0701 - Meds

In social chit-chat, pills and pains are popular subjects, and since politicians love to be popular, they too talk about drugs, medical care, and a lot of other subjects they don't know much about. Among the OO Staff, pills are also a leading subject, and as usual, we have complaints. Start with a simple matter: the pill names. Surely you know that all drugs have two names in the United States: the trade name, say "Plavix"and the supposed chemical name ,"Clopidogrel". The trade-named drugs, if still under patent, are wildly expensive in the U.S., but when off-patent become quite cheap – after all, they are then just chemicals. On Anguilla, close to French St. Martin, you can take the ferry to buy French-named drugs, which of course also have a French chemical name. The hospital pharmacy here sells some off-patent drugs, cheap, but not a lot of the fancier patented drugs. Life is not always simple on Anguilla.

In France, and elsewhere, the citizens get drugs quite cheap, and in the States, if you are lucky enough to be over 65, they have added what is called Medicare Part D. The Part D procedures, like the U.S. tax laws, are wildly complex. To add to the complexity, and to avoid cries of "Socialized Medicine" everything under Part D is handled by several levels of public and private bureaucracy. The Feds of course register you under Part D and give you a card. You pay a flat fee for Part D "coverage", which is subtracted from your Social Security coverage. Then, you go to some organization (the OO uses AARP), which for a fee sells both supplemental Medicare coverage ("Part B") for procedures, and Part D Supplemental coverage, separately. But, AARP, a non-profit organization, hires United Health Care, another giant private "provider" to deal with druggists and generate computer records. The hapless over-65 patient then goes to a drugstore – Walgreens has it down pat – to actually buy the drugs, deal with United Health, and start the chain of computer records up to United and the Feds.

In France, and elsewhere, the citizens get drugs quite cheap, and in the States, if you are lucky enough to be over 65, they have added what is called Medicare Part D. The Part D procedures, like the U.S. tax laws, are wildly complex. To add to the complexity, and to avoid cries of "Socialized Medicine" everything under Part D is handled by several levels of public and private bureaucracy. The Feds of course register you under Part D and give you a card. You pay a flat fee for Part D "coverage", which is subtracted from your Social Security coverage. Then, you go to some organization (the OO uses AARP), which for a fee sells both supplemental Medicare coverage ("Part B") for procedures, and Part D Supplemental coverage, separately. But, AARP, a non-profit organization, hires United Health Care, another giant private "provider" to deal with druggists and generate computer records. The hapless over-65 patient then goes to a drugstore – Walgreens has it down pat – to actually buy the drugs, deal with United Health, and start the chain of computer records up to United and the Feds.

You will note that you now have four bureaucracies dealing with your pills: the Feds (Medicare), AARP, United Health, and Walgreens. The different drugs cost you, out-of-pocket, different sums at varying times of the year, starting with varying "Tiered" costs, but when the drug costs are over US$2,400 (it's easy), you are in the "Gap" and must pay all cash for a while, but then when you have exceeded $3,850 out of your pocket, what you pay is very little. All this avoids evil "Socialized Medicine", although the layers and layers of administration must be quite expensive, don't you think? Do not try, though, to become a drug importer from some country, say Canada, that buys its patented drugs cheap, as the U.S. does not, although you might think they'd get a nice price. That is illegal because, the Feds say (but we do not believe) that imported drugs from Canada may be dangerous. Somehow, free trade here is bad.

We have on file a huge stack of publications about all this tangle of paperwork, yet the foregoing information is not guaranteed. It's too complicated to explain what they call "TrOOP" [did you ever see a worse acronym? – it means "Total true out-of-pocket costs"]. We will also only mention that you must re-order yours meds every three months because you can only get 90 days of pills at a time. Who knows what is supposed to happen in months that have 31 days. Also, on the political side, the future costs of Medicare, both for Part B and Part D, are growing wildly. Why? Well, it seems that all this drugging is extending the life span, although the smokers and morbidly obese are bravely fighting the trend. So, big pharma lobbyists are alerted to political dangers, and at least 18 prospective U.S. Presidential candidates are talking health care, although we suspect they don't know much about it. So stay well.

Next time: Manuals [OO #702]

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