learning universal truths from watching rice grow (Vagabond) or describing the struggles of wheelchair basketball players (REAL), he has a deep sense of personal satisfaction that makes the box office grosses ( I don't know if there is an equivalent term for this for manga) irrelevant. But when Rumiko Takahashi churns out another bit of Inuyasha clone, she is just going through the motions--in which case that royalty check is the carrot. But that could be----no, that probably is just my personal bias.

(And if you are not listening to Peter Hammill perform "Flight" please go click on the link.)

Now, for the counter argument. Think about Alan Moore, probably the most talented English language author alive today now that William Burroughs has gone off to the Western Land. Think about how the Comic Book Industry has used him. Think about Hermann Melville, whose Moby Dick, the greatest American novel of the 19th century was trashed by the British critics---who were not amused by the novel's themes of God-killing which is another form of anti-colonialism---and who therefore died in near obscurity. Think about William Blake, whose poetry was rescued by the merest chance---his Free Love agenda coincided with that of Victorian poet Algernon Swinburne. And no, I am not going to argue for a state subsidy for starving artists and poets. These writers received support----not financial support, moral support. They were and are the "Voice of honest indignation" (to quote Blake) which we so revere---

But you've gotta wonder. Worry and wonder. What Donnes labored and died in the cotton fields of Alabama, their words of beauty and wisdom lost forever, because it was illegal for slaves to learn to read and write? What Yeats are going unheard at this very moment, because they are too poor to afford a computer, and even if they had one, they don't have electricity in their third world hovel? All those rebels with a cause I mentioned above, those were and are all white guys with educations and good health and supportive families. When your life is a plane crash, how do you make yourself heard? What do you do if society does not give you a black box?

Ok, now read the lyrics to Peter Hammill's song that I hope you have listened to at least once or twice by now. But do not read the lyrics unless you have listened to him sing them, because he is a singer-song writer not a poet and the delivery is three parts of the poetry. (In keeping with the four paragraph rule I'll post two stanzas, I urge you to go read the rest yourself, the lyrics are from the album version, the live version is a little different):

It was then that I knew I'd been thoughtless -
something had slipped my mind:
I'd strapped myself into the Fortress
but the Fortress was flying blind.
We got full clearance, so someone down there
ought to know the truth of our disappearance -
If even that still shows it accuses and blames me,
but nothing was quite what it seemed

snip

No looking back from tomorrow,
no, there'll be no looking back on today;
better be looking on to tomorrow...
better think on today.

http://www.songlyrics.com/peter-hammill/flight-lyrics/#265H4MWMi3oVLBkx.99

What the hell did any of that stuff about mammon and muse and voices of honest indignation have to do with Peter Hammill's 1981 version of a song about a plane crash as a metaphor for life? If we did not have people willing to do art for art's sake, then we would not have so many works of art waiting to touch that nerve that needs to be touched when the proper moment arrives. As we do our forensic investigation, read the tea leaves, examine the entrails and consult the stars for the answers that will keep something like this from ever happening again, I suggest that we also examine ourselves, because if we do not know ourselves we can not hope to know anything. And because life is so very fragile and so very fleeting and because so many people with such beautiful stories were not gifted with beautiful voices, I recommend that we take time to listen and then tell those stories. If every work of art strove to be Grapes of Wrath rather than---say---Twilight---think about what the world might be.

"I can't tell you nothin'. You got to go there." John Steinbeck The Grapes of Wrath

March 9, 2014

Poor Folks in the U.S. Can No Longer Afford Treatment for Pneumonia

Yes, this is a scary headline. Almost sounds sensational. It isn't. It is a cold hard fact. At this moment, if you are counting your pennies, trying to scrape up enough to pay for a $4 drug at Wal-Mart or Target, you can not afford an antibiotic that will treat your walking pneumonia---meaning that you could end up in the hospital saddled with tens of thousands of dollars in medical bills.

For years, doxycycline has been a valuable drug for physicians who treat the indigent --- unemployed or underemployed folks without insurance. A staple of $4 drug lists, it can be used to treat everything from bronchitis to "walking" pneumonia to urinary tract infections to skin infections to acne to venereal disease---and it covers some rarer infections like Lyme's and is sometimes used for malaria prevention, too.

For as long as I can remember--and I am pretty damn old---doxycycline, a twice a day form of tetracycline has been widely available and cheap as dirt.

And then, this winter, something surprising and very troubling happened. A patient with a list of medical problems longer than his arm and no income (he was still appealing a Social Security Disability denial) came down with bronchitis, possible early pneumonia--the two can be difficult to differentiate. I wrote him a prescription for doxycycline. He took it to the pharmacy. They wanted over $50 for it. He did not have over $50. He had $4. That was how much the drug used to cost at the same pharmacy.

He is not alone. Here is an LA Times Story about someone who had the same problem last year. Turns out that the difference can depend upon which generic drug manufacturer is making a specific medication at any given time. And apparently, right now, the one making doxycycline charges an arm and a leg for it.

http://articles.latimes.com/2013/mar/07/business/la-fi-lazarus-20130308

A CVS pharmacist in Los Angeles, who asked that his name by withheld because of fear of retaliation by the company, shared with me the average wholesale price of different makers' doxycycline, as made available to pharmacists by the McKesson Connect online ordering system.

The system shows that the average wholesale price of 100 doxycycline pills made by Watson with a strength of 100 milligrams is $328.20. The same number of doxycycline pills at the same strength made by Mylan cost $1,314.83.

