Friday, March 11, 2016

Dirty Secrets: Corruption and the American Way

When Bernie Sanders rails about our "rigged" economy,something deep inside me  resonates with that, likely for reasons Bernie cannot know, except in the general sense, but from the specifics of my experience, a rage wells up. He has tapped into that.
The best Congress money can buy

When I ran a small business (a solo practice of medicine) I tried to buy health insurance for my secretary.  This was an eye opener into the deep seated corruption/perversions pervasive in the American way of doing business, a corruption abetted by the government agencies we would expect to restrain misbehavior.  

As we tried to choose among the different health insurance companies (back in the early 1990's) we tried to be intelligent consumers, and we read through the thick directories of participating physicians and saw her doctors listed in Blue Cross Blue Shield of the National Capital area,  and we thought, great, she can keep her doctors if we go with this plan. 
But then we phoned the doctors' offices listed, and one by one it turned out her physicians no longer participated;many had stopped accepting this company's insurance years before.  So we went on to the next company and then to the next: same story with each.  

"This is false advertising!" my secretary said. "They tell you if you buy this insurance you get this benefit, care from Dr. X or Y or Z but you do not. You actually have only three or four choices and none of them are doctors I'd want to see on a dare."  
When I phoned the insurance companies they said, well, those doctors once did participate but have stopped and the companies said they  simply hadn't had a chance to update their catalogs of participating physicians. No chance, you understand over the past 10 years.  They did not update their catalogs every year because it was too expensive, they said. But clearly, when they did, they never bothered to delete physicians no longer on their "plan;" they only added names.

It isn't your father's healthcare any more

It was institutionalized bait and switch.  Every health insurance company in the Washington, DC area published bogus catalogs of participating physicians which listed every doctor who had ever had a contract with those companies, even though those doctors had bailed out years before. Every company, in effect, was claiming it offered you wide choices while in fact offering only very narrow choices.

So I called the department of Health and Human Services to protest this was a form of deception and all the companies seemed guilty of it and I was bounced around various agencies and none of the government employees wanted to hear about it. It was like talking to cops who didn't want to take the rape report because it was just so much paper work for them.
Only one thought counts
Corruption is not new

Another instance:  Examining my 20 page office phone bill I discovered a $15 monthly charge from a company I did not recognize. Calling the number provided, it turned out to be a company which was charging me for internet services to the office, and this fee  was part of my phone bill. 
Trouble was, we did not have internet services in those days and I had never purchased this, never authorized it. 
Calling the company collecting the charges they claimed my secretary "Donna" had approved of the contract.  Donna, of course denied every having talked to them and said she would never approve such a thing and would have put that on my desk. "Oh, but we have a recording!" the company man said and he played back a recording, obviously doctored,  in which you hear Donna's voice saying, "Donna," and then the company man asking if she wants to approve this contract and then you hear Donna's voice, shopped in, saying, "Yes." Of course, what they had done was to call the office and ask who they were speaking to, and recorded that and then some other "yes" and there you had it.

So I called the FCC and a variety of government agencies and they said that the phone company was powerless to remove the charge from my phone bill and there nothing anyone could do about this case of fraud. In effect, the government, the phone company, a utility, were complicit in the scam. They knew this company was engaging in theft but wanted nothing to do with the complaint. 

More recently, I confronted  a more complicated but no less noxious example of how the rich bilk the poor and good people just stand by and let it happen.

