Bizarro #8 – Sy Syms

Remember SY Syms? He was the clothing magnate who used to advertise on TV with the tagline ‘an educated consumer is our best customer’.

I never understood what education had to do with discount double-knit polyester leisure suits, but ‘ol Sy sure used to move a lot of schamtas, so I’m certain there’s some correlation.



Sy understood that we’re a nation of consumers. He understood that we love a bargain. And that we want to get the most for our money. Most of us have learned (the hard way) the dangers of being an uninformed consumer.





I remember back in the 1970’s when my brother needed to by a new car. He came across a unique model neither of us have ever heard of before – a British model called an Austin Marina. It was a late model with low mileage and in excellent condition. The only defect was a dent in the roof above the driver’s door. Try as we might, we could never figure out how that dent got there. Well, the price was too good to be true, and my brother became the car’s new owner. Over the course of the next 3 weeks, the car broke down 4 times, costing my brother in repairs close to what he paid for the car. The fourth and final breakdown so agitated my brother that he got out of the car, swore, and slammed his fist down on the roof – dead center of the existing dent. Mystery solved.

Of course, nowadays, with the internet, he would have never have made the mistake of buying that lemon. A quick google of ‘Austin Marina’ shows that the car is universally recognized as a lemon. The British Automotive show ‘Top Gear’ has named the Marina ‘the worst car ever made’ and has taken glee in destroying a number of them on camera over the years – most notably by dropping a piano on them. In the 1990’s, it was determined that less than 1 in 1,000 Marinas ever sold were still on the road – making it the most scrapped car in British motoring history. Expensive lesson learned.



For many of us, even before the internet, the magazine ‘Consumer Reports’ has given us the tools to be an ‘educated consumer’. Their monthly product reviews and annual buying guides help us determine everything from what car to buy (or not to buy) to what is the best coffee maker or toaster oven. Many Americans read their publications religiously and depend on their expert reviews to make informed buying decisions.



The bizarre thing here is that few of us put as much research and effort into our health care purchases that we do when we purchase a new vacuum cleaner.

Fortunately, the good folks at Consumer Reports are out to change all of that. They recently published a report on prescription drugs and published it online for all to see. Everyone who takes prescription meds should check out this particular report – it’s a real eye opener:


http://www.consumerreports.org/health/best-buy-drugs/best-buy-drugs/generic-and-brand-drugs/index.htm



With Big Pharm spending close to 11 billion a year in advertising to consumers and physicians, it’s difficult for anyone to get unbiased information on the relative benefits of various prescription drugs – until now. Consumer Reports web site has let the cat out of the bag – and what a cat it is. It turns out that many so-called ‘generic’ drugs (that Consumer Reports have re-labeled ‘Best Buy’ drugs) are not only just as effective as their name brand counterparts. In some cases, these ‘Best Buy’ drugs are even more effective then the new name brand formulations that cost 50 to 75 times as much. As a further insult to Big Pharm, ‘best Buy’ drugs are also usually much safer than the new name brand meds. Their data is based on US Government reports and not on reports that were financed by Big Pharm.



If most Americans were to become ‘educated consumers’ and switch over to ‘Best Buy’ meds, we could make a real dent in the cost of health care. So if you take any prescription medications, be sure to read over Consumer Reports fascinating web site, and then discuss your findings with your doctor on your next visit. A few minutes of research might save you serious money. It might even save your life.









Just tell your Doctor that Sy sent you.






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Bizarro #7 - Goodfellas

Thanks, Hollywood.

Because of your obsession with organized crime, most Americans are intimately familiar with the world of organized crime – even those who live in North Dakota.

Over the years, ‘Mafia’ movies are perennial favorites with the American moviegoer. Such classic films like the Godfather trilogy, Goodfellas, Once Upon a Time in America, Casino, and my all time favorite, My Blue Heaven have given us a an immersion into the life of American Mafioso.

Not to be outdone, the small screen has contributed to our national obsession with such classic series such as ‘The Sopranos’ and ‘Boardwalk Empire’. The History, Discovery, and Biography channels also contribute their fair share of Mafia inspired reality stories.

Fortunately for me, being raised in Northern New Jersey, I was never subjected to the real thing . RIP, Tony Pro.




Most of us are familiar with the modus operendi of the American mob. Gambling, Robbery, extortion, and prostitution were all major revenue streams for the 20th century mobster. However prevalent these activities were, however, the classic mob fundraiser has always been the ‘Protection’ racket.