Mylan? Where have I heard that name before? Oh, yes. ALEC. As in "The Koch Brothers" and their corporate welfare mentality.

http://www.sourcewatch.org/index.php/ALEC_Corporations

Where else have I heard of Mylan? Oh yes, the great lorazepam price fixing scandal.

http://abcnews.go.com/Health/story?id=117795

The Federal Trade Commission approved a $100 million settlement with Mylan Laboratories, the largest monetary settlement in the commission’s history.

The agency had charged Mylan, of Pittsburgh, Pa., with conspiring to deny four competitors ingredients necessary to manufacture widely prescribed generic versions of anti-anxiety drugs. The practice resulted in a 3,000 percent boost in the price of the drugs, according to the FTC.

“Anti-competitive acts in the pharmaceutical industry potentially cost consumers millions of dollars in higher prescription prices,” says Richard Parker, director of the commissions’ bureau of competition.

Mylan is now the third largest generic drug manufacturer in the world since it acquired an Indian generic drug manufacturer--meaning that it is in great shape to corner the market on these all important key ingredients needed for drug manufacturing.

http://triblive.com/x/pittsburghtrib/business/s_582510.html#axzz2vVDPxdWb


Not so long ago, the nation watched as patent drug manufacturers paid generic drug makers NOT to produce their product---keeping drug prices high. Keep that in mind as you ask yourself why a drug as popular as doxycycline is in short supply. This is not one of those orphan drugs that no one wants to make because almost no one needs it. This stuff sells itself. The more that is made, the more we will see it used. Why isn't supply attempting to keep up with demand? Where is the bottleneck in the so called "free market economy"?

If this were a fictional mystery, I would now tell you why doxycycline has gotten so expensive that poor folks can no longer afford it. Since this is real life, I don't know. If someone out there knows the answer, please tell me. Meanwhile, when a patient without money and without prescription drug coverage comes in which bronchitis/and or pneumonia, I am going to be hard pressed to get him treated with what is currently available on most $4 lists.

March 8, 2014

Managed Care Denies Coverage for Generic Albuterol, Will Only Cover----Name Brand Albuterol

I have blogged before about Managed Medicare abuses. About how a loophole in health care law allows the plans to bill their own internal Q&A as direct patient care. And about the massive number of medication denials which they issue, most of which are designed to create patient and doctor hassles rather than save the insurance plan money.

The latest target: albuterol inhalers, the inhalers that every asthmatic uses for asthma attacks now that all the competitors are gone. That's right. Albuterol is the only drug available in the U.S. for use as a rescue inhaler. There is nothing else that can take its place. And, because of reformulation issues, all of these inhalers are extremely expensive--too costly for a cash strapped senior or disabled person to buy his or her own, no matter how badly he or she is wheezing. So, how did I get not one but three Medicare Managed Care denials for generic albuterol inhalers in one day?

I wanted to know the answer to that one myself. So, once my medical assistant got a representative of the insurance plan on the phone and discovered that while the plan did not cover generic albuterol inhaler, the plan did cover Pro-Air--a name brand albuterol inhaler, I took the phone.

"Why?" I asked the young man at the other end of the line. "Does Medicare Advantage Plan C cover a name brand albuterol inhaler but not a generic albuterol inhaler? Why can't the participating pharmacy substitute Pro-Air for 'generic albuterol inhaler'?"

"Um..."

"This is the doctor. I really want to know why my patients can not get their asthma inhalers when they need them. Why do they have to do without their medication until their doctor can talk to an insurance rep? Can I talk to your supervisor?"

Ten minutes of holding and no supervisor came to the phone. While waiting for the supervisor that never appeared, I looked up the drugs in question. My drug handbook listed all the albuterol inhalers as being interchangeable. I gave up waiting and I called a pharmacist. "Are Pro-Air, Ventolin, Proventil Inhalers and generic albuterol inhalers all the same thing?"

"Yes, they are," said the pharmacist.

"If one was not in stock could you substitute another as long as the prescription did not specify name brand only?"

"Yes, I could."

Very strange indeed. So, basically, my asthmatic patients on Medicare had been forced to do without their rescue inhalers until their insurer could fax my office a worthless piece of paper that my nurse showed to me the next day that I was in the office--meaning potential refill delays of up to 72 hours. How does that keep my patients healthy? It doesn't. Instead, it scares them. Anyone who has asthma knows how bad it feels to need your inhaler and not have one.

In what kind of country is it legal for someone's insurance company to deny them a necessary medication for 72 hours for absolutely no reason? A crazy country. Why would an insurer want to do this? That's easy. Scare your sickest patients enough and they will drop off your Medicare plan and sign up for a different Medicare plan. Since Medicare Advantage plans are paid a flat fee by the federal government for each enrollee, they have an incentive to keep healthy people happy with bicycle socials and sick people scared by denying them their medications. And it is working. People with the biggest burden of chronic illness are the ones most likely to drop off a so called Medicare Advantage Plan and back onto traditional Medicare, meaning that the tax payer picks up their bills while the privates collect premiums--and then pay themselves for denying services and benefits (the Q&A loophole).

This is not an isolated incident and it is not confined to a single Medicare Advantage Plan. See my old diaries for other examples. This fragmented Medicare is ruining the best insurance plan in the country---and, in the process, making it even less likely that we will ever see a single payer insurance plan since the privates can point to the mess they have made of Medicare---siphoning all the money off and leaving all the debt for the public to pay---and say "See? See? Single payer is too expensive."