I sent a patient to Walmart with a prescription for insulin. There are only 2 companies who make insulin: Lilly and Novo. Walmart has done a huge service to the nation by buying insulin, pasting the Walmart label on the bottles and selling the insulin deeply discounted.
  But recently, Walmart switched from buying from Lilly to buying from Novo. When you write a prescription with your electronic medical record program you cannot order insulin as just "insulin." You have to order it by the brand name, Lilly insulin called "Humulin" or Novo insulin, called "Novolin." 
It's as if you send your kid to the grocery to buy milk and he calls back and says, "They won't sell me milk. They insist I pick Hood Milk or Stoneyfield milk."  
"And you say, 'Any milk will do.' And the clerk at the register says, "You have to choose a brand."
For some years I had written "Humulin" because I knew that's the brand Walmart sold. But I forget Walmart has switched to Novolin recently, and write for Humulin and when the patient arrives at Walmart, she is handed her two bottles of insulin and she has her precious $50 in her hand, but she is handed a bill for $300, which is about half of her monthly rent. 
The fox is very clever and knows many things

I get a frantic phone call from the patient . I call the pharmacist and the pharmacist says, "Well, you ordered Humulin."
 I say, "But until today that was $25 dollars a bottle." 
"Well," the pharmacist says. "We switched to Novolin, and you didn't write for that."
"So you couldn't just give her the Walmart insulin you knew I wanted and she wants?"
"Not if you wrote for Humulin."
"And you know they are exactly the same insulin, just made by different companies. It's like Market Basket milk vs Hannaford's milk."
"They are not designated bio-identical by the FDA. We have to follow FDA rules."

So I phone the FDA and I'm told:
1/ In the first place:
The FDA has not determined the two are "bio-equivalent" or "bio-identical" whatever that means.  The FDA spokesman would not comment on my assertion there's not a whiff of difference between the NPH insulin made by each company.
 Insulins do differ by "type" depending on how fast the insulin works, how fast it dissipates: R insulin starts working quickly and disappears quickly; NPH starts slowly and hangs around all day. But both Lilly and Novo make NPH and R and they are exactly the same.  You can use a 1/4" wrench and whether it was made by Sears or Home Depot, it works the same.

2. In the second place, the FDA lady tells me: 
"The state of Massachusetts writes the applicable laws which prevent the pharmacist from substituting,  so stop phoning the FDA to complain. This is a state issue."
"But the pharmacist told me it was an FDA rule."
 "Well, the pharmacist was wrong. Everybody blames the federal government for everything."

Tea party Republicans in charge: You're on your own

"This is what makes people angry about government," I told the FDA lady.
"Well, I can't help that," she said. "Anyway, it's the companies who make the insulin."
"And it's the companies who make the rules, apparently," I said. "And the FDA hasn't stopped the states from screwing things up."

A hedgehog

So Bernie Sanders is on to something when he talks about how what is "legal" in America is all too often,  immoral.
 It used to be legal to refuse to serve a Black person who walks into your restaurant or who tries to sit at your soda fountain. 
It used to be legal to own another human being.  
Those laws never made it right.
She fights alone
Did the cream rise to the top or was the game rigged?

Elizabeth Warren has tried to make an issue about what is done to "consumers" daily by big corporations but she cannot change things from the Senate. And she cannot change things alone.

The image of the executive offices at Lilly and Novo, lined in mahogany, occupied by men in thousand dollar suits, who have second homes in Hilton Head or wherever, who live lives of luxury, while my patient stands at the counter at Walmart, clutching her $50, which is a lot of money to her, and suddenly, she is faced with a bill for 6 times that amount, which is half a month's rent, because of some "rule" which was made to protect the profits of drug company executives, just makes my blood boil.

Big guys sucking the blood from the little guys, draining them pale.

Doesn't bother me to see our country go from white to brown. Doesn't bother me to hear a cacophony of languages around me at the mall or on the street. Diversity is just fine with me. Makes us stronger.

What bothers the hell out of me to see people who were born poor and who stayed poor but who worked hard and did the best they could to be treated this way by rich people.

Pretty clear who the cops work for and who the law does not protect

These are just three instances in which corporations injure the little guy and the government stands by like cops watching protesters beaten to a pulp by thugs.

You just want to say, "At long last, sir, have you no sense of decency. Have you no sense of decency at all?"

The hedgehog knows only one thing, but he knows it very well

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