• Baby Boomers,  Corporate Greed,  Justice, the Human Construct,  Medicare,  Politics

    Medicare and the Ethos of Congress

    Medicare Part D is a Vicious Lie that Keeps Insurance Companies Wealthy at the Expense of the Elderly.

    Please note that I am disabled (newly 5 years ago) and am reaching my Medicare age also. And note that I have a master’s degree in public health. 

    This past year I went with the lowest Part D Prescription coverage available. The reason I did was because my medications come primarily from Costco and it is all cash, so medications are cheaper there than my Medicare D insurance copays.

    National Cancer Institute

    The mistake was that I had to go on a new and expensive prescription in December, after I made all of my Medicare elections. I was diagnosed with COPD and was given Trelegy. This medication has helped me so much. I had started going to a cardiologist to find out why I was so breathless. He did several studies on me and I have no heart problems. I should have guessed COPD because I am a recovered cigarette addict. I smoked for so many years, it was ridiculous. Of course I was due for lung problems.

    My “donut hole” started in July. I’ve been paying 180.00 per month for Trelegy since August. With expensive medications, you need an expensive plan and I had chosen a cheap Medicare D plan (after all, I buy the majority of my medications for cash from Costco).

    The Agony of Medicare D

    For a couple of reasons, I’ve waited to get my estimates for the new year’s part D coverage and costs. It’s been a rough year. I have all new doctors because of my geographical move. I had to change several medications, partly because of new doctors and partly because my body just couldn’t continue the medication.

    Here I am once again looking down this corridor of ridiculous medication prices and impossible conditions that I cannot get away from.

    Buying Medications and HealthCare in America Should NOT be a Rip-Off

    More than sixty five million Americans are on Medicare. The insurance companies are cheating each and every one of us. They overcharge for premiums for medication and they certainly overcharge the United States enough to provide care (if an Advantage plan) and yet they do not provide care. The insurance companies fight patients to stop health care that they don’t want to pay for. That’s what prior authorization is, a way to stop a patient from getting care, a way to say no. The point is to ensure that insurance is profitable, insurance companies don’t care about patient care. We know this and yet it continues. Original Medicare does NOT require prior authorization, that’s because it’s health care, which is left to health professionals.

    I don’t understand how Medicare part D insurance works, but let me tell you that with insurance, I pay MORE for my medications than if I just pay cash at Costco. And the double dealing doesn’t stop there. Read this excerpt from the Medicare website about part D deductibles.

    Deductibles per Medicare:

    “This is the amount you must pay each year for your prescriptions before your Medicare drug plan pays its share.

    Deductibles vary between Medicare drug plans. No Medicare drug plan may have a deductible more than $505 in 2023 ($545 in 2024). Some Medicare drug plans don’t have a deductible. In some plans that do have a deductible, drugs on some tiers are covered before the deductible.”

    What I want to know is does the deductible count for anything? Does it count against my annual out-of-pocket expense for my drugs? These deductibles are high! I can’t find anywhere that Medicare addresses this or any practical financial questionnnnnnnnnnn.

    Back to Shopping for the Plan

    As a Medicare recipient, I am shopping right now for the best plan for me. It’s a long and tedious process – what my daughter calls a “rabbit hole”.

    Again, I buy a substantial number of my prescriptions from Costco for cash. Let me show you the difference between buying with a premium drug plan and cash:

    With my new drug plan the cost of Baclofen is:

    Baclofen 10mg tablet$62.26
    Medicare Website

    If I pay cash, no Medicare D insurance:

    • Baclofen              $16.79
    • from the Costco Website, drug pricing
    Albuterol sulfate hfa 108 (90 Base)mcg/act aerosol solution$55.57
    Medicare Website

    If I pay cash, no Medicare D insurance:

    • Albuterol Sulfate               $11.49
    • Costco Website

    I’m going through the trouble of copy and paste because this happened on 10/26/23! I compared prices and this is what I found.

    Why are Americans paying MORE for medications with insurance than without? WHY? Help me understand what kind of back room politics pulled off this deal?

    Most of my medications are like this, cheaper with Costco than with insurance. I need the insurance for medications like Trelegy. It’s $500.00 per month and the only way that I can afford it is with insurance. I pay $180.00 per month for Trelegy. Before I got into the donut hole it was $40.00 per month.

    How did the drug companies convince Congress to allow the drug companies to cheat the American people into poverty?

  • Psychology of Life

    House of Rep — We Need a Redo

    Johanna Baynard

    Johanna Baynard

    I’m not sure I understand why the great states of America are still following some old rules as made up by and for the House of Representatives. These rules have been around for far too long and they don’t serve the American people.

    One of the most enduring tests of logic is does “this” work for the apparatus that it is serving. When we ask this question about the current rules around the House of Representatives, when we ask this question about the Electoral college, when we ask this question about so many political concepts…the answer is no. Almost without exception, the rules around the House of Representative and Congress were made by a bunch of old white men, who are not even the majority in this country.

    A group of people are ostensibly elected by other people in this country. Those who are elected can commit crimes and still continue to legislate in this country. In fact, the legislative body has made quite a few laws that are nothing but to their own advantage. For their entire tenure Congress has health care that is highly subsidized, up to 75% but usually no more than 72%.

