Ground Control to Major Tom. We’ve discovered a new medical loophole.
According to my TV Set (so it’s gotta be true!) there is a new medical billing loophole in town.
A new commercial for the “CPAP Care Club” is telling Sleep Apnea patients that, with Medicare and Commercial insurance, they can get new masks and tubing for their CPAP machines every 90 days. And shipping is free.
Now, I’m not saying that Sleep Apnea patients don’t need a new mask every 90 days – I don’t really know. All I’m saying is if they’re advertising the fact that people can get a new setup every 90 days on television, somebody is making a boatload of money on these masks.
You see, advertising on TV is very expensive, and the relative number of CPAP users is relatively small when compared to the general population. Yet, in spite of this, they are advertising these masks on TV – and you can bet that they are not losing any money. Ergo, the profit margin on these masks must be incredible.
It also means that the American medical consumer – you and I – are helping to pay for these overpriced pieces of plastic.
So now sleep apnea masks have joined the power wheel chairs and disposable catheters as the latest medical products that most people don’t use but are still heavily advertised on television. As I’ve often said, if you want wasteful spending and medical insurance abuse, just turn on the TV.
Hmmm…disposable catheters and CPAP masks. Maybe Mr. McGuire from the movie “The Graduate” was right – the future is plastics!
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I recall watching the old black and white ‘Lassie’ TV serial as a kid. I also remember being bored by it even as a youngster.
You see, even as a youngster I realized that the show’s writers were lazy. Practically every show followed the same old contrite formula:
Little Timmy would go out exploring on the Family Farm with his sidekick, Lassie the Dog.
Little Timmy would fall down an old well (or abandoned mine shaft, or into an old cave – whatever) and break his leg. Because he was injured, and out of plain sight, he had no hope of rescue. Egads!
In a flash of inspiration, Timmy would send Lassie to ‘Go get help!’
Meanwhile, back on the farm, Mr. & Mrs. Miller, Timmy’s adoptive parents, were getting worried – it was getting dark outside, and Timmy and Lassie were no where to be found (‘It’s not like him to stay out so late – I’m getting worried’ Timmy’s mother would lament.)
Timmy’s father would go looking for them, perhaps with some neighbors and farm hands, but they would always return to the farm empty-handed. Timmy’s mother would burst into tears.
Meanwhile, back in the cave, Timmy would either shiver in the cold or whimper in pain. Sometimes he would do both.
Cut to stock footage of Lassie running through farms and fields. Sometimes she would be waylaid by some angry farmer or overly earnest dog catcher, but she would always escape and make her way back to the Martin farm.
Lassie would burst into the farmhouse and communicate, nonverbally, with Timmy’s parents as to the whereabouts and medical status of their adopted son. (What is it girl? Is it Timmy? He fell down a well? He’s hurt?)
Lassie would tug on someone’s pants leg. Somebody else would state the obvious – “Why, I think she wants us to follow her!
Lassie would lead them to Timmy. Timmy’s dad would carry him back to the farmhouse. The kindly old town doctor would arrive in his horse and buggy and set Timmy’s broken leg. “He’s going to be just fine!” he would announce after leaving Timmy’s bedside. Timmy would be lying in his bed, hugging his beloved dog saying “You saved my life, girl! I love you so much!”
Fade out to a commercial for some toy that was later recalled as a choking hazard….
The same old plot – week after week.
LASSIE FUN FACT #1: Timmy’s TV Mom was originally played by famous funny girl Cloris Leachman (aka Frau Blücher – whineaaaaaaa!) Cloris left after season one due to a contract dispute.
LASSIE FUN FACT #2: Timmy’s second TV Mom was played by June Lockheart, who later went on to play another TV Mom, June Robinson in ‘Lost in Space’. While this T series was arguably much more successful than ‘Lassie’, at least the ‘Lassie’ show had a decent family pet – a nice collie dog instead of Bloop, the space chimp with the bad wig and funny ears. No one ever accused ‘Lost in Space’ of being over produced.
LASSIE FUN FACT #3: The animal actress that played ‘Lassie’ was actually a female. Somehow, I always thought the collie was a male. Who could tell, between those tiny B&W screens and all of that collie hair?
Well, recalling these old Lassie shows, I have now come to realize how lucky Timmy was. Not just because he had such a great dog, but because he broke his leg on the family farm and not in New Jersey. Let me explain.
In a recent letter that I received from my auto insurance company. it was stated that the average fee billed for fixing a broken leg injured in an auto accident in New Jersey was well over $17,000. Medicare pays less than $2,000 for the exact same procedure. While we must accept that Medicare’s tightly controlled fees are usually less than a physicians regular fees, we need to ask ‘why do doctors charge 900% more to fix a leg that was broken in an auto accident?’
