Category Archives: Life

“Have you had a fall recently?” my doctor asks these days.  Well, Doctor, yes I have.  I fell into a donut hole.  I didn’t think I was that feeble.  And I never saw it in front of me.

I wasn’t even aware of my fall until my spouse went to our pharmacy last month to pick up my monthly supply of Eliquis.  She called me at home from the pick-up window and said, “They are charging $111 for your prescription — that can’t be right, is it?”

I had been paying $37 a month for Eliquis, a so-called Tier 3 “preferred brand” medicine that helps prevent clot-formation if you have atrial fibrillation or certain other conditions.  Eliquis costs more but has many advantages over traditional anti-coagulants like warfarin (an inexpensive generic) including less unintentional bleeding, almost no food interactions and no routine blood testing.  I am glad that God invented Eliquis.*

In any event, I told my spouse I would pick up the prescription myself, after I had a chance to look at my Medicare Advantage coverage.  Doing so, I nearly (metaphorically) fell over.   Medicare’s prescription drug coverage gap (popularly called the donut hole) begins when $3,820 has been spent on drugs during the calendar year.  I thought the $3,820 referred to what I have spent on drugs, but no — it means what the drug companies were paid.

This is an important distinction, because after you enter the donut hole, you pay more for all of your medications, not just brand-name drugs.  I am now responsible for 25% of the $441 paid to Bristol-Myers Squibb for my monthly supply of Eliquis, and 37% of the $76 paid to Rising Pharmaceuticals for a 90-day supply of my generic blood-pressure pills.

In the Sea of Donut Holes (with the Blue Cross Meanies)

I will remain in the donut hole until I have paid $5,100 out of my own pocket for drugs, which is not going to happen this calendar year.  So my fall into the donut hole will cost me an additional $303, assuming there are no medical surprises.

Shame on me, someone who is reasonably well-versed when it comes to what I pay and what I get, for not paying more attention to my benefits statements.  The donut-hole rules, as complicated as they are, should not have come as a surprise to me — but I’m still taken aback at how much money the drug companies get for my medications, even the generics.

You may have read elsewhere that provisions in the ACA (it’s alive!) will finally close the drug coverage donut hole in 2020.  But here’s the thing, as Joe Biden likes to say: closing the donut hole on paper does not mean I will pay the same copays all year long.  The fact that I paid (only) $37 for Eliquis before I hit the donut hole is best thought of as a benefit of my particular plan — by law, I was “responsible” for up to 25% of the cost even before I reached the donut hole.  Under some other plan, I could have been paying $111 a month from the outset instead of that $37 copay.

Confused?  I know I am, and I’m not alone.  Wading through the explanation of costs and coverage on medicare.gov calls for a lot of patience if not an accounting degree.  As far as I can tell, not a whole lot is going to change for me in 2020.  I will start out with low copays, but once my total drug costs reach $4,020 (the new threshold), I will pay 25% of whatever price the drug company asks.  I will stay in this (ghost) donut hole until my out-of-pocket costs reach $6,350 (a $1,250 hike from 2019), after which I will pay 5% of the retail price for my medicines.

As there is no standard Medicare drug plan, I can’t predict what all this means for others.  If you take even one non-generic drug, read your coverage documents carefully.  Not that this gives you a lot of choice.

• • • 

One last item, about the politics of all this ridiculousness.  Paul Krugman pointed this out in 2005, when Medicare Part D was signing up its first participants:

Republican Congressional leaders who rammed the bill through in 2003 weren’t actually trying to protect retired Americans against the risk of high drug expenses.  Their purpose was purely political: to be able to say that President Bush had honored his 2000 campaign promise to provide prescription drug coverage by passing a drug bill, any drug bill.

