Generics: The Big Lie

Imagine this scenario. I am contacted by a representative from a large drug company that makes an expensive new drug. An offer is made. For every prescription for their drug I write, I will receive a monetary reward.

What would you think about me if I wrote that medicine for you? Would you wonder whether it was a decision based on what was really best for you, or it was a decision based on my own selfish interest? You would be right to wonder. I would wonder myself, were I in your position.

It would be possible, of course, that I really felt the medicine was the best one for the particular case at hand. But the appearance of impropriety would remain. That just makes sense for you to wonder.

Sadly, this is exactly the situation occurring every day, at almost every pharmacy in every town in this country. Pharmacists are paid bonuses for prescribing certain medications - generics.

The generic medication industry pays money to insurance companies and to PBMs (pharmaceutical benefit management) companies that provide medicine coverage for insurance companies. Those companies, in turn, pay cash bonuses to pharmacists who change prescriptions written by your doctor for a name brand medicine to a generic alternative. The percentage of name-brand medicines they arbitrarily "switch" to generics is recorded as the generic substitution rate (GSR). In some large pharmacies like Walgreen's and CVS, there is actually a quota that a pharmacist must reach each day in order to make their bonus.

This should give you a shudder. Are the pharmacists switching your doctor's orders out of loyalty to you? Or out of a desire to make more money personally? It is a legitimate question.

This is made more serious by the fact that generics, long touted as being "equivalent" to the name brand medications, are not at all equivalent. In keeping with the original Hatch-Waxman Act of 1984, the Congressional Act that gave birth to the modern generic industry by relaxing the rules leading to their availability to the market, a generic medication only has to be somewhere between 80% and 125% as effective as the name-brand medicine.

What does this mean for safety? Well, in some cases, it's not a huge deal. In other cases, however, it is a critical difference. For some medicines, the accuracy of the dose can have real life-and-death consequences for the unsuspecting patient. Take coumadin (Warfarin), a common anticoagulant medicine, for instance. If I prescribe 10mg of coumadin, it is because the patient needs 10mg. No more, no less. If the patient only receives 8mg (entirely possible under the Hatch-Waxman Act), the patient might develop life-threatening clots. If the patient receives 12.5mg, conversely, they might suffer over-anticoagulation and die from an internal bleed. Not exactly a minor difference, right? It doesn't get much more stark than life or death.

Now Senators Hatch and Waxman are at it again. They want to bring the most advanced new medicines - so called "biologics" - to market at a cheaper price. But because biologic agents are more difficult to copy, they have done away with the inconvenient "bioequivalent" language in the original act. They are only requiring these new generics to be "biosimilar" to the original.

I don't know about you, but I would just as soon not be given a medicine that "may be kind of like" the medicine my doctor prescribed. Maybe it's just me.

So the next time you hear someone griping about the high cost of prescriptions and rallying for cheaper generics to be made available, remember this post. Sometimes you really do get what you pay for.

The Inconvenience of the Bill of Rights

Amendment One: Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.

My simple question is this: does this say anything about exceptions in certain cases? More specifically, do we have a right to speak freely or not? What about speech that is inconvenient? What about speech that is treasonous? Despicable? Hateful?

What exactly constitutes "hate speech"? I am assuming that government has not developed the super-human ability to read minds - to see with perfect clarity the intention of a speaker or the true contents of his heart. And if they lack this ability, how do they presume to be able to label something as speech that is motivated out of hatred?

Further, how is it any of their business? When someone says that they oppose marriages between homosexuals, this is inconvenient, even offensive, to some homosexuals. A statement of this type might even be motivated by a sense of hatred toward homosexuals on the part of the speaker. In a similar way, calling a beauty pageant contestant a Nazi because she opposes homosexual marriage might also be offensive. A statement at a recent White House correspondents' dinner (about a wish that a popular radio show talk host with whom the speaker disagreed would die) might also be considered hateful. Unfortunately for the proponents of the belief that some speech is not protected by the First Amendment, all these statements are perfectly legitimate.

"Hate speech" isn't some special category of speech. It's just speech. It is enshrined in the Constitution. It is our right as free people to speak freely about whatever we wish, regardless of the way it makes someone feel.