The way ‘protection’ works is simple - If you don’t want your small business to suffer from broken windows or worse, you would pay your local mafia soldier a weekly stipend to ‘protect’ your business interests. An ‘unprotected’ business also suffered because legitimate customers were fearful to patronize the establishment, as they might be subject to some form of retribution themselves for doing so.




Thankfully, law enforcement has worked tirelessly over the past century to help eradicate this type of “strong arm’ behavior.

Today, the world of ‘Protection’ schemes is mostly limited to the silver screen…and your doctors’s office.

Yes, health insurance companies utilize many of the same threats that mustached Pete’s used to employ in their protection schemes. Sure, they don’t send a few goons to an office and have them crack a few heads (that could potentially result in some unwanted and expensive neurosurgical claims to process – and they certainly don’t want that) but they do employ many of he same fear tactics in order to get providers to join their networks (and accept lower fees).



Thirty years ago, when manages care plans were first being marketed, physicians were urged to join the networks in spite of the lowered compensation that they offered. “Soon everyone will have this type of insurance” they were told. “If you don’t join our plan, you soon won’t have any patients”. Many physicians fell for this line, and soon afterwards the hold outs started following them as they grew fearful of being left out.





Like the Mafia itself, these physicians soon discovered that, once joined, these networks were almost impossible to get out of. Leaving a plan would mean losing a significant chunk of their patient base all at once as these patients would switch to an in network office in order to avoid the high out of pocket expense of “out-of-network” benefits. Like a small businessman beholden to a Godfather, these in network offices were forced at accept an ever-growing list of demands and compromises from these carriers lest they get dropped from a plan.




This scenario was especially true of primary care physicians. Sub-specialists could normally survive leaving a network (or never joining one in the first place) especially if they were the “only show in town”.

I worked extensively with one such sub-specialist who never joined any insurance networks. He was constantly barraged by different insurance plans, all cajoling him to join their networks. When he refused, they would always act incredulous at his audacity. As time went by, these same companies would make his business more and more challenging as they would underpay or even out rightly deny claims for out of network benefits. It soon became a full time job to collect on these out of network claims. We would have to make numerous phone calls and write threatening letters to the carrier. At one point Horizon Blue Cross decreed that they would no longer accept letters of phone inquiries regarding claims from out of network physicians. If the patient was deceased or incapacitated (as was often the case with his office) there was nothing that you could do with the carrier to collect on a claim. Often we would enlist the aid of the state medical society and the Department of Insurance to intercede on our behalf. Often we would be forced to hire a well known law firm to handle our collections from these carriers. It would often take years to collect on a simple claim.

While they didn’t employ goons carrying baseball bats or ice picks, these were nonetheless strong arm tactics used by these companies to threaten the doctor and to get him to ‘play ball’.




I think I know why you can’t buy Blue Cross insurance from an out of state plan – doing so would violate the RICO Act.

If an Italian-American businessman tried to use these same tactics with his customers, he would end up on trial racketeering charges. Yet, we allow our health insurance companies to use these fear and intimidation tactics without any retribution.




Tony Soprano types used to claim that they were in the ‘waste management’ business. Today, it wouldn’t surprise me if they say that they are in ‘health insurance’.

Bizarro.

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Bizarro #6 – Back Seat Drivers

Your Mama's yappin' in the back seat
Tell her to push over and move them big feet
Every Monday morning I gotta drive her down to the unemployment agency
Well this morning I ain't fighting tell her I give up
Tell her she wins if she'll just shut up
But it's the last time that she's gonna be riding with me

---Bruce Springsteen - "Sherry Darling"

EEEAAAHHH! What is worse than a back seat driver? How about a back seat driver that doesn’t know how to drive?

MYOB – or mind your own business – is a concept that most of us have been familiar with since an early age. AKA ‘don’t stick your nose where it doesn’t belong’, it’s a fundamental part of polite society – and generally accepted good business practice.

As a hypothetical example, imagine planning a family vacation to Disney World. With cash being tight, you decide that you will have to save money somewhere in order to pay for those $6.00 frozen lemonades and for those pancake breakfasts with teenagers sweating profusely in heavy costumes that they can’t see out of.
So, instead of forking over $1,500 to Continental (and running the risk of your four year old being subjected to a full cavity search), you decide to pack up the family truckster and drive down to God’s waiting room.






You call the Auto Club and get a trip itinerary, detailing the best route to Orlando. However, the night before your departure, you get a call from your Auto Insurance Company. It seems that they have gotten wind of your trip itinerary, and didn’t like the fact that you were planning to take Route 95 all the way there. It seems that there is a slightly higher statistical risk of getting in a fender bender on the interstate. In the name of saving money, they are demanding that you drive down to Florida on Route 1 instead. Sure it’s going to take twice as long in a car filled with bored and vocal children, but they insist that everybody has to do their part in keeping Auto Insurance affordable.



