drgrph's Comments (86)

“The human cost of medical errors is high. Based on the findings of one major study, medical errors kill some 44,000 people in U.S. hospitals each year. Another study puts the number much higher, at 98,000. Even using the lower estimate, more people die from medical mistakes each year than from highway accidents, breast cancer, or AIDS.
> Institute of Medicine, 2000

Lakewood, Colo. (July 27, 2004) – An average of 195,000 people in the U.S. died due to potentially preventable, in-hospital medical errors in each of the years 2000, 2001 and 2002, according to a new study of 37 million patient records that was released today by HealthGrades, the healthcare quality company.

If we were to accept these studies wouldn't it be better to be a non-insured individual? While I cannot vouch for these figures either, as a pharmacist I have seen some past statistics regarding iatrogenic misadventures (aka doctor- or medically-causes mistakes) and know they're significant.

I believe I often agree with the Mark Twain quote, “There are three kinds of lies: lies, damned lies, and statistics."”

“I appreciate the link and will review the study this weekend. Thanks!”

“Yes, I can see the difference. BUT what I question is how accurate the 3600 figure is. If it is inaccurate, like I believe, then it IS a scare tactic. Do you see the difference?”

“Exactly how certain are you that 3600 individuals die due to lack of insurance? I hope you are not matching up death statistics with insurance coverage. After all, a lot of people, insured or not, die from automobile accidents. How would their insurance status play into their ER care, provided they lived long enough to make the hospital. Certainly a lot of people, insured or not, die from accidental and intentional gun violence. Would lack of insurance make a difference there? I could go on and on raising scenarios about smokers who do not want to quit, the overweight who won't change their eating or exercise habits, drug addict who won't or can't quit, etc.

Listen, I understand your point that some without insurance or inadequate insurance may forgo treatment of acute or chronic conditions. But you can make that case without the ominous scare tactics using what I believe to be unsupportable figures. All you're doing is the same thing you accuse the Right of. Win your case on the merits, not on fear-mongering.”

“Let me see if I understand you correctly. No Democrat should consider the merits of the bill and make a decision, say, like every other time they need to vote. If they chose a position that their constituents have expressed, they should disenfranchise the voter who elected them to represent them. Failure to vote in goose-step with the other progressive Democrats are to be punished by having committee chairs stripped from them, again disenfranchising their constituents.

Thank God that Congress is not a business because I believe the methods you described are commonly referred to as extortion. I think it is incredibly sad that you are unable to "win" this bill on it's merits. I don't think you could - no bill written in this fashion at now over 2000 pages is really even worthy of consideration. This needs to go back to the drawing board and remain focused on the goal which I thought was helping the uninsured. This bill leaves too many uncovered and exposes it as a trojan horse bill meant to regulate further our lives.

So why don't you man up and write/meet/call your Congressman and in bullet-point explain why they should vote yes using solely it's merits. Strong arming may have its place in union or the Mob but it has no place in American politics. At least the pre-Obama politics.”

“My point was not to compare Herceptin with typical pharmaceuticals. My point was about cost reduction. For one thing reducing overall costs allows for the savings to be redirected. This was one of the original intents of healthcare reform, wasn't it?

Who owns the bulk of generic manufacturers whose products are sold in America? As you would likely say "Big Pharma". The best example I have of this is the birth control pill known as Yasmin. Shortly before the generic product called Ocella hit the market, lo and behold they reduced 1 hormone by 0.01mg, tested for different indications for use, and the product Yaz was born.

But it gets better. Look at a box of these 2 products. Bayer makes Yasmin, Barr distributes Ocella. I state it that way since they are both manufactured in Germany by Bayer. All Barr does it buy it from Bayer.

But it even gets better. I still have patients who insist on buying Yasmin...even when I show them the truth.

That is an example of the American patient and explains why I know that this bill can never reduce costs until incredibly strict measures are put in place. It will hurt the patient and financially hurt this nation.”