    A protest sign says When Injustice Becomes Law Resistance Becomes Duty
    Photo by Gayatri Malhotra on Unsplash

    And what really happens is ridiculous. Ethics seem rare in public office. If a public officer breaks a law they are just as likely to change the law and back-date it, once the case is reviewed. This was how DeSantis resolved his use of public funds to take migrants from Texas and fly them to a northern state in a publicity stunt early in his campaign for presidency. Nothing has happened to him, he hasn’t even been questioned.

    Those who work for these types of public officers, people who wouldn’t take a paperclip home with them, will allow and defend their bosses to continue this type of unethical behavior. In fact, the unethical behavior couldn’t continue without the help of their staff (paid for with public funds).

    Back to the Point

    We have a Congress that is not working. The reason they are not working is that they don’t care about working for America anymore. They are focused on their own righteousness and that is just about all that is happening in the House of Representatives. And the rules allow them to behave this way.

    Let’s make some new rules~

    If you’re not participating, in a working process, then get out.

    When you cease to serve the people of the United States, get out! We don’t need you.

    Tommy Tuberville, get out. You aren’t working for Americans anymore, you stopped quite a while ago. Why do we have rules that allow Tuberville (all by himself) to hold up our military to the detriment of national security?

    Photo by Nathan Shively on Unsplash

    Clarence Thomas decided that being around an uber wealthy friend who gave him uber wealthy gifts would not affect his legal opinion. He has been getting away with it for 30 years because we don’t have any rules to manage unethical Justice’ behavior. Our supreme court justices are supposed to be above all of that, sort of like Congress? Above the laws of “other” people. Their job doesn’t depend on their criminal behavior, they can continue making laws for the rest of us mortals.

    It’s B.S. and everyone knows it.

    It no longer serves us to follow the old white men rules, we need to make our own!

    Legislation

    Justice

    Ethics

    Injustice

    Congress

  • Psychology of Life

    Software and the Old Lady

    Johanna Baynard

    Johanna Baynard

    4 min read

    My husband and I got into a roaring argument about Society’s dismissal of older women. Older women’s experience is of no consequence, and older women are barely tolerated in society.

    Photo by Ravi Patel on Unsplash

    Guess who the old lady is? It is I. He exhorts me not to respond to the bland dismissal that everyone has for old women. It is bizarre to me that such a valuable commodity (old women) would be dismissed so heartily. It is as if we have been relegated to the old clothes pile, never to be considered again.

    Yesterday I was at the Emergency Room because of a UTI and intense pain in my back. I have an extensive medical history that I have kept track of assiduously. I have had back surgery and now have a spinal cord stimulator. It takes a bit of effort to keep my pain manageable. So here is quandary #2: disability. People really do not know what to do with disability and illness. (Beside the point for this paper, apologies.)

    The P.A. assigned to me asked me about how I was feeling and made a comment that my back treatment history was extensive. I asked him how he knew that. He smiled coyly as if he was a magician revealing a trick, and even commented that he was magic. I was asking because I wanted to know which set of medical records he was viewing so that we could be on the same page. I asked him again, he smiled again, next to me I could feel my husband stiffening up. He could tell that I was losing my patience with Mr. Magician who knew nothing about medical records. The records he was viewing were over two years old — old information that was irrelevant to our life now. Most facilities have contracts for medical records, but they do not share with other facilities that are out of their own network. Because of this you may have several sets of medical records, interspersed with your providers. Medical Records are not integrated.

    Photo by Ravi Patel on Unsplash

    I did not want to confront the P.A. and with my husband stiffening up, I gave in. I let him be magical. (Whatever.)

    At 12:30, I told him that we had to leave and asked if he would finish recordkeeping so that we could pick up prescriptions. Again, at 1:00 he is the coquette, look at all I have done for you, I faxed your prescriptions to…

    I looked at my husband. I looked at the P.A., “can you change this for me please? We have moved and this information is ancient.” The P.A. replied, “but this is what you told me.” He realized his error and back tracked. I hadn’t told him anything, remember the magician, he knows it all? He made us wait another 15 minutes, which was completely unnecessary. He even walked into the waiting room with my paperwork and turned around to help someone else. He was obviously resentful about the correction. Why?

    In the meantime, they sent my records to a primary care doctor that I no longer have. They had not updated anything, even though I asked.

    On my end, getting the prescriptions straightened out was difficult. He had not cancelled the original prescription and so when the correct pharmacy went to fill the prescription there was a duplicate that had to be removed. — All of that because old ladies are to be dismissed, devalued and ignored.

    Later that evening we were having a family gathering. I was having trouble with my words, most definitely. My granddaughter was describing how she met her boyfriend and she said “he DMed me”. To which I responded, “what software were you using when he did that?” My granddaughter said Instagram. Then my daughter-in-law laughed at me and said, “well she wasn’t using Quickbooks”. I’m guessing that the point was that an ap-plication is not software. Again, I am feeling like huh? Software includes applications. How do applications work? Well, they are software.

    Why is it so important for us to one-up each other? It is a continual game that I see people playing constantly. When are we to the point of letting it go? I don’t think safety and security reduces it; indeed, I’ve seen safety and security increase the need for one-upmanship to the point of creating exclusive enclaves that no one is welcome to unless they meet this criterion.

    Why is this old lady’s question ignored? Why is this old lady’s statement about software laughed at? What have I done to make these others treat me this way? I have grown old.