The Past Comes Calling

Today I will begin with a bit of background. My mother died of ovarian cancer that invaded both her colon and her bladder. The colon 'fix' was a colostomy. To 'fix' the bladder a surgeon went through her back and surgically inserted a tube directly into each of her kidneys. The tubing was brought together into a Y that joined a central tube that drained into a catheter bag. We cared for her in our home and she died there. My father did not thrive after her death. Six months later we again called for delivery of a hospital bed, and home health nursing. It was back to a catheter, and for him it was diapers. He died seven months later, also in our home.

I almost never let those memories out of the space I've kept them locked all these years but last night Bob opened the door and let them out.

I suppose he'd been thinking about those days, and wanted to talk, I did not. It may have been good for him but it was not good for me. I did not sleep well at all after our talk.

I can't let my mind go there. If I do I'm going to be no good to either of us. I must focus on one day at a time. I so hope neither of my children have to have this experience with me but we don't get to choose how our lives will end.

There are a few things I learned from my mother that I hope I can remember.

1) Always be pleasant and express appreciation to caregivers. They're doing their best and dealing with a grumpy,  complaining patient is not the treatment they deserve.

2) Keep current in what's going on in your community and the world. Don't let the world pass you by.

3) Mother was completely housebound the last 15 months of her life but she continued to have visitors every day of that time. I decided it was because she never talked about herself.  She was interested in those who visited and wanted to know what was happening in their world.

She was a little vain and didn't want her visitors having to look at a catheter collection bag hanging on the side of her chair. I bought pastel gingham check quilted fabric, eyelet edging, and some velcro. I made myself a pattern and sewed some bags to cover that bag. She could just drop her catheter bag into one of those bags and close the top with velcro and no one saw anything but a cheerful gingham bag. I was the only person that knew all the horrible things that went on under her clothing. 

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Yesterday I finally got time to write a nice review of our ER experience on YELP. I've mentioned before that hospitals now receive some funding based on good reviews from Medicare patients. Unfortunately people are much more likely to write a review if they're unhappy than to write one when they're pleased. It's a small thing I can do to say thank you to our hospital system for the good service we receive in their ER.

We feel very fortunate to have Medicare and good insurance.  We're also very grateful for the provisions of the Affordable Care Act.

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On the subject of 'Obamacare,' let me say just a word. If you've been led to believe it's going away, put that thinking behind you. I think all Republican candidates as well as Republicans in Congress continue to say they will repeal Obamacare, not. 

Very recently I took the time to research what it would take to repeal it. First, they have to get a Republican in the Whitehouse!  Given that, it can be done, but the chances of Republicans being able to steer that very narrow path is indeed slim, very slim. But let's pretend they accomplished the path to repeal it, they have no plan to replace it. Obamacare has been the law now for six years. In that six years Republicans have repeatedly voted to repeal it. All votes have failed. Wouldn't it have been better use of their time if they'd looked for ways to improve it?  Nobody thought it was a wonderful plan when it went into law. Every lawmaker has a choice to help in making it better or continue the futile effort of repealing it.

Finally, if Republicans reach the goal to repeal it, their party is in shambles. In six years they've been unable to agree on a plan to replace it. What makes you think they will come together now in agreement?

Frugal Healthcare

There are many blogs today about living frugally.  Do you ever hear anyone talk about spending healthcare dollars frugally?  Not a word.

At our house we have excellent health insurance and almost never have any healthcare expense.  It worries me when that happens to people because I'm of the old school that people don't value what costs them nothing.  Perhaps I am the exception.  I cringe at all the waste I see everytime I'm in a clinic or the hospital.

How about Medicare?  Spend those Medicare dollars you say.  Not me.  I have a chronic condition that lands me in an Urgent Care Clinic about every three to four months.  I don't know what that costs but I figured there had to be a cheaper way.  I set about to come up with a plan.

Why did Medicare and my insurance company need the expense of me visiting an Urgent Care Clinic when I knew, my doctor knew, and the Urgent Care Clinic knew what the problem was.  All I needed was a prescription.

I decided to approach my doctor about allowing me to keep on hand the prescription I needed, give me a limited number of refills and cut out the expense of the Urgent Care Clinic.  He agreed.

Have you noticed how wasteful hospitals and emergency rooms in particular are with supplies?

An elderly family member was recently prescribed a back brace that was terribly expensive.  She will never wear it.  It was a waste of Medicare dollars.  The doctor should have been smarter.

No wonder healthcare expense is out of control but if you said the word frugal in the same sentence with healthcare people would go all Sarah Palin on you.  Frugal doesn't mean cutting quality, it means cutting waste.

Let's hear it for frugal healthcare dollars!