There have been some who basically agree with me ideologically who have recently made statements to the effect that many of the statements by some on the Left are "hate speech". This is a grave error. What differentiates us from the Left is our belief that we are free people with certain rights, some of which have been specifically named in the Constitution. If we allow ourselves to give legitimacy to their perverse theories by fighting them with their own weapons, we fall into their trap. I oppose pork-barrel spending, even when it is done by my own Congressmen, to my benefit. It is wrong, no matter who is doing it. This belief that we should adopt a "my Senator can beat up your Senator" is only perpetuating the false philosophy of the Left, and we must stop it.

Support speech of all types. Combat stupid and hateful speech by pointing out the inherent flaws in what is said - not by squelching your opponent's right to make such statements. We are either free or we are not. It's that simple.

"Fixing" Healthcare: A Humble Proposal

I'm no economist. Well, at least not any sort of formal economist - I am a consumer, which may be at least as important. Here's my proposition for fixing healthcare. It will be roundly criticized by all the important players, for a number of reasons. Government will hate it, because it requires that government butt-out, for a change. Insurance companies will hate it because it will deprive them of the ability to continue charging people ridiculous premiums, then not paying for anything. The public will probably hate it, too. They won't really have a good reason to, but they'll be told to hate it by the people who are the paid servants of either the government or the insurance industry. The public always obeys.

Nevertheless, I really believe that this solution would work. I look forward to your comments. At least I'm trying, right? Never let it be said that MOCKBADOC offers no solutions.

The Idea:

1. All U.S. Citizens will have a health savings account (HSA) set up in their name, under their Social Security Number.

2. Contributions to this account will be made with each paycheck, either by the citizen themselves, their employer, or jointly.

3. The account will not be placed in the market, but will be in something stable and safe, so the money can't be lost.

4. The money that would have been spent each month on useless insurance premiums will, instead, be placed into the account, which will be available for use by the citizen in any way they so choose, so long as it's for health-related stuff.

5. A minimum balance will be required for minor emergencies. For example, you couldn't spend down to zero balance on a nose job. You might need to go to the ER the next month.

6. Citizens would then be able to purchase insurance for the unlikely event that they have something catastrophic happen, that would exceed their ability to pay from the HSA. A deductible of at least $10,000 seems reasonable.

Pros:

1. Brings competition back to medicine: bad doctors lose patients, good ones get more patients.

2. The patient is back in charge of their own health care. They get to make the decisions for themselves without interference.

3. The cost of health care, which is inflated arbitrarily by the presence and interference of insurers and government, would immediately plummet, making things much more affordable.

4. People could carry over their money in the HSA from year-to-year, allowing them to save for expensive but elective things like plastic surgery, etc.

5. The money, which is now making vast amounts of interest for the insurance companies, would instead be making interest for the insured person.

Cons:

1. What to do about the unemployed, and therefore, uninsured?

2. What if somebody spends all their money and still needs more stuff?

3. What about kids?

Answers to Cons:

1. Unemployed could have their HSA replenished in a number of ways, either through the current COBRA system, which would continue to make deposits for 6 months to the HSA instead of the ridiculously-priced insurance they currently provide. The HSA deposits could be part of unemployment benefits. Better yet, the HSAs would give a superb opportunity for charitable contributions to be made to help a neighbor down on his or her luck.

2. If somebody spent all their money on something irresponsible, they should not be protected from the consequences of their own irresponsibility. They should have to repay whatever they spend over and above that amount for routine care. If, however, they need something that exceeds $10,000 in price, they could tap into the catastrophic care insurance provided by their employer.

3. Kids would have their own HSAs, and contributions could be provided by their parents, their parents' employer(s), or both. Needy children could have their HSAs contributed to by their home state or county. Just like adults, kids would have a safety net above $10,000 - an insurance policy designed to cover more expensive stuff.

I can't take total credit for this idea. It is already working (and working very well) for the Whole Foods grocery chain.

Government isn't the only answer to our problems, guys. It's just the worst possible answer.

The View From the Inside: Obama and Tribunals

Hypocrisy in action, once again. How many flip-flops before he's called on it?

