I don't Understand how Some Things Come about

I was perusing the latest MDNG that had been sitting on my desk for two weeks and read Mike Hennessy’s (MDNG Publisher) invitation for readers to become bloggers. I love to write. I’m editor of our Hillsborough County Medical Association BULLETIN, based in Tampa, Fla. I think I’m rather opinionated, ok, very opinionated and also think that medicine, as noble a profession as it is, is in dire trouble. I offer my viewpoints and hope that others will read and agree with me, although I guess you get more popular if people disagree.

I’ve been in family practice for over 33 years and am currently an employee in a large primary care organization in west central Florida. It’s nice not to be the one hassling with insurance companies over contracts and reimbursements. I went to Tulane undergraduate and medical schools, did my training at Tampa General Hospital in Tampa, and went into private practice in 1976. I’ve had my share of bad practice management companies and bad management in general, and I can empathize with others who have experienced the same.

I don’t understand how some things come about. Who exactly came up with the “donut hole” in Medicare Part D prescription plans? How can you expect senior citizens on a fixed budget, who are getting pricey meds from their doctors to treat their diabetes, hypertension, hyperlipidemia, and other disease entities, to pay a reasonable percentage of costs, and then stop at some point and make them responsible for thousands of dollars out-of-pocket for meds? It’s not their fault that brand name diabetic, antihypertensive, and hyperlipidemic meds can cost hundreds of dollars. Even generics can run into the high double figures. And many doctors don’t even know how much these meds can cost.

President Obama is now talking about reforming health insurance more than healthcare. How about a subsidized plan where patients pay no more than $10-$15 for any generic and no more than $25-$30 for any brand name, as long as that drug would have an average retail price of less than $300 a month? Wouldn’t life be a lot easier without having to get a prior authorization on a medication that a patient has been taking for 3 years and doing well? Wouldn’t the insurance companies ultimately save money without having to hire staff to send us denial letters? Wouldn’t it benefit the patients to be able to buy and take the best medications we can prescribe? If they were affordable, wouldn’t that improve compliance and make for healthier patients? And if a patient couldn’t afford the price of a brand name, then he/she could discuss that with their doctor and they could decide what’s best for them, not some third party benefits manager. Hmmm, “benefits manager,” an oxymoron for sure.