The simple answer is, they can. You see, unlike most medical procedures performed on auto accident victims, the repair of a broken leg is not covered by the State’s predefined fee schedule. As a non-scheduled item, doctors can charge whatever they want for repairing a broken leg – and they do. They look at this as a loophole in the NJ Auto fee schedule – they may have to accept lower than normal fees for treating auto accident injuries for the services that are on the fee schedule, they can make up some of the difference by charging much higher fees for non-schedule procedures.
This is the NJ medical communities version of the infamous $640 toilet seat and $436 hammer. The problem is that doctors have to charge the same amount to their regular patients as they charge the auto insurance companies for these non-scheduled procedures. Which means, if you’re not a member of an HMO or on Medicare, you’re going to be charged over $17,000 to fix your broken leg in New Jersey.
For the poor Martin family, this is probably more then their old farm was worth back in the 1950’s. (With the current state of Real Estate, it definitely is more than the farm is worth today!). Which means that the Martin’s would have been faced with a very difficult decision. Faced with losing their farm, they would have most likely been forced to shoot the dog to keep her quiet, and leave poor Timmy to rot in that well.
Like many families today, they would have been forced to make a medical decision based upon purely fiscal reasons.
And, like Lassie, that’s really a bitch.
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Ten Tears After was one of the great classic rock bands of the 1970’s. Featuring the work of ‘the world’s fastest guitarist’, Mr. Alvin Lee, they delivered some of the most seminal music in the early days of classic rock.
Even if you don’t recall this band, I’m. sure that you’d recognize several of their classic rock anthems, most notably “I’d Love to Change the World”:
I’d love to change the world, But I don’t know what to do, So I’ll leave it up to you.
This was a great sentiment back in the 1970’s, but today, September 11, 2011, ten years after that awful day, it’s an empty phrase. An anachronism. A silly folly of yesteryear. Because we all realize, on this day, ten years after, that if we leave the world’s problems up to others to solve, the world has a way of biting us in the ass. We have come to realize, that if it is to be, it’s up to me. Whether the problem is world peace, the economy, or the health care crisis, we can’t just sit around waiting for someone else to solve the world’s problems.
Many people are wondering how they will commemorate this ten year anniversary. Many of us will watch the ceremonies at Ground Zero on television. Some will be attending local tributes. But I decided to do something different.
Today I'm going down in the basement and digging through my old LP's. No, I’m not looking for my ‘Ten Years After’ album. Instead, I’m going to pull out my well worn copy of Elvis Costello's 'Armed Forces'. Then I’m going to listen to it at much too loud a volume for a man my age.
Back in college, that was my roommate Steve's favorite album and we would blast it often on our other roommate’s monster stereo.
Stephen J. Fiorelli was one of the nicest guys that I have ever known. In a University apartment of four wild post-adolescent males, Steve was always the voice of sanity and reason. He had a slightly off-center sense of humor that melded with my own. Steve was a true gentleman in every sense of the word – just one helluva nice guy.
After that semester, Steve and I managed to keep in touch. I remember our last day together. I had just moved into my first off campus apartment, and Steve, now graduated, came back to New Brunswick for a visit. We spent a memorable afternoon hanging out, drinking beer, and listening to music. Steve was excited, as he had just landed his dream job as a civil engineer for the Port Authority. Sadly, I never saw Steve again after that day.
I often rue the fact that this was before the days of Facebook. I’m almost certain that Steve and I would have reconnected. But it was never meant to be.
So, today, ten years after that awful day, I will repeat our college ritual, featuring Mr. Elvis Costello, some big ‘ol tower speakers, and 100 watts per channel.
Ten years after the day that Steve went down in Tower One.
I know that Steve will be listening with me.
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I’m well into my 50’s, and I take 4 prescription medicines on a regular basis. I have a prescription plan, and I try to stick with generics whenever I can, so my monthly outlay for prescription drugs isn’t all that terrible. Sadly, the same thing can’t be said by many of our Senior Citizens.
I was working in a practice recently, and they told me that many of their older patients have as many as 25 different prescription medicines. Wow.
While I found this rather shocking, it did answer several questions that were nagging me. First of all, I now know why many restaurants offer smaller sized portions for seniors. After taking all of their pills, they probably have very little room for food in their stomachs.
The second mystery (now solved) is why old ladies carry such humungous purses. All those meds must take up a lot of room.
Who knew that Big Pharms influence reached into the hospitality and the fashion industries? I think that I smell a conspiracy here. Or maybe that perceived smell is just a side effect from one of my meds.