But it doesn’t stop there.

They also start dictating where you’re going to stop on your road trip.

So you were thinking of visiting Pedro at South of the Border and picking up some sparklers for next year’s Fourth of July? Not so fast – they want you to stop at Big Jimbos’ Discount Fireworks and Roadside Museum – home of the world’s largest gallstone.



You were planning a stop at Stuckey’s to pick up a nice nut log for Grandma? Nope – they want you to buy her some hard candies at 76 truck stop.




Your kids are hungry and want McDonalds for lunch? Sorry, your auto insurance company insists you dine at Bojangles instead. They’ve even picked out the menu for you (you say that you don’t like fried chicken? Too bad. What size pop you want with that? You want that tea sweet or unsweet?)




Of course, this is a ridiculous scenario. No one would tolerate this behavior from their car insurance company. After all – they are just an insurance company – how dare they try to tell you how to run your life? Or to ruin your family vacation?

However, this is exactly the type of rude behavior that we put up with in the world of health care. In fact, we’ve grown to accept it as being normal, acceptable behavior.

And the situation keeps on getting worse.

As years pass, the health insurance companies are getting more and more aggressive in their influence on your medical care. From what drugs you can take, what tests you can have, and how frequently you can see your doctor, the health insurance carriers are making more and more decisions on your life and health.

This ingress does not stop at the doctor’s office. I recently heard a radio spot by Horizon Blue Cross on their new program where they are ‘working with’ hospitals to help them reduce the number of infections. While this sounds altruistic at first, you can come to ask “who the hell are they to ‘help’ run a medical facility? They are not doctors, nurses, or other health care professionals. They are not medically or ethically liable or accountable for patient’s health. They are, at best, an insurance company. In actuality, they are an unwelcome middle man who is sucking up 20 – 40% of your health care dollar. They are a bunch of bean counters who have interjected themselves into the health care system.

Of course, they will try to defend themselves by saying that they are ‘doing their part’ to keep health care affordable. Hey Horizon – do you REALLY want to help make health care affordable? Stop trying to micromanage it. Act like a real insurance company and cover catastrophic loss instead of dipping your beak into every transaction.

Americans should be up in arms about these giant leeches that are sucking the life blood out of our health care system. But, sadly, we’re passively letting them continue with this outrageous behavior. We’ve been thoroughly brainwashed to accept this mistreatment from our health insurance carriers when we would never remotely tolerate it from the other insurance companies that we do business with. If our auto, homeowners, or life insurance companies acted like out health care insurance companies did, there would be riots in the streets. Somehow, health insurance companies keep on geting a pass from America for their unethical profiteering.

Bizarro.



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Doctor Jokes

Did you hear the one about…..

When I was a kid, used to like reading my Mom’s copy of Readers Digest (Yes, in someways, I was a weird kid). I especially used to like the humor sections. One such section I recall reading was titled “Laughter is the Best Medicine”, which featured medically related jokes.

I still have more Bizarro posts, but they’re really starting to get my blood boiling. So I’ve decided to take a short break from all this heavy discussion and lighten things up a bit with some medical humor.

However, please be forewarned that these are jokes that you wouldn’t find on the pages of Reader’s Digest.

Here we go:

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Q: How many Chiropractors does it take to change a light bulb?

A: Only one, but it takes 30 – 40 visits.

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A doctor is on the first green of a golf course. He goes to write down his score and absent-mindedly pulls a rectal thermometer out of his shirt pocket. When he realizes what he’s done, he curses under his breath. When his golfing partners ask him what’s wrong, he complains “some asshole has my pencil”.

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Did you hear about the pediatric gynecologist who went to the eye doctor? It seems that everything was looking fuzzy to him.

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A brain surgeon wakes up on a Sunday morning to discover that a pipe leak has flooded his basement. After frantically calling around, he finally finds a plumber who is willing to come out on a Sunday. The plumber goes down into the basement, walks up to the leaking pipem removes a wrench from his back pocket, and stops the leak with a few quick turns. He then hands the doctor a bill for $500.00. The doctor is incensed – he yells at the plumber “I’m a BRAIN SURGEON and I don’t make $500 for 5 minutes work! The plumber shrugs and says “that’s why I gave up my practice…”

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A doctor meets a lawyer at a cocktail party. The doctor complains how everyone is always asking him for free advice. He can’t figure out how to put an end to it. The lawyer says “That’s easy – do what I do. Whenever I give someone legal advice, I simply mail them a bill for my time. Either they pay my bill, or they quick asking me for free advice”. The doctor exclaims “That’s brilliant! I’m going to start doing just that!” The doctor was thrilled with his new-found solution until the next day, when he received a bill in the mail from the lawyer….

