America – Weary Wretch

The complexity of Death Panels

For those that don’t know, I have asthma. No biggie, I just use my medicine as I should and I’m OK. The symptoms come on, seemingly in a random fashion. In other words, I can’t (nor can doctors) predict when or why I have a flare up and have to have these medicines at hand.

Want to know why that matters to me, and will to you, eventually?

The first issue came about on obtaining the medicines. In an effort to curb the rapid rise of health care costs and to stop evil patients from abusing the Medicare/Medicaid/private insurance industry, Congress and Obama decided to put the crunch on wasteful prescribing and use of medicines.

This is the pharmaceutical side of death panels, by the way.

This is how it works. The doctor sees the patient and prescribes medications that are felt to be needed for up to the next 3 months. At the time of the doctor-patient visit, the doctor is under pressure to prescribe for the symptoms or diseases that need treatment, and in some cases, may need treatment in the next 6-12 months. As I pointed out to my doctor one year, he/we were dead wrong in our predictions on the degree the asthma would affect me that spring. I ran out of medicine, couldn’t get an appointment to see my doctor and had to resort to all manner of probably illegal methods of obtaining what I needed. I survived and we talked about this and he offered a solution.

Horde!

So my doctor’s solution to this congressional-caused chaos was to cheat the system. So I did. I insured that I had several inhalers on hand, in case the asthma symptoms returned at an inconvenient time for my doctor. But, here is a white elephant in the room. Packaged medicines don’t have an infinite shelf life. They expire. The co pay for the drug may be nothing or $75. Now what does one do? Use the expired drug and hope it works, or at least doesn’t kill you? Or, try to replace the expired drug with an unexpired unit?

The prescribing pharmacy refused to replace the unopened, unused and expired drug.

Enterprising fellow that I am, I decided to trace down the manufacture. In the old days, whenever that was, it was common practice for the pharmacy to replace expired, unused medications. The manufacture of one particular drug that I needed was GlaxcoSmithKline of Canada. I googled (which makes it official that I’m a google doc) GSK and read their online replacement policy.

Great, “No return authorization required.”

Just send the drug(s) to the address provided. So, I grabbed up the 4 unopened, unused units of medicine and went to the post office. That’s the United States Postal Service. The one that requires me to fill out a United States Customs Service form to declare what I was sending to this foreign country. Oops, another white elephant in the room. As of just recently, they, the USPS, will not ship prescription drugs through their service, by act of Congress. Sorry bud.

Do you know why our august Congress decided to make it illegal to ship prescription drugs?

Well, let me tell you. It’s for a variety of reasons but the last straw is the opioid crisis. Truthfully, a little more than just opioids, but drugs of abuse in general. See, one of the major avenues of illegal drugs into the US is only partly due to the absence of a wall on our southern border. Other major avenues include the USPS, UPS, FedEx and the like. The WWW, the Internet, Google. K2 (synthetic marijuana), anabolic steroids, opioids, Viagra and a host of other medications have been flowing south for years. It’s a cost issue as well as an access issue.

My expired, unused asthma medication cost me a pretty penny in co-pay ($300). It was prescribed by a US doctor, dispensed from a US based pharmacy (probably the largest in the US) that had obtained it from a Canadian based USCS approved importer of pharmaceuticals into the US and I can’t get it replaced through the company approved system because our US Congress thinks I’m importing (exporting?) illegal drugs, or at least facilitating others to do so!

Now we are down to the point of all this. We’ve all heard the phrase, “Be careful what you ask for, you might get it and then what would you do?” There are versions in all the major religions and folklore. In the mid-twentieth century, Robert K Merton, an American Sociologist, coined, “The law of unintended consequences.” Plagiarism at its best.

Another witticism. We want to stop illegal drug abuse, illegal immigration, gun violence, rolling stops at busy intersections or whatever. Just pass another law, that’ll fix it.

Your grumpy Uncle Dave.

Weary.

Death Panels

I received a 7 page double sided letter from CMT. Care Management Technologies, which sounds real official. It is part of Missouri Department of Social Services that monitors drug claims, diagnoses and ER visits. It is also part of Missouri Medicaid Audit and Compliance Unit (MMAC, read Death Panel). Probably a whole lot more, but I’ll come back to that.

The purpose of the letter was to bring to my attention that a patient I saw and gave narcotic medication (opioid narcotic, gasp) to who had also received narcotic prescriptions from 5 other doctors. Of course 2 of the others were hospitalists that had taken care of the patient while he was in the hospital.

I had given the patient one hydrocodone tablet while we were waiting for lab results in the ED. No other medication was given by me and no scripts were given by me.

In contrast, he received 334 tablets from the 4 other physicians over a 3 month time frame. That sounds like a lot, but it is 25% less than the maximum recommended dose over 98 days.

