MInutia

Minutia

        In 1957 an American motion picture, a musical drama, was banned in many towns throughout England after being slammed as "sex crazed and disgusting" by British film critics. London critics described the film as "An unsavoury, nauseating and muddy brew of delinquency, bad taste and violence". In Australia, church leaders and psychiatrists tried to have the film banned.  The name of this cesspit of cinematic tripe?  Jailhouse Rock ! Since the bulk of the film was set in a prison and having, myself, been one of the eager American teens who shelled out a quarter to see it, (popcorn was 10 cents a bag, as I remember) I recall absolutely nothing sexual about the  movie. I suppose this shouldn’t be surprising, considering that as recently as the beginnings of the first Gulf War the dorks at the Beeb banned “Waterloo” (ABBA) and “Killer Queen” by …well. Queen. Even the Beatles “A Day in the Life,” an acknowledged, masterwork, was banned for several years. BBC banning and censorship finally succumbed to listeners abandoning it for “pirate” broadcasters. (see the 2009 film, “The Boat That Rocked” if only to see the incomparable Philip Seymour Hoffmann at his best)

        In another musical oddity:   Although Frank Sinatra topped both the US and UK charts in 1966 with "Strangers In The Night", winning a Grammy Award for Best Male Pop Vocal Performance and Record of the Year in the process, he (Sinatra) despised the song and called it "a piece of shit," and "the worst fucking song I ever heard." Go figure.

But seriously folks,

        Donald Trump will have to look hard to find “positives” of his administration to use as campaign issues. (Note: vintage Trumpism generally eschews positives, rather focusing on slandering the opponent) One “accomplishment” he will probably attempt to mine for useable talking points is immigration. “They never show up for the trial. So, by the time their trial comes, they’re gone. Nobody knows where they are.” – Donald Trump. 

       Both Trump and former Secretary of Homeland Security, Kirstjen Nielsen, have stated that immigrants going through removal proceedings—particularly those applying for asylum—simply do not appear at their court dates, instead choosing to remain in the United States unlawfully. The truth is more than a bit contradictory. The Department of Justice’s own statistics show that nearly three-quarters of all immigrants appear at their hearings, including nearly 90 percent of those seeking asylum.

       In prior years, when the Obama administration ran a pilot program where asylum applicants were let go with a promise to appear vice incarceration and family separation, 99% showed up in court at the appointed time for their hearing. That Trump lied is not surprising. That so few of his supporters will acknowledge it, much more so.

        Trump also ran on a promise to provide a “very much better, really, really, great, (or some equally flowery blast of drivel) health care alternative to ‘Obama care.’” He has not. I have written at length on health care costs in general and specifically about the advantages of single payer systems and lies we’ve been bombarded with on that subject. It is worth noting that the pharmaceutical industry (Pharma) leads all industries in lobbying donations. Top House member recipient?   Minority Leader Kevin McCarthy (R-CA), just under half a million! (and over 4 times as much as Mrs. Pelosi.) Of course, McCarthy is being paid to oppose the Affordable Care Act, isn’t he?

        This pathetic national health care situation, specifically ludicrous drug costs, was reaffirmed for me on a personal level this week. Having been diagnosed with Psoriasis years ago, the newer drugs which actually control it are little short of miraculous in effect. I rarely have a “flareup”, but with the monoclonal antibody class of drugs, tolerance and decreasing effectiveness can happen. After 13 years of using one treatment, its efficacy waned and my dermatologist switched me to another.  Yeah, I know.….So?

          So, as a military retiree, I have Medicare as first provider and Tricare for life (military retired Medicare supplement and drug plan), which covers both Emily and I. How good is it? I have a $33,000 hip for which I have paid nothing!  Tricare also uses Express Scripts (an online pharmacy) as drug provider.  I received my first dose of my new psoriasis drug, Stelara, Thursday, - one syringe. With it was the statement of coverage, listing my copay (just $21.00) and what Tricare paid, which was $6,700! That’s what the government via Tricare paid the provider of the medication. I can assure you that, at that price, the drug’s manufacturer, Janssen biotech, is making a huge profit for their 90 ccs of Stelara. Am I content with the price I pay? Of course. But…!

        The list price of Stelara is over $12,000 per month, but it isn’t a monthly injection, rather every three months after a loading dose. Using GoodRx as my source, l found that a refill of Stelara (with a coupon, no less) costs over $22,000! It costs a small decimal fraction of that price to produce. Private insurers, like Tricare, which is administered as a private insurer also, negotiate far lower prices, hence the $6700 every three months, which is actually a bit lower than some private Medicare Advantage plans. According to the National Psoriasis Foundation, without insurance, the retail value of a year’s worth of Stelara injections would cost between $30,000 and $70,000. None of these drugs is a cure, so this cost is the gift that keeps on giving,

        Now the rest of the story. A patient on Medicare who has no part D drug plan or other insurance would pay retail, that is about $22,000 per refill. Obviously, that is well beyond the means of many, or most, of us, but, and this is huge, Medicare Part D (drug plan) itself will pay (and must by law) the actual list price, no negotiating, no reduction. The same is true for Medicaid. Patients over 65 may pay less out of pocket because their Private Medicare advantage plan has no restrictions on negotiating lower prices (hence the $6700 my plan paid). This vast difference between what private insurers bargain down to and the “list” prices, which Medicare and Medicaid must pay, is what drives the huge annual Medicare /Medicaid monetary outlay for drugs. In 2018 that number was $1.347 trillion! Changing the part D law to allow the bargaining of prices, as private insurers do, would reduce that number by more than 50% per conservative estimates. For the sake of comparison that reduction would have eliminated federal budget deficits each year from 2013 to 2016! So, remember, when Republicans whine about “Entitlements” the biggest one of all is the “Full Price guarantee” given Pharma by Medicare part D legislation. No wonder advertising and lobbying are now the Pharma industries’ first and second largest expenditures annually.   

And I do believe that’s all I have to say about that.