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I thoroughly enjoyed a beautiful couple of days on the Atlantic City beach this past week. While it’s now world-famous (or perhaps infamous) for its casinos, there was a time when Atlantic City was famous for its beaches.
Not so long ago (before it descended into the post apocalyptic wasteland that it became in the 1970’s), AC was a favorite seaside destination for my family. I gleefully recall the long trips in my aunt’s blue 1964 Impala down to that mystic city.
Long days on the beach were followed by nights walking the famous boardwalk. I remember the original Steel Pier, the Million Dollar Pier, the Diving Horse, and Mr. Peanut himself hawking his wares.
But, perhaps, the thing that I recall the most clearly were the agonizing trips back home, where my siblings and I, burnt red as lobsters, squirmed and jockeyed to find a comfortable position in that un-airconditioned Impala. A few days after our seashore excursion, our skin would blister and peel off in long sheets and strips.
You see, boys and girls, in the 1960’s, we didn’t use sunscreen. Instead, we used suntan oil, that would magnify and focus the UV rays for maximum impact. Who cared about skin cancer back then – after all, the missiles from Cuba were going to be the death of us all. Let ol’ Sol do his worst.
Today, of course, I slather myself with SPF 50 before venturing out onto the sand. After all, I now know better. Too bad the damage is already done.
Coincidentally, watching the evening news in my hotel room, I was pleased to hear that the FDA had just approved a new drug for treating melanoma. This new miracle drug from Roche, Zelboraf, is particularly effective for patients with certain types of metastatic melanoma. The drug inhibits the cancer-spreading action of a particular gene, which is present in about half of people with metastatic melanoma.
This is, of course, good news for many melanoma patients. The bad news is, unfortunately, this wonder drug costs $9,400 a month (just a smidgeon over $300 a day). For that much money, you can get a beautiful oceanfront suite at an Atlantic City casino. Even if you have health insurance with prescription drug coverage, you’re going to have a tough time getting them to fork over that kind of money every month on your behalf. And most folks would have a tough time (nay, an impossible time) to come up with that kind of scratch each and every month. Even some affluent individuals would have to make sacrifices in order to cover their monthly Zelboraf tab. Conceivably, many will have to sell their pricey shore residences in order to finance their treatment…now isn’t that ironic?
This all begs the question “why does Roche charge do much for this wunder drug? Like the old joke “why does a dog lick his own privates?”, the answer is simple – they can. As the only game in town, patients can now choose the financial misery of Zelboraf or the medical misery of skin cancer.
I guess most of us will have to wait patiently for some competitive products to be approved, or for a generic form of Zelboraf to be released. On that glorious day, the only cancerous mass at the Garden State’s Seashore will be the low-life New York youth that star in a certain television reality show.
Sadly, there doesn’t appear to be any drug on the horizon that will eradicate that particular disease.
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The SR-71 Blackbird remains the most sophisticated aircraft that the US Air Force ever flew – at least that we know about.
Until it was retired in 1998, the Blackbird spy plane was the fastest thing in the skies. It still holds numerous air speed records, and, at least on one occasion, flew coast to coast in just a hair over an hour. Top that, Southwest. Most experts say that the SR-71 most likely flew even faster than that, but, nearly 15 years after it’s retirement, its top speed remains classified.
Because of the extreme speeds it flew, everything on the plane was designed to deal with the heat that was generated from friction between the airplane and the atmosphere. It was said that the engine oil in the Blackbird, at over $200 a quart, costs more then the finest Scotch Whiskey. Such high operating expense was one of the primary reasons why this super spy plane was retired in 1998.
The SR-71 allowed the US to keep a close eye on our enemies during the Cold War, and there is no doubt that it was instrumental in bringing that terrible phase in world history to an end.
Thank goodness that the engine oil for the SR-71 wasn’t manufactured by the US Pharmaceutical industry – if it were, the Blackbird probably would have ever gotten off the ground.
Tonight, I picked up some prescription eye drops. Even though I have a prescription plan, a 2.5 ml bottle of these drops still cost me a ridiculous $35.00. Yeah, I know that $35 is not a ton of money these days, but this was for a TINY bottle. At this rate, the eye drops cost around $13,250.00 a quart – and that’s with a prescription plan. If I had to pay full price for the drops, the best price I can find on-line was $91 for the same 2.5 ml bottle.. This translates to an outlandish $34,500.00 a quart. Even worse, this is for a .01% solution. So, if I paid retail price for the active ingredient alone, that quart of ‘pure’ eye drops would have set me back almost 3 ½ million dollars a quart.
Which makes the SR-71 engine oil – or the world’s finest Scotch Whiskey – seem like a real bargain after all.
Which is a good thing. After figuring out what these prescription drugs are actually costing us, I think I’m going to need a stiff drink.
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