Once you recognize that the drug benefit is a purely political exercise that wasn’t supposed to serve its ostensible purpose, the absurdities in the program make sense.  For example, the bill offers generous coverage to people with low drug costs, who have the least need for help…  Meanwhile, the people who are actually likely to need a lot of help paying their drug expenses were deliberately offered a very poor benefit.  According to a report issued along with the final version of the bill, people are prohibited from buying supplemental insurance to cover the doughnut hole to keep beneficiaries from becoming “insensitive to costs” — that is, buying too much medicine because they don’t pay the price.

This has always been conservative dogma: if we make health care easy to get, people will use too much of it; if we force people to pay for it, they will reconsider whether they really need it; and if we let health care prices seek their own level, that will effectively ration it. 

It is easy to spot the flawed premises here.  It presumes people like going to the doctor and taking medicine and would seek out such activities if there were no restraints.  It presumes ordinary people have the means to shop for health care as well as the expertise to judge its cost-effectiveness.  It presumes that cost-sharing by patients is an appropriate way to get patients to use lower-cost drugs — when the only real choice most patients have is whether to get their prescription filled.  And it equates health care with consumer goods, in that some people can afford the best and some can’t and that’s the way it oughta be in America.

Maybe conservatives would like to talk about cost-sharing with people who take Revlimid for multiple myeloma.  (Medicare spent $3.31 billion on Revlimid in 2017, more than any other drug.  Eliquis came in second at $3.07 billion.)  The copay for one dose of Revlimid is often $7,000 or more, which would immediately push a patient through the donut hole.  Or maybe conservatives should ask people with chronic hepatitis C whether they can just live with it — after all, even the new generic version of ledipasvir costs $15,000 per course.  Finally, with respect to so-called lifestyle diseases, maybe conservatives would like to share their evidence that forcing people to bear the financial burden of past unhealthy behaviors serves to deter those behaviors.  (I think it only serves to punish them.)

The Medicare Part D approach to prescription drug coverage is based on false premises and should be scrapped.  Health care should be a societal burden, not an individual one;  yes, we should all live healthier lives, but no one I know asked to have atrial fibrillation or multiple myeloma or hepatitis C.  Every patient should receive the most cost-effective treatment that has been shown to be medically effective and respects her quality-of-life.  The patient’s personal financial situation and the type of insurance she has should not be factors in selecting her treatment.  This implies no more deductibles, no more donut holes. No more misguided incentives placing burdens where they don’t belong while failing to address the real causes of outlandish medical costs.

So here is where I part ways with the “Medicare for All” and “Public Option” proponents. Medicare may be better than other alternatives but it isn’t good enough.  I am waiting for other presidential candidates besides Bernie Sanders to step up and say so.

_____________

* U.S. Patent 9,326,945 was issued May 3, 2016 to Jatin Patel et al and assigned to Bristol-Myers Squibb.  The next drug God should create (with help from Dr. Patel) is an over-the-counter anti-inflammatory that one can take with Eliquis.
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My Life in Toys

Do one’s toys say anything about a person?  I think so — in fact, your toy stories may reveal more than you might imagine.  Here are some notable toys and games that I grew up with and the stories behind them.

FIREBIRD 99 (Remco).  This is one of the earliest toys I remember.  The activities on this yellow car dashboard included: turning the wheel right and left (which made the speedometer rise and fall); beeping the horn; running the windshield wiper; opening the glove compartment; pretend-lighting a cigarette; and losing the key.  As I recall, the batteries for the toy ran down quickly and were not replaced often, which made the Firebird 99 a lot less fun to drive.

COOTIE (Schaper).  Many of my childhood toys and games were hand-me-downs from my sister and Cootie was one of those.  It was probably the first dice-based game I learned.  You know the drill: rolling a (1) gets you the body, (2) the head, (3) one of the antennae, (4) one of the eyes, (5) the proboscis — my favorite — and (6) one of the legs.  My sister was my usual opponent and, even though Cootie is all luck, it seemed to me she usually won.  I must have remembered my defeats more vividly than I did my victories.