“In what I have read so far you are completely overlooking one of the best healthcare professional that can reduce costs - the pharmacist. Indulge me for a moment to explain.

My mother was receiving Tricor as an adjunct to maintain her lipid level (e.g. cholesterol). Under Medicare Part D she was paying $114. I supplied her physician with article regarding how there's no therapeutic difference between TriCor 145mg and fenofibrate 160mg. Know why? The 145mg strength was a "patent extender" release shortly be generic fenofibrate 160mg hit the market. Her new copay became $7 for an annual savings of $428.

Another elderly woman was receiving Lipitor when the insurance company's formulary changed. This resulted in a copay of $70 (for 1 month supply). Fortunately her insurance plan required prior authorization, so I was able to discuss alternative and encourage she contact her physician. She was changed to generic simvastatin with a monthly copay of $5 (or $780 annually).

Do the math - 2 meds and over $1000/yr saved. Imagine if this done every day with every patient. Due to low reimbursement rates a lot of pharmacies just don't do it. It's not "all about the money", but a business (yes, pharmacy is a business as well as a profession) does need to at least break even.”

“I believe you are missing the point why job creation has been poor. It is a fact that the President hates small business. That's right, hates small business. (An obligatory nod to Congressman Grayson)

Seriously, the President doesn't want job recovery unless, maybe, there's a union involved. Upon what do I base my belief? The so-called Stimulus Act. Show me where any consideration was given to small business. No tax reduction or credits, no easing of regulations - nothing.

On the other hand, we had more that enough money and interest to act like fascists and acquire Government Motor and Chrysler. Then effectively hand them over the unions instead of allowing the real owners, those who had invested in their stock), reap the just due.

This wholly partisan President has effectively locked most Americans and the businesses they work for out of what used to be considered "the American Dream". Now we must live "the American nightmare". Maybe my Grayson imitation was on the mark after all.”

“And your apologies for similar rants against former President Bush would be....?

BTW, isn't it time to get over the President's race? I've seen and judged him solely as a man. Period.

He is not Mr. Obama and he is not a black man. I like to think of him as our President. His race has nothing to do with his failed presidency, it's his lack of experience and progressive agenda. Period.”

“Beck is a patriot. He is honest. He cares for his family and all who live in this formerly great country. Most people would tend to agree that the GM/Government Motors take over was fascism. Exactly how did the GM lose his job? If health care reform, as currently defined by the Congressional bills stand, socialism has been instituted.

I suppose the only idiot here is myself, thinking that fundamentalist Progressives and liberals give a d@mn about the truth. Maybe I should just wait until the day that the Left realizes that truth exists in forms outside of the reality they choose to believe.

God (that's right - not god, G-d, Gawd, or whatever "cool" term is in use here) help this nation.”

“I don't believe that you would receive significant additional financial benefits if the government were allowed to negotiate discounts. Currently it is the insurance company that negotiates pricing and preferred vs. non-preferred formulary status. By current law a pharmacy cannot charge the government above that of the lowest price any single patient receives in the pharmacy. So the government already receives the best price courtesy of the insurance companies. Unless we are planning to fundamentally change America from capitalism to socialism (and some would argue we are) there is only so much lower you can go.

That's why I'm planning to drop Medicare B (supplies, equipment). Unlike the vast majority of other healthcare providers, Congress did not exempt us from several statutory requirements. The resultant extra costs to doing Medicare B business results in loss (v. profit) for each prescription. So I've chosen to stay open for the scores of patients in need by turning away the handful of Medicare B. Certainly no business wants to turn away customers. But with constant financial loss I'd eventually have to close and turn them all away.

Now you may not agree with me, but as I see it the government through low reimbursement and costly regulation have forced my small pharmacy out of the Medicare B business. As they have others. A government option, through actions like I've described, will never create competition. It is anti-competitive at its core and will drive out the private options.”

“Well, if they go to an emergency room they'll be treated. Efficient? No. But they would not go without care.