Barack Obama. He built an entire campaign...heck, an entire political career on the contention that the terrorists housed at Guantanemo were unfortunates who'd simply been wearing a turban in the wrong place at the wrong time on a battlefield in an illegitimate war for oil.

Barack Obama. The savior of the Guantanemo detainees. Outspoken vitreolic critic of military tribunals. Now the prince of self-righteousness is reinstating the policy of using military tribunals to try terrorist suspects at Guantanemo. See for yourself...:

http://www.npr.org/templates/story/story.php?storyId=104189678

(I made sure to quote a communist news agency so nobody could claim Fox or Rush Limbaugh put me up to this...all us bloggers for Liberty are just shills, you know)

My initial reaction was anger. Then I felt a strange sense of gratitude that even Obama sees the reality of the situation now. Things look a lot different from inside the Oval Office, apparently. Not so easy to criticize now, I guess.

Oh, before I forget...have you seen all the giant anti-war protests going on about Iraq? Obama promised to get us out of there, and hasn't delivered, and they're furious and protesting. Cindy Sheehan even set up a makeshift compound outside his Chicago home because there's been absolutely no change in anything after 100 days. Now they're carrying signs about detainee torture and abuse at Guantanemo, talking about how his policies aren't any different from Bush's, and how he hasn't delivered on his campaign promises. They've said that they are furious, because their cause of peace and the ending of overseas wars is more important than any campaign, and Obama's failure to act makes him no better than GWB. Have you seen all that?

Neither have I. Nice hypocrisy liberal left. Guess your passion is only skin-deep. Remind me to continue not listening, not giving a crap what you idiots say.

Liars, hypocrites, traitors, thieves and cowards. You disgust me.

The Philosphy of Self-Destruction

Many would love to see the rich "taken down a notch or two". Not being very productive themselves, they've believed the infernal lie that all their desires have been kept from them by those more productive, and therefore, more wealthy than they are. They believe that their lives will improve if only someone would destroy the rich. This is a self-destructive creed.

With every wealthy person who discovers, at long last, that their increased productivity only exposes them to further harassment from the government, and makes the only logical decision left to them - that they become less productive in order to lower their profile - the system grows poorer.

When the productive become less productive, either through increasingly violent taxation policies directed against them, or through their own willing self-abasement, the system becomes less solvent. Tax rolls shrink. Employment numbers suffer. The dollar becomes less valuable, causing buying power for all citizens to become lower. Non-profit organizations (always a favorite of the liberal elites) can no longer count on the donations that are made exclusively by those with excess money to spend on such things. Artists and their arts suffer. In short, the entire system of our lives changes for the worse. All because of jealousy and misplaced hatred of the so-called "rich".

As for me, I have already decided that I will not submit to socialized medicine. I will not be enslaved by a demonic policy that uses my skills and abilities to enslave both me and my patients. I will not institute a connected electronic medical record (EMR) which subjects my patients' vital health information to review by a government that has shown itself to be unworthy of even the most rudimentary level of trust - much less our most precious medical secrets. When the inevitable happens, I will no longer practice medicine. The "system" will have to go on without my skills, abilities, and tax revenue.

The choice lies with each one of us. Will we willingly submit to the erosion of our personal liberties and the taking over of each element of our lives by a government that sees us as merely tools of their continued existence? Or will we fight to protect ourselves?

Which philosophy do you follow? The one that believes that everyone should have the right to amass a fortune, if possible, through hard work, ability, skill, the value of their work, and sometimes a little luck? Or the one that seeks to destroy the rich in an attempt to reap vengeance against a world that has not rewarded them equally, thereby ensuring the destruction of all of us, in a last, defiant, suicidal gesture? We shall soon see. The pitchfork-wielding mob has called for the heads of the doctors. When we are gone, who will be next?

D-Day: 31 July 2009

The Obama administration and his socialist allies in Congress have announced their intention to ram their socialist health care program down our throats by the end of July. This means that I've only got a little over 2 months to get my side of the story out. If you are in agreement with me that this is not only a colossally idiotic plan, but is also a true threat to our liberty, then I invite you to speak your mind.