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A Washington, DC based doctor is driving with his young son in the car. His son asks “Daddy, what do they call that big building downtown where men sit around all day and argue about how to run things?” The doctor answers “they call it the hospital”

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Q: What’s the difference between an Oral and a Rectal thermometer?

A: The flavor

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Famous American architect Frank Lloyd Wright supposedly once complained that “Doctors can bury their mistakes – all I can do is plant vines.”

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Q: How many surgeons does it take to fix a light bulb?

A: None. Scalpels can’t cut through glass

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Did you hear about the gay male nurse?

He was so good, he could make a patient without disturbing the bed!

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Michelle Obama was touring a hospital to see first hand how national health care was affecting patient care. When the tour arrived at the Urology section of the hospital, she was shocked to see an entire ward of elderly men sitting on their beds masturbating. “What’s going on here!” she demanded. The doctor giving the tour explained that all these men suffered from enlarged prostates, and since prostate surgery was not covered under national health care, that this was the only way they could get any relief. Next they came to a semi-private room, where they found another elderly man, who was being serviced by a young candy striper. Even more shocked, she asked “…and what’s going on HERE!!!” Her tour guide explained “He’s got the same issue as those other guys, but he’s got Blue Cross”

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Q: A Valedictorian finishes first in their class and a Salutatorian finishes second in their class. What is the special name that they give to the person who finished LAST in their class at Medical School?

A: Doctor

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The importance of a good vocabulary

A young man visits a surgeon and asks to be castrated. The surgeon is shocked, and explains how this is a very a drastic procedure for a young man to have and urges him him to reconsider..

“No,” says the young man, “I have thought long and hard about it, I have read all there is about it and my mind is made up. I must have the operation.”

The operation was duly carried out and when he had recovered from the anesthetic and was back in the ward he got to talking to the other patients.

“And what are you in here for?” he asked the fellow in the next bed.

“To be circumcised.”

“DAMN, THAT was the word I was looking for!”


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A Proctologist, giving a vigorous examination, remarks “I think I’ve found something. I’m feeling a series of hard nodules.”

The winching patient replied “I think they’re my molars…”

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A guy meets a psychologist at a cocktail party. He tells the doctor “…you wanna talk about CRAZY…..my brother thinks that he’s a CHICKEN!”

The doctor replies that this is a sign of a severe psychosis, and that the man should take him to see a mental health professional as soon as possible.

The man just shrugs his shoulders and sighs “I would, but I need the eggs.”

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A grossly overweight woman is so depressed about her weight that she seeks out the services of a noted psychologist. At her first appointment, she is ushered into the doctor’s office, which is empty except for the desk where the doctor is seated. He instructs her “Lie down on the floor in front of my desk”. Puzzled, but never having been to a psychologist before, she obliges. The doctor studies her large, prone figure and then remarks “No – that isn’t it – lie down under the window”. Again she obliges, and after a few more moments of contemplation the doctor says “No – that isn’t it either – lie down next to the door”. She does as she’s told, but the doctor still shakes his head and says “No-no –no- try lying down against the far wall”. Once again, she complies and the doctor says “That’s it! You are severely depressed over your weight and how people don’t see you as a complete and valuable person. The key for you is to realize that your worth as a person is not in any way related to your weight and size. Once you’ve reached that understanding, you will be able to move on with a full, productive and happy life!”

The woman undergoes a catharsis. She leaps to her feet, and thanks the doctor profusely. “You are a miracle worker! That’s exactly the insight that I needed! And to think – you were able to diagnose me without having me say a single word – just by having me lay down on your floor in different spots. AMAZING!”

The doctor laughed and said “That had nothing to do with it. Your problem was obvious the second you waddled through my door. It’s just that I’m having a new couch delivered this afternoon, and I’m trying to figure out where to put it.”

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Alright - that's enough for now. Maybe I'll do this again.

Do you know any good medical jokes? If so, please send them to me and I'll include them the next time I do a Doctor Joke blog.

Just make sure that they're in bad taste!



***** Found this Interesting, Entertaining or Informative? Please read the complete blog at: *****
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Bizarro #5 – Gas Pains

Ouch. I just heard that they think gasoline might soon reach 5 bucks a gallon. Oh joy.

I just paid $3.35 for a gallon of regular on the Turnpike today. Actually, I’m secretly thrilled about this – it’s actually quite a bargain.