And, the pain the patient was being treated for was metastatic prostate cancer. Prostate cancer metastasizes to bone and is the most excruciating cancer pain known. There is no cure and treatment options include estrogen hormone supplement and castration to lessen testosterone which stimulates the prostate cancer to grow. Otherwise the only thing modern medicine has to offer is relief of pain.

So, you must be wondering why I am going on about all this trivial and complex issue. If you remember, we have suffered a few years of Obama Care and the rationing of health care that was predicted to result. Here is evidence that the pundits were right to predict that the “Death Panels” were coming. And, they are here. Actually, they’ve been here for a lot longer, they are just more functional since Obama.

And last week, President Trump signed the “Omnibus Budget Act” leaving Obama Care intact. And, President Trump vowed to stop all the opioid abuse, like my giving this patient one pain pill in the emergency department.

I have been writing about the pending doom of this opioid hysteria for a couple of years. Again will I stress;

There is no opioid crisis, there is only opioid hysteria.

There is a crisis of poor law enforcement, poor government regulations, poor prescribing habits and poor management of psychiatric health issues in America.

There is no opioid crisis.

Venting from your grumpy Uncle/Brother Dave.

Weary

Why We Should Ban All Guns

February, 2018

Another school shooting convinces me that the anti-gun hysteria may have some basis.

We should ban guns so that the FBI can continue to not do their job and keep their job.

The FBI was informed and “investigated” Cruz before the shooting.

We should ban guns so that Law Enforcement can continue to not do their job and not loose their jobs.

Local law enforcement was called to Cruz’ home 39 times over 7 years before the shooting.

We should ban guns so that Deputy Sheriffs do not have to get in harms way to stop a maniac shooter.

So far, 3 deputy sheriffs did not enter the school to attempt to stop the shooting as it was happening. One has resigned over this.

We need to ban guns so that our perverted can use other methods of killing, like knives, clubs, bombs and other creative methods.

Jeffrey Yao stabbed a woman in a library multiple times in Massachusetts.

We need to ban guns so that stupid, liberal, helicopter parents can have mean, immoral, evil children without guilt.

Too many examples to list.

We need to ban guns so that violent crime will be free to escalate.

Several studies have shown that violent crime is inversely proportional to the availability of guns. That means that more guns means less violent crime.

We need to ban guns so that tyranny can prosper.

Hitler in Nazi Germany and Stalin in Soviet Russia.

Your grumpy Uncle/grumpy, weird and compulsive Brother Dave, just thinking.

Weary

Budget and Taxes

February, 2018

I was listening to NPR on the way to work today. NPR, you may think means National Public Radio, but it doesn’t. It means National Platform for Ridiculousness.

I listen because I want to know what the enemy is doing.

So, it was about all these liberals complaining about the excessively high budget and taxes Congress and Trump were passing. I know, I know. Who’d of thought liberals would complain about high taxes and a big budget, but they were. They interviewed this “expert” about what the American people thought about such abuses. He said something to the effect,

“When our country was beginning there was a Boston Tea Party to protest the excessive taxes coming out of Washington.”

No pause, that might have indicated that he realized that Washington (or America for that matter) didn’t exist at that time or that the beef was with the King of England.

Why do physicians get sued even when they did the right thing correctly, and idiots like this are allowed to spew stupid gibberish like this?

Your grumpy Uncle/Brother Dave. All childish invectives used in this post are appropriate and true.

https://www.npr.org/2018/02/09/584640265/bipartisan-budget-agreement-spends-too-much-money-for-most-conservative-republic

Weary

Stoned and Stupid

January, 2018

Do you know why California legalized recreational use of marijuana? No, stop. Don’t answer that question. At this point it is a rhetorical question.

Did you know that California is one of the highest state income tax states in the US. Yeah well, they just instituted a new Gift Tax Relief Program. Here is how it works. For every dollar you earn, California normally takes about 13.3 cents. But under the new Gift Tax Relief Program, if you give that dollar to the state, California will not tax that dollar. What a deal!

The 2018 California state tax rate table shows that for a single head of household earning $0, the effective tax rate is 1%. (Yup, California is right up there with the Common Core Math Method that is driving everyone crazy with it’s stupidity.) And the top California state tax rate is supposedly 13.3%.

Oh yeah, and something else you probably didn’t know. The spokesman for the new Gift Tax Relief Program mentioned above commented that what is good for California is good for the US, because California is the driving force for the US economy.

Now we can revisit the original question. Do you know why California legalized recreational use of marijuana? Well yes, the sanctioned sales of all that weed does generate more tax dollars, but…

To enforce this madness, California needs to keep it’s population stoned and stupid.

Just your grumpy Uncle/Brother Dave’s opinion.