We've allowed ourselves to be brow-beaten into submission. It is difficult to face the slings and arrows of our enemies - I know. They own the media. They own the college classrooms. They own the high school classrooms. They like to believe that there is no dissent, since they've been so effective in silencing it.

I happen to believe, however, that there are a lot of us who aren't comfortable with what socialist health care would mean to us and our families. I urge you to fight. Fight with the same courage and conviction that allowed a group of simple colonial merchants to declare their Liberty from their own tyrannical government. Fight with the same knowledge of right. Fight as if your future and the future of your posterity depended on it. Fight as you would fight to defend your home from a jealous and obstinantly lazy mob, armed not with right, but with clubs and torches.

Fight this way because this is in fact our struggle. Our freedom rests on our ability to fight that mob, whose single purpose is to destroy the productive. Our liberty depends on our victory over a tyrannical State, whose purpose is to use the power we've loaned them to make us their slaves. Don't give up until they are thoroughly defeated, or we leave them the rotting wasteland that is the natural outcome of their struggle. A world devoid of the productive, where each man and woman parasitizes his or her neighbor in a misguided attempt to achieve "equality" is a world without law and without hope.

Socialized Medicine 2009: What is Choice Worth?

Plumbers. Have you ever called a plumber? Have you ever called one on a weekend? It's expensive. Very expensive. Don't get me wrong - they do a very important job. I would gladly pay for their expertise in an emergency. Busted pipes can definitely ruin a weekend.

But what if you don't like the one you called? What if they rub you the wrong way? What if they are rude or surly? Ask anybody and they'll likely give you the same response. They'd flip open the yellow pages or check the internet and find a new one. No hard feelings. You see, you have a right to spend your money however you see fit. Plumbers know this, so they work to provide a service that is likely to please their customers, lest they get "fired". The arrangement between plumbers and their customers is one of a free association between two free and consenting people.

Medicine, on the other hand, is under assault in this sense. If you don't like your doctor, you have the right to go to another one that suits you better. You can decide not to associate with a doctor for any reason, or for no reason. Under government health care, however, this is destroyed.

Even if President Obama's socialist dreams of large, government-run "super-clinics" fails to come to fruition, you must realize that any professional relationship where one of the parties is forced is problematic. When a doctor is forced to see you, the doctor-patient relationship, one based on mutual respect, market pressures, and a free association is destroyed.

It is interesting to me to note that many of the same people who argue vehemently that gay marriages or civil unions must be respected because government has no right to interfere in the free association between free, consenting adults are the same people who argue with equal vigor that doctors should be forced to see whomever, under whatever circumstances the government mandates.

It is time for you to decide what your rights to free association are worth. Once government runs health care, they will have to contend with the same difficulties that have made health insurers some of the most detested companies on earth. When money is limited, there are only two ways to decrease the cost of services provided: cuts in services or cuts in who is covered.

Since "universal coverage" is the mandate that government has chosen for itself in this endeavor, this leaves cuts in services as the only viable option to cut those costs. Your choice of physicians will be secondary. If there is a doctor available, then their responsibility to you is finished. They couldn't care less if you like him or her. If you don't, you will not have any choice left. After all, it won't be your money paying for it. It will be ours. As for me, I hope they give you the cheapest option, not necessarily the best. It's my money you'll be spending.

What is your choice worth to you? And what is quality worth? What if your child needs an expensive but life-saving operation? The best place to have it done is Kansas City, but you live in Santa Fe. Oh, well. Pray that the inferior but "accredited" program in Santa Fe can get the job done. You're not taking your child to Kansas City.

Are you willing to sacrifice your child on the altar of social justice for others? Are you willing to sacrifice someone else's child? If you are, then you are a fool. If your self-righteousness is so powerful that you are willing to subject an innocent to your social experimentation, if you don't want the best for your child - just the same as everyone else, then I would classify you as a child abuser.

If, on the other hand, you (like me) are not willing to trust someone else with the health of your own child, especially an incompetent and self-interested government, then you know already what course you must take. You must oppose socialized medicine with the same animalistic furor as you would defend your child's room from an intruder, as I do. My choice is worth everything to me. It is one element of my liberty, and I would rather die than live as a subject or a slave.