Here’s how I see it:

The cost of a barrel of crude oil has just topped $105.00. Since that barrel consists of 42 gallons of the brown sticky stuff, this means that crude oil itself is selling at $2.50 cents a gallon. After refining, that barrel will yield about 20 gallons of gasoline. The remainder of that barrel will be made into other valuable products, such as diesel fuel, #2 heating oil, and lubricants. Most of these products are actually more costly than gasoline, but let’s not quibble – for the sake of argument, let’s just say that the cost of ‘raw’ gasoline is $2.50 a gallon.

If Big Oil starts selling it for 5 bucks a gallon, this would mean that they are marking up the raw materials by 100% - doubling the price of the raw product. The actual mark up is much less, because the 5 buck purchase price includes things like state and federal taxes, but for the sake of argument, we’ll say that Big Oils’ markup is a healthy 100%.



So, how do you think that Americans are going to react to that $5.00 gallon of gas? Do you think that we’ll be dancing in the streets singing ‘I’m so Glad we’re Living in the USA’? Or do you think that there will be protests and general bitchiness about the price of gas and how Big Oil is raping the American public? Based upon recent history, I’d bet on the second scenario.

I think that America will no longer tolerate outrageous profits made by big petrochemical companies. Good for us.

So, how come we put up with mark ups from other giant chemical companies that make the profit margin in gasoline look like the bargain of the century?



(Note: By other ‘giant chemical companies’, I am referring to, of course, America’s pharmaceutical industry.) These guys make Exxon look like an also-ran in the arena of ludicrous mark up. Just because they are part of the health care industry, Big Pharm gets a pass from the American public when it comes to outrageous markups.

Bizarro.

Let me elaborate.

A recent investigation by Channel 7 News in Detroit showed that Generic Drugs enjoy a markup from the cost of the raw materials of as much as 3,000 percent. If gasoline were marked up at the same rate, that gallon of gas would run you a cool $75.00. Now you know why WalMart is hawking those $10 generic prescriptions – they’re probably the highest profit margin item in the entire store.

Keep in mind that this is for the ‘no-name’ generic drugs – what’s the profit margin on our favorite ‘branded’ prescription drugs?

Glad you asked.

Let’s look at the markups for some of our ‘Rock Star’ drugs – America’s best sellers. We’ll start with Lipitor, the Bono of prescription medicine.

According to the NJ Attorney general’s web site, a 90 day supply of the #1 selling drug would run me about $460.00 bucks. The raw material cost to make those pills is a whopping $5.80. This translates to a markup of 7,931%. Our $5 gallon of gas, at this markup, would run us around $198.00 per gallon.

Does this revelation driving you crazy? Why not take some Prozac?



At about $250 for a 90 day supply, this little helper contains just 11 cents of raw materials which translates to a nice healthy markup of 227,272%. At this rate, that gallon of regular is going to sell for $5,682.50.

Almost a quarter-million percent markup. I never realized that percentages went that high. As astronomical as the number is, Prozac isn’t even the markup king.


In fact, it isn’t even close.

So far, the current champ is Xanax, which runs about $140.00 for a 90 day supply. Here, the raw ingredient cost is just under 2.5 cents, for an industry leading markup of 568,300%. At this rate, that gallon of regular would run you just over $14,200.00.




Oops – I forgot to add 9/10’s to the end of all those projected gas prices.gas prices. Mea culpa.

There is a positive side to all these gasoline markups – at these margins, our service stations would once again be able to give you a free steak knife when you fill your tank. At over a quarter million dollars to fill an averaged size tank, that steak knife will come in handy to slice your wrists with. Try not to get too much blood on the rich Corinthian leather.













Maybe they could start offering S&H Green Stamps again as well. If they do, I’m going to get enough stamps for a sailboat every time I fill up the Volvo. How exciting.













Of course, we’ll never see those kind of mark ups for gasoline. If gas was marked up that much, it would destroy the US economy. The government would never allow it.

Those crazy mark ups are allowed, of course, in the world of health care, especially with prescription medications. High drug prices are helping cripple the health care sector of the US economy, yet the US government has yet to step in and stop it. Instead, they’ve historically enacted legislation that helps ensure that that we continue to pay the highest prices for prescription medicines in the world.

Bizarro, indeed.







***** Found this Interesting, Entertaining or Informative? Please read the complete blog at: *****
http://healthcarehullabalo.blogspot.com/

Who are you? Do you agree with me, disagree with me, or have another perspective to share?

PLEASE put your 2 cents in by leaving a comment or email me at HealthcareBlog@SystematixOnline.com



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