PARCHEESI (Selchow & Righter).  Luck was also the main ingredient in the board game Parcheesi, another hand-me-down which I played with my (Great) Aunt Pearl on nights she looked after me.  Aunt Pearl had a kind heart and a frisky sense of humor — and the patience to spend hours upon hours playing simple games with me.

In all the times we played Parcheesi, I’m not sure Aunt Pearl ever set up a blockade to impede my progress or used any strategy whatsoever.  In fact, I would not be surprised if she used her knowledge of the rules to ignore them in my favor and help me win. 

The same was true in our dumbed-down version of Monopoly.  Aunt Pearl and I played Monopoly without money: properties were simply awarded to the player who landed on them first, and the Chance/Community Chest cards with dollar amounts were ignored.  When all the deeds had been handed out, the game ended and the player with the most properties won.  Aunt Pearl would complain how terrible it was when she was sent to jail; her laments only delighted me more as I hopped around the board and she languished.

Later, when I grew old enough to play Monopoly by the rules, I was disappointed to learn how complicated the game was when money, mortgages, houses and hotels were involved.  Aunt Pearl’s version was more fun.

LIFE (Milton Bradley).  If I remember correctly, I convinced my mom to buy me this game on one of our many visits to the local department store.  She would browse the (boring) sewing patterns on the mezzanine, while I headed downstairs to the (interesting) toy department.  Life appealed to me because it had cars, roads and mountains.  The money part was secondary.

I played Life mostly with my best friend Bill.  At our age, we didn’t understand insurance or bankruptcy and we never used the numbered betting strip either.  Instead we turned the game into a race to the finish line.  We counted our money at the end as a formality, but the real winner was whoever finished first.

Today I remember Life mostly for the fact that I left the game on our picnic table one day after we played, and it rained that night, and the next morning I learned that cardboard is not waterproof.  The game was ruined.  Mom gave me a lecture about taking care of things — and bought a replacement.  Life lesson learned.

MARBLES!  I inherited my sister’s glass marbles and later on was given a bag of steel marbles by my Uncle Rudy, who was actually the husband of the sister of the wife of my mother’s brother.  And that is pretty much all I recall about Uncle Rudy.  But I do remember the names I gave to various marbles. For example, the one marked P (see photo at left) was Peppermint, M was Marvel and F was Fenwick.

Marvel was my favorite.  She/it was slightly bigger than the other marbles, the Babe Ruth of the bag.  She/it also excelled in the marble race game I invented.  In that game, I would select a pair of marbles, put both in my hand and then toss them toward the baseboard at the other end of my bedroom.  The marble that bounced back the farthest won that race and was then matched against another opponent.

There were a couple of fateful developments in the marble race game.  One was the race when Marvel lost a big chip from her/its side and could no longer roll straight.  The other was the day I noticed all the pockmarks in the baseboard and started to contemplate what Mom would do when she noticed.  The marble race game ended thereabouts, with Mom never saying anything about the noise in my room or the baseboard.

MATCHBOX JAGUAR (Lesney).  My friend Bill had different toys than I did and he also seemed to have discretionary income.  One year, Bill was into buying Matchbox cars.  He and I would take the bus downtown and visit Majestic Wallpaper and Paint which, strangely, also sold model cars and these miniatures.  Matchbox cars cost about 59¢ each but for me they may as well have been $59.  I did find enough money one day to buy a red Jaguar E-Type with real windows and a functioning door.  It was the only car that looked like something James Bond might drive.  Today this toy, in good condition, would go for $30, a 50x increase in value.  Not bad, considering that a real Jaguar E-Type that cost $6,000 in 1963 is now worth about $200,000, or only 33x appreciation.

The Jaguar wasn’t my only toy car. I collected a few others from Alpha-Bits cereal boxes.