When they come into my pharmacy I work with them the best that I can. There are Pharma-sponsored programs that can be "tapped". I can work with the physician, physician assistant, or nurse practitioner to find another medication that would be cost efficient and effective (I worked over a decade in long term care and we constantly addressed this concern). I do have room for price overrides, if warranted. Finally, there have been times that I have personally paid for their medication. I know physicians that will do that (for their visit), too.

All it takes, sometimes, is simply being able or responsible enough to admit one's need. Healthcare providers don't go around making a big deal about since one of the reasons we do this work is to help people in their time of need.

So what do I suggest? I believe in increasing capitalistic competition by eliminating state barriers. And tort reform is, sadly, a must.

From experience I could never suggest a government option. Their record with Medicare and Medicaid clearly shows that it would fail fiscally. Plus the barriers to proper care already result in suboptimal treatment.”

“Amen brother! But I doubt anyone will take up the challenge. After all, if they don't have a straw man to demonize, whether it be a person like Beck or a company/industry like Big Pharma, then it comes back on us. No one supportive of Big Government wishes to accept that a free people are a responsible people. If you think through the laundry list of positions that the left holds you would see that an unwillingness to accept personal responsibility seems to connect many of them.”

“I'd like to ask an honest question. Exactly when did it become appropriate for a boss to have a sexual relationship with an assistant? Part of my diversity training with (the former) Thrift Drug taught me many "rules" regarding my interaction with different races, religions, and sexes. Generally speaking, in view of this training I'd have to say... never!

Adding the above to what I understood of the womens rights movement of the late 60's - 70's, I don't understand the silence. For example, are we absolutely certain that Mr. Letterman didn't use his "power" or "position" to draw his female staff into "relationships"? Or where's a professional relationship allowed to acceptably cross the line from abuse of position to consensual?

Is Mr. Letterman's problem my business? Not really, it's the CBS's problem. But in a way it is since a high-profile example like this may affect others regarding diversity. My concern isn't Letterman but how others might now view the role of boss/subordinate. It's a like the Polanski case - the point isn't Polanski but under what circumstances is it appropriate for a 40+ year old man to have sex with a 13 year old. I would like to think that most people would answer like me...never!”

“Not trying to be picky but I believe praying "for" someone is not the same as praying "to" someone. We can pray "for" Glenn Beck "to" God; we cannot pray "to" Glenn Beck "for" God.

Also Glenn Beck is not thought of by anyone as God in the flesh. If he were then you could call him an idol, which means false god. Sure, after the past week or two some might want to say that "Glenn Beck is God". But this would be in the same way others say "Clapton is God".

You might want to hold off on that lightning thing, too, unless you believe you are like Elijah (if you don't understand the reference try Googling "Elijah Baal" - pretty good story whether you choose to believe it or not).”

“You know if half of you out there crying "Bush lied us into Iraq" had looked at the previous administration (Clinton) the way you are looking at the Bush administration, we would not be a dying nation right now. At the end of the day, the deposition videotape clearly showed President Clinton lying about his relationship with Lewinsky. You missed the boat and then you decided that something was amiss because a Republican was in office! That is why you were, and still are, dismissed.”

“I don't really understand your hostility and what Bush/Cheney has to do with my original post. I'm talking about the present situation we're stuck in. You cannot change or influence the past (outside of re-writing history). It's time to give up the Bush-hatred, move on, and channel all that energy into something positive for the here and now.”

“Did I mention Bush/Cheney? No. I was referring to President Clinton.

In its current state, if the "reform" passes, I do lose. And you'll lose. Everyone outside of the ruling class (Dem/Rep) loses.

As my acronym might allude to, I'm a pharmacist. Been one for 30 years. Never failed to serve anyone regardless. While that + $1 might buy you a Dr. Pepper, I do know a little bit about our health care system. My duties placed me in nursing homes almost every day for over a decade. I saw and had to deal with the (typical) unfunded government mandates. Sure they meant well but...I saw no improvement in care and less staff (since no extra govt $$$) to serve the elderly.

