WickedEye's Quotient

12/10/2014 at 06:16

Play Spent

Today my class has to take the bus, or walk, from the clinic to the pharmacy to the grocery store, then plan a grocery list for a family of 3 for a week with $128.00. It’s an assignment designed to allow physicians-in-training to understand a little of what many of their patients have to cope with.

The alarm, dismay, and consternation displayed by some of my classmates when we were given the details of this assignment were a revelation. It’s no secret that I grew up on the wrong side of the tracks—which, not coincidentally, is where I live now (on which more in a moment). Public bus systems just aren’t that scary to me; I walked, or took the bus home from school, on and off from ages 12 to 16.

I came to medical school with a car that might or might not last, so my house is 9 blocks from school, and only 1 block and 6 blocks from St. John’s and Memorial hospitals (hence the high-risk location), with a grocery store 4 blocks away. I don’t expect grocery planning to be terribly challenging, either: Eating nutritiously (if uninterestingly) on the cheap is another ongoing hobby of mine.

All of which is to say that when I got the assignment, I wasn’t anticipating trouble completing it—unless I got really unlucky crossing the road.

But it turns out that there was another component to the assignment: Spent.

And that feeling smug goeth before a fall, and complacency before a kick in the rear.

I thought I understood some of my patients’ challenges. Turns out I don’t. No matter where I grew up, or where I live now, or what my intimacy with public transport, I’m not an adult with a family trying to survive at the federal poverty line.

Play ‘Spent’ in the next week, even if you do nothing else to understand those outside your circle and circumstances. Because no matter what you think you know about what it takes to survive on a low income…you don’t. You really, really don’t.

Go play. Have a good week. And share the game, where and as you can.

We’re all in this together. Pass it on.

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Blogger tonyl said...

Hi, there. I hope all is well for you!

I really should comment on your Peter Jackson post, but… I can say I’ve been busy.

I’m hardly in a position to appreciate the difficulties faced by real people, but two things: first, I got a 404 error clicking the link, and second, I’ve been seeing an opthamalogist for glaucoma, and his staff was astounded to earn that my co-pay for the drops he prescribed was $93 per refill. (My astonishment came from the fact that the insurance company paid like $3.) I realize that insurance plans differ, and that drug prices are designed to keep the drug companies profitable, but I thought a prescriber should have a better idea of the cost of the medicine they write into patients’ daily lives.
Your school’s experiment seems like a step in that direction.
Thanks for sharing!  

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Blogger Scientiae said...

Wonderful to hear from you too, Tony! I hope the business involves writing...I need to hop over to your blog to find out. Thanks for the heads-up on the link; hopefully it's fixed now.

Looking at medicine prices *is* something we're taught, beginning in 3rd year; and that's a staggering co-pay. A lot of glaucoma drugs are still in patent, as I understand it, which accounts for the ridiculous prices, but for your insurance company to pay almost *nothing*...well, it recalls words the late, great Douglas Adams put in Dirk Gently's mouth: “If the insurance company failed to pay up--which seemed increasingly likely in light of the strategy that insurance companies had adopted in recent years, of merely advertising their services, rather than actually providing them...”

It's none of my business what insurance you carry, but maybe you could find a better deal...?

I'll be hopping to your blog in a few minutes, so I'll see you on the other side.  

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Blogger tonyl said...

Yeah. All the internal pressure reducing drugs (for glaucoma, as you suggest) seem to be tier 4 drugs, which calls for the insane co-pay. And a couple hours loking for different prices offered costs not significantly different. And in the interest of full disclosure, I’ve had tier 4 drugs where I paid my $93, and the insurance co paid more than that. Still, you wonder, sometimes, until you remember: The drug companies, the insurance companies and the doctors’ associations (some at least) are doing what for profit firms do: making a profit.

I fear I’ve been spending time on things other than my blog, which needs some serious updating. But if you use RSS, your reader will tell you when I do that. Just like yours does me.  

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Blogger Scientiae said...

This comment has been removed by the author.  

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Blogger Scientiae said...

Tony, I've been to your blog, and tried commenting 3 or 4 times. Nothing ever shows; I'm not sure what's wrong. I'll try again once I can figure that out.

I haven't really thought about this issue specifically, before, but opthalmologic drugs do seem to be extraordinarily expensive in general--ocular antibiotics, for example, are also very pricey. I'm not certain why this is; normally I'm skeptical of the idea that a drug is expensive because of its ingredients, but the eye is such a delicate set of tissues that I'm willing to believe the necessary buffers might be much more expensive than typical components. For example, the eyedrops I use (I have chronic dry-eye) run $15-20/oz, and no generic I've tried approaches their efficacy.

I know all too well what for-profit firms do, which is why I've been convinced for quite some time that healthcare should not be for-profit. The root causes of healthcare cost overruns are many--and many can be laid at the feet of the pharmaceutical industry--but I can tell you one thing of which I'm certain: In other countries, where medical students are educated for free once they're admitted, and never have to worry about paying back ruinous student loans, doctors survive quite happily on $75,000-100,000/year fixed salaries.

I don't use RSS, though I can certainly try it...I need a feed reader, I think, and will have to look over RSS clients. In the meantime, let me know if I've made some fatal error in trying to comment on your blog.  

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Blogger tonyl said...

We're carrying on quite a conversation here.

Given the size of the containers used for eye drops, I don't believe the intrinsic cost of ingredients is the issue. It doesn't seem reasonable to me that the eye's tissues are all that more delicate then some other body parts, but, hey, I'm an EE, so what do I know.

Whether or no, I believe the patent content is the ingredient that drives the price, that and the R&D done to generate new business. While I wouldn't argue that the FDA over-regulates drugs headed to the market, that is a cost not faced in most innovation-centric industries.

As for whether or not healthcare should be for-profit or not, it's my considered opinion that a for-profit industry will always be driven by profit: it's what the purpose is. The profit itself, and other costs related to generating a profit rather than supplying either product or service, will always cause the price of whatever is sold to be higher than a non-profit. However, take away the profit motive, and another has to be generated in order to motivate entrance to the market. But I think I'm preaching to the choir. :)

I gave up on Firefox' RSS capability and chose Vienna. If you have bookmarks in your browser, you can import them to Vienna, and it's easy to use. It comes with a bunch of feeds (some Apple-centric, BBC News, and their own support blog for example) pre-loaded which you can read, or delete, as you wish.

I spent some time looking at the settings on my blog, and I can't see any that would prevent you from commenting. Try again, please; I turned off the captcha requirement. See if that makes any difference for you. And tell me what happens. Since I'm the owner, I'm not sure anything I try would point to a problem. However, I'll put up a little test post for a trial.

Yup. I can comment on my own post just fine.

And thanks for not only sharing but engaging, too!  

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