BOOK OF KNOWLEDGE FLASH CARDS (Grolier).  Some of my books, toys and games weren’t handed down or pleaded for but doled out by Santa.  One Christmas, I was given a set of “Famous People” flash cards with illustrations on the front and short biographies on the back.  Among the cards in the box were George Washington (of course), Charlemagne, Helen Keller and Joan of Arc.  The one I remember best is Mohandas Gandhi, the only brown-skinned person in the 54-card set. (The other Asian was Genghis Khan; there were no African-Americans.)  The cards were often laid out end-to-end as roadways around my bedroom, where I drove my Jaguar over the likeness of Mohandas Gandhi.

DOMINOES and LINCOLN LOGS were other hand-me-downs that I generally used for purposes other than intended.  I played Dominoes with Aunt Pearl a few times, but I doubt that we ever followed the rules (which I still don’t know).  The best thing to do with Dominoes was stack them in a line and then tip them over.  Same deal with Lincoln Logs — the main reason I built things with Lincoln Logs was to crash my cars into them. 

Both Dominoes and Lincoln Logs served long and honorably as guard rails for the road network in my bedroom.  When I ran out of flash cards for “paved” roads, I used Lincoln Logs to stake out a few more miles of “dirt” (i.e., carpeted) roads.

CAREERS (Parker Brothers). Scorecard for Careers game.  Credit: owlworksllc.comThis was my favorite game and I’m not quite sure why.  Each player began the game by writing down a (secret) success goal comprised of money, fame and happiness in arbitrary proportions.  The paths (careers) that a player selected during the game helped him accumulate the money, love and fame points he needed to reach his goal.  As a result, I did a ton of uranium mining and sea travel by the time I reached sixth grade.

Although the game was 90% luck, it did illustrate the value of an education as well as the link between risk and reward. There were many decisions to make, which made Careers feel more strategic than it was. Most decisions, in retrospect, were as meaningful as picking ice cream flavors.  In the end, a player either felt vindicated for having concocted a winning formula, or frustrated by his inability to meet the points-and-money objective.  The message to losers: it was your fault for choosing a bad goal!

HARDBALL / SOFTBALL.  I grew up in a baseball neighborhood.  Guys might toss a football around for a couple of hours each fall, but we played baseball from when the springtime mud was still squishy to when you had to wear gloves on both hands.  Maybe it was because our beloved Pittsburgh Pirates had won a World Series whereas the Pittsburgh Steelers stunk.  (How times change…)

We usually played softball — as opposed to hardball, i.e., baseball — because a softball was easier to pitch, easier to hit, and less dangerous to try to catch.  Softballs also held up to mud and water better than hardballs did.

My dad started me off with a Richie Ashburn infielder’s glove (above).  It was okay for a couple of years, but when we started to play hardball more often, it became clear that this glove was not only useless but a liability.  It hurt to catch a ball in the thinly lined pocket; but if you tried to snare it in the web, the ball threatened to slip right through.

I coveted the first-base mitt that our “gang leader” Ralph used.  It seemed like Ralph was able to catch anything in its huge web, even if he threw his glove at it (which he would do).  But as mentioned earlier, I had no discretionary income — until Mom agreed to let me use the spare pennies my parents had always tossed into the giant glass jug in the living room.  I bought a new first-base mitt with those pennies, and it didn’t matter that I hardly ever played first base.  That glove could catch anything I could reach wherever I played.  It was worth every penny.

TAPE RECORDER (Panasonic).  Reel-to-reel tape recorders seemed to be a thing in the 1960s — two of my friends had one so I had to have one too.  What do boys do with tape recorders?  We get creative.  Bill and I pretended we had a radio show and made up silly skits.  If we got bored with that, we would make crank calls and record them.  One day we came up with the idea to call random people in the phone book and ask them to spell rhinoceros, supposedly for some school assignment. Better yet, we (Bill or I) claimed to be Tom Tardio, vice-president of our student council.  The results were hilarious.  We could hardly contain our giggles at the mangled spellings offered by our surprisingly cooperative targets.