I say fix what is broken and hands off of what works...you want to fix what's not broken? I would hope not. Mix in tort reform, take the money from the trial lawyers and fund grants for additional health care education. As you can see, like most Americans I recognize the need for change and have alternative approaches. Just because Pelosi/Reid endorse an approach that doesn't make it the de facto best choice. They need to quit stifling the Blue Dogs and should listen to the Republicans. What bill would come out of that? I believe one a whole lot better than now.”

“Uh, I'm a registered Democrat who voted for Obama in the PA primary. Did I mention Bush/Cheney? I meant Clinton, although the mistress thing applies...”

“Did I mention Bush/Cheney? If I suggested so, I'm sorry. I was thinking of President Clinton. Hated his policies, but he had extensive executive experience and knew how to lead. Shame he couldn't keep his pants on, though.”

“Honestly no, I did not. But as I was not a fan of Country music at that time I could care less.

BTW - depending upon perspective libertarians may be liberal or conservative. I make no bones that I am currently a registered Democrat and conservative (think Governor Bob Casey).”

“Quit whining. Elections have consequences. If you elect someone with no executive experience expect a president who cannot lead. That's what you've got. So deal with it.”

“Where is the dilemma? Buy what you NEED at Whole Foods. Your health clearly outweighs railing against a leftist with a plan not in sync with the President.

Personally I believe in the 1st amendment and support political diversity, so I plan to go out of my way to buy at Whole Foods.

Tell me when did freedom of thought die? Or is it only the fundamentalist progressives that finds others opinions dangerous and blasphemous? To steal a line from my fundamentalist religious friends, "Progressives said it, I believe it, and that settles it".

p.s. If you feel then need for penance, why not do something actually useful to President Obama. Host a gathering of friends or neighbors to present and promote a public option. I mean, wouldn't it be better to affect several people in a positive fashion than to focus so much energy on 1 man negatively? Live the change (positive vs. negative) that the man you voted for proclaimed.”

“I'm unclear as to whether your mention of physicians "medical care profit comes from volume" is meant to bolster or demean physicians. As a pharmacist I, too, need volume to make a profit. Most health care providers require "volume" due to the fact of insufficient reimbursement from whoever the payer is.

Insurance companies and the government (may be state or federal) set reimbursement levels apart from actual costs. In 2007 a study was released suggestion pharmacy dispensing costs to be $10.50. Medicaid reimbursed the pharmacy costs at approximately $4.50. While I'm not familiar with physicians costs, my guess is that the findings would be similar.

For this reason alone, albeit there are many, you should re-think national health care or insurance. Only a fool would believe that we'll receive adequate reimbursement. Please - save the non-profit idea, too. Not because I believe in capitalism, either. Sub par levels of reimbursement leads to bankruptcy of the provider. An increase in reimbursement to simply revenue neutral levels leads to either national bankruptcy, significant tax increases, or rationing of care.

I don't have the answer for this incredibly complex issue. But I know it cannot be found in an undebated (in Congress) 1000+ page bill. We cannot afford "the Law of Unintended Effects", meaning having other negative things occur just because of the initial change.”

“To be fair and balanced you need to include groups like Code Pink. If you actually believe breaking into a Congressional committee with red hands and yelling at Secretary of State Rice "legitimate protest", then you are wholly biased - using different standards depending if they reflect your position or not.

Maybe it's just that legitimate protest is all in the eye of the beholder. Was the Weather Underground's bombing of the Pentagon "legitimate protest"? How about animal rights activists that break into offices to "free" what is being used for testing? Was the trashing of LA post-Rodney King verdict or Newark post-MLKing "legitimate protest"?

Some will say that these were legitimate forms of protest while other would not. What I'd really like to know is how yelling at tone deaf Senators and Congressmen became such a big deal at all. Am I the only one who is insulted by canned, off-topic responses to e-mails or the dismissive office help when calling my Congressman?

There is one thing that you might help me with, though. Where is the definition of "legitimate protest" in the Constitution?”