Prescription Drugs Price War

The cost of prescription drugs is a big issue in providing healthcare in America.

"The chief medical officer, Steve Miller, at Express Scripts, the largest pharmacy benefit manager in the U.S., has been essentially auctioning off his 80 million customers to the drug companies that will give him the best deal.

Express Scripts and its rivals including CVS/Caremark and OptumRX manage prescription drug coverage for insurers and employers.  They're trying to spark price wars among drug makers by refusing to pay for some brand-name medications unless they get a big discount.

The result is that average costs for many drugs are falling.  At the same time, consumers are being forced to change medications, sometimes to brands that do not work as well for them."

This year more than half of all patients will have a prescription excluded from coverage.

"Express Scripts pioneered a strategy two years ago, when it announced it would no longer pay for 48 brand-name drugs.  Right out of the gate it took on some big-name products, such as Advair - the blockbuster asthma drug made by GlaxoSmithKline, now known as GSK."

"Advair's price had risen more than 20 percent in 2013... Then on Jan. 1, 2014, Express Scripts tossed Advair off its drug list and moved its customers to rival asthma drug. Symbicort."

"The results were immediate.  Sales of Advair dropped $1.8 billion that year.  The prices of both Advair and Symbicort fell 20 percent in 2014 and are still falling.  Advair was restored to Express Scripts' formulary last year."

What would you suggest is the best way to bring the cost of prescription drugs down?

Medicare vs VA Drug Formularies

Well rats, the Republicans are having another tantrum, this one involving the president's proposed budget. I'd like to call your attention to a few things that affect senior citizens that they're refusing to consider.

The Center for Medicare Advocacy laid out the impact the president's proposed budget, if passed, would have on Medicare drug policies.  I'm using the short version posted on Time Goes by.

~ Restore drug rebates for brand name and generic drugs to beneficiaries who do not receive the Part D Low -income subsidy (LIS)

~ Greater transparency in drug pricing

~ Negotiate prices with drug manufacturers for biologics and high-cost prescription drugs covered under Part D.

~ Close the Part D doughnut hole in 2018 - two years earlier than under current law.

This NYT article, titled "The Reason Medicare is a Lousy Drug Negotiator" is worth reading.

"The real problem is that Medicare can very rarely say "No way" to a drug company.  Medicare beneficiaries wanted the program to cover most drugs that older people would want to use.  So Congress put in place rules that strengthen the hand of the drug companies in negotiations."

"The government does have one program that can say "no" to drug companies, and it gets much better deals than Medicare.  The Department of Veterans Affairs negotiates hard with drugmakers. But it is also bound by fewer rules than Medicare, and one result is that it covers far fewer drugs."

From personal experience we have found the drug formulary for the military to be very different from the formularies of Medicare and private insurance companies.

Last year when Bob's twin was dying he needed a drug that was prohibitively expensive, more than $5,000 a month.  It was not covered by Medicare or his insurance company.  Fortunately he had served in the Navy and qualified to go to a veterans hospital.  He got the drug there for free. What if it had been his wife that needed that drug, where would she have turned for help?

I find all this troubling.  How about you?

Obamacare Meetings

A few months ago I received a phone call asking me to meet with a group of medical providers, hospital staff, and patients to discuss the Affordable Care Act's requirements and how they were being implemented by our community hospital.

As you can imagine I found that exciting and it was more fun than I could ever have imagined.  We meet every three months to discuss different issues and hear a report on the progress made on prior issues we've discussed.

This is education in the fast lane for me.  It gives me a chance to see the Affordable Care Act through the eyes of the hospital and what they're doing to meet the requirements.  Very interesting.

I get to see through the eyes of clinic and hospital staff the issues they're dealing with every day.  Many of those issues have nothing to do with the Affordable Care Act but the discussion then turns to anything in the Affordable Care Act that might help in managing those issues.

And, I get to hear other patients experiences, some good and some bad.

In March we will discuss patient medications.  Oh my, what a nightmare.  I can promise you no solutions will come from that meeting but we'll gnaw around on the topic for a while.

The Affordable Care Act is an enormous piece of legislation with so many pieces it would be impossible to put the puzzle together to see the whole picture.  I know of no one who thought this legislation was all that it needed to be at the time it became law.  It's a working piece that will hopefully become better with time.

It's in everyone's best interest if we work together to make healthcare work in this country.  When I see congress voting as many as fifty times to repeal this legislation I get angry.  The reason I get angry is these people know when they call these votes that their vote will be vetoed by the president and they don't have the votes to override his veto.  Wouldn't it be smarter to spend their time looking for ways to make the current legislation work better?  Healthcare should not carry a political party label.