In what would be our final call that day, the woman who answered the phone and heard my pitch said, “Tommy?!  How are you!  You sound different!”  Somehow, out of 25,000 numbers in the book, we had managed to call one of Tom Tardio’s relatives.  In a panic, I said I had a sore throat but avoided the subject of how she knew Tommy/me.  The woman went ahead and spelled rhinoceros for us, and as I recall her spelling was just as bad and hilarious as the rest.

Sorry, Tom, for having borrowed your identity to generate some good junior-high laughs.  I don’t think we hurt your reputation, much.

SUBARU WRX was the midlife crisis car.  It was yellow.  It was sporty.  It had a turbo and a spoiler and a leather shift knob.  What it did not have, as I would learn after a few thousand miles, was a decent clutch.  When shifting from first to second, your choice was a shuddering lurch or a clutch-cooking engine surge.  Nothing in between.  This was hardly midlife-crisis performance.

I threatened to install a new clutch but never followed through.  I drove it for seven years without finding the sweet spot, at times resorting to starting out in second gear.  I wanted to sell the WRX but my spouse wasn’t ready, so it became her winter car.  Crisis resolved.

Photo by Bas Fransen from www.basfransen.comJAGUAR 2016 F-TYPE.  I end with an imaginary toy. Oh, the car is real all right.  Someone somewhere in the world owns and drives this car.  In fact, it is probably one of many exotic sports cars this person has in his collection.  But I can only imagine how it drives, as I would never spend what it would take to find out.

I will get along just fine never driving a Jaguar.  The important toys are not the ones that cost a lot but the ones that encourage us to explore ourselves, each other and the world.  Some of my most valuable toys in that regard were: blocks; blank paper; crayons; sand; and even dry leaves floating on rainwater heading to the storm drain.  And not to get all Wonder Years about it, but a day at the creek with a friend, a sandwich and a fishing rod instills a sense of personhood in a ten-year-old boy that he does not get by playing with cars by himself in his room.  I do know that I wouldn’t be me without all of that.

______

Jaguar F-Type photo by automotive photographer Bas Fransen (basfransen.com).
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QUESTION

Joe:  I’m a newbie on this forum, so I apologize if you have answered this question before.  I can’t figure out how to do x.  I already tried a, b and c.  What am I doing wrong?  I know you are the experts on this, so I hope you can help.  THANKS! 

ANSWERS (13)
☒ indicates most popular answer

1 ☐  SergeyB:  Try Google?

2 ☐  Narco88:  You shouldn’t do x.  No one does x anymore.  You should be doing y.

3 ☐  Shatnrr:  Duplicate question — already asked and answered at this thread.

4 ☐  BCoolBabee:  I don’t answer people who use all caps.  Be rude somewhere else.

5 ☐  Moderator:  Question is off-topic for this forum and has been marked for deletion.

6 ☐  CoreMan:  How do you expect us to help if you don’t give us enough information?  Provide all configuration data, do a total memory scan, and post the results below.

7 ☐  PankoCrumb:  Instead of a, b and c, you should have done c, b and a.

8 ☐  Frank van Pelt:  Use Linux.  If you were using Linux you wouldn’t need to do x.

9 ☐  XMakoHe:  Install Inscrutable and give permission these you allow them to private. But do not set real on option, because that is global selection which voids a next step at all. Or those still do not support local setting, run Unthinkable in proxy alias.  By doing these, your accessing is greatly controlled by yourself.  After that, turn off the immediately to set your system into a peace quite world again.  Then now can try x.

10 ☒  RealMom:  Check out this link!  I make $5,000 a month working part-time at home and so can you!

11 ☐  FizzyPopz:  Read the manual! 

12 ☐  Eeyore:  Probably a fatal virus.  You need to wipe your system clean and start over.

13 ☐  Stu2:  People who don’t know what they’re doing have no business asking questions on this forum.  Goodbye.

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