Tuesday, November 27, 2012

The State of Health Care: The Desonide Story

So You Thought That ObamaCare Was Fixed
After getting the green light from the Supremes, it's working, right?

This is not a posting about a drug or even about a disease.  MeanMesa is an old geezer who gets his medicine from Medicare via the Part D Pharmaceutical benefit.  

This means a couple of things.  Since the country was briefly consumed with consideration of the ideology of Medicare during the Presidential election of this year, MeanMesa thought that this would be a good time to tell a short story about using the system.

The "other thing" has everything to do with costs.  The major theme of the ideological "chit chat" was about reducing the costs of "entitlements."  

Of course, the reactionaries among the oligarch party would never rest for a single moment in their absolute commitment to persuading every citizen of the entire country to consider programs such as Social Security and Medicare as "entitlements."  The Republican Party and its owners firmly believe that they are, in fact, "entitled" to the "entitlements," themselves, even though, of course, we of the tax paying "little people" class actually paid for these "entitlements."

Further, as is the case with every consideration of a Republican Party "position" on anything at any time, there is a deception, and it is a deception which must be dislodged before any actual observation can be made.

In this case, the deception is to be found by examining one of the "owners" of the Republican Party, that is, the massively corrupt pharmaceutical corporations, Big Pharma.  Big Pharma was a Big Presence in the Congress during both the health care "debate" and the Part D Pharmaceutical Medicare "debate."  Big Pharma pumped hundreds of millions of dollars worth of "campaign contributions" into candidate coffers during both spectacles.

Not all of the coffers where attached to Republicans, either.

Senator Max Baucus, (D-Montana) replaced the late Senator Kennedy (D-Massachusetts) as the Democrat in charge of ushering ObamaCare through a cynically hostile Senate.  Baucus got enough cash from Big Pharma to retire.

MeanMesa wishes that he had.

These comments are, of course, only a bit of preparation for the actual tale to be told in this post.  That will be the story of a single episode of "dealing with Medicare."
As mentioned before, this post is not about a disease, a medicine or a cure.  We're talking instead all about cost, policy, procedures and effects of the Part D Pharmaceutical program.  This is a story of what it's like to deal with Part D.

The Desonide Story

First, we should briefly address the question of what, exactly, is Desonide.  For both speed and convenience, we need look no further afield than our trusted WIKI.
Desonide is the generic name of a low-potency topical corticosteroid that has been available since the 1970s. It is primarily used to treat atopic dermatitis (eczema), seborrheic dermatitis, contact dermatitis and psoriasis in both adults and children. It has a fairly good safety profile and is available as a cream, ointment, lotion, and as a foam.

Corticosteroid Desonide (Wiki)

It's also important to note what Desonide is not.   It is not a brand new "discovery drug" which is a miracle cure and which costs $10,000 per milligram.  Desonide is an old drug, developed in the 1970's as a kind of generic skin lotion.

MeanMesa's Medicare Doctor, after noticing that these old hands were dry and itchy, prescribed Desonide.  MeanMesa's pharmacy filled the prescription and hand over a small squirt bottle full of the skin lotion.  After applying the lotion to the skin where the problem had been found, MeanMesa discovered that the Desonide prescription was, in fact, "just what the doctor ordered."

The skin on the hands and arms improved almost immediately.

"Business-wise," the transaction also seemed quite routine.  When the prescription was ready at the pharmacy, the co-payment was $5, typical for a Medicare Part D medication.

However, when the end of the month rolled around, MeanMesa received the also routine "Monthly Medicare Part D Statement."  That statement lists the costs that Medicare Part D has paid, month by month, through the year for prescriptions.  The reason that the "Monthly Medicare PART D Statement" is interesting at all is because it is precisely where one's approach to the dreaded Medicare Part D "doughnut hole" will first be seen as it approaches.

Although most Americans, interested or not, have, by now, been unavoidably informed about the "infamous Medicare Part D doughnut hole," during the "debates" about "fixing" Medicare, perhaps a quick recap is still in order.

To satiate the "cash appetites" of not only Republicans who worked for Big Pharma, but also a fair number of Democrats who would have very much liked to have exactly the same very lucrative "part time jobs" -- Democrats such as Senator Baucus -- an ideological "cap" was placed on the Part D legislation when it was being passed at 3 AM in the House of Representatives, sliding along on a rancid wave of under the counter checks and over the counter arm twisting. (Ezra Klein/Washington Post story here.)


That "ideological cap," a precursor to Palin's famous "death panels" under a different name, set out the rules for using the Part D benefit.  Each year,  Medicare will only pay the insured part of pharmaceuticals up to a certain point.  When that point -- $4800 -- is reached, Part D simply quits paying until a much higher point is reached -- in the cases when the Medicare recipient somehow survives the "doughnut hole" -- then, the shattered, bankrupt Medicare "parasite" is once again covered under what is termed as "catastrophic coverage."

Of course, by that time, it is precisely the coverage which has become catastrophic, not the illness.

Dorothy in the Wizard of Oz would musically call this place "somewhere beyond the doughnut hole."

So, as MeanMesa was reviewing the monthly costs paid by Medicare Part D on the statement, something quite peculiar appeared there.  It was the insured portion of the cost of the Desonide lotion.


Yikes!  At that price, MeanMesa's doughnut hole was galloping towards a show down a long time before the end of the year arrived and the Medicare Part D coverage could be "reset" for another year.  There were, after all, some other important medications which had to be procured under that pre-doughnut hole Medicare coverage.

Of course, even though the Desonide had been very effective, MeanMesa decided to not further torpedo the already dwindling pre-doughnut hole balance shown on the monthly Part D statement balance.  The hands and arms would just have to suffer through it.  $235 was simply too much to pay for the relief.

Move the calendar ahead a few months.

Now, hands still itching and peeling, it is nearing the end of the "Part D Year."  Because every reasonable economy had been put in place through out the year, MeanMesa finds November's Part D balance to still be a ways shy of hitting the doughnut hole!  In  fact, there is enough coverage left to at least consider taking a risk and re-filling the Desonide prescription. 

The prospect was that the Medicare Part D balance could handle one last, $235 prescription refill since there was only a month left in the current Part D period.

MeanMesa called the pharmacy to refill the prescription.

However, when it was time to pick up the prescription, there was more bad news.  The pharmaceutical company which makes Desonide had quit making the little bottles of lotion.  The nice pharmacist, however, offered up an alternative.  He told MeanMesa that Desonide was still in stock and available as an ointment cream.

All that would be required was to get the prescribing Medicare doctor to change the prescription with the pharmacy.  Cringing, MeanMesa sheepishly asked the Pharmacist what the alternative Desonide prescription would cost.


The $17.00 Desonide Cream works great.  MeanMesa's hands have not only quit peeling, but MeanMesa's Part D doughnut hole is also not yet chomping at the front door of the Galactic HeadQuarters like the vicious wolf licking his cops for one of the Three Little Pigs.

The Point

The point is simple.  All across the country stories similar to the Desonide tale are unfolding daily.  There is simply no telling how many zillions of Medicare dollars Big Pharma is sucking through its straw like a strawberry milk shake on a hot afternoon.  Here's the point.

Universal single payer health care.

Enough said.  We're waiting.

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