ONE DAMN THING AFTER ANOTHER

I’m back.  I did not watch the inauguration because I spent the morning on the phone with Tier 3 Apple Support people trying to remove spyware that was not detected by my Malware program.  It was messing with my contacts, even trying to invade bank accounts, blocking people even when they were white listed, and other mischief.  I have to say that all the Apple people were patient, cheerful, and a pleasure to work with.  They were also all female.  

This is a long-standing problem and since I depend on my email to make contacts for writing, it’s a problem that can cost me money and make enemies because people think I’m ignoring them.  We may have gotten the problem licked.  It was installed through 3rivers.net who claimed they knew nothing about it.  Techies there are hired through some agency elsewhere.  I suspect they were bluffed by a rogue.  Maybe they should be bonded, but bank tellers are and that’s who stole my credit card number.

The next prob on the list is fleas.  We’ve still got them.  The systemic flea med that you put between the shoulder blades of the cat made Bunny allergic and now she’s looking pretty moth-eaten plus spending a lot of time chasing itches.  There are 8 cats that come into the house and four of them can’t be caught except with a trap.  A second kind of flea med “Flea Bully” turns out to be laundry soda.  It says,  “Lather the cat thoroughly and rinse well.”  Right.  The third kind is for carpets:  “Sprinkle on, leave four hours, vacuum thoroughly.”  Seems to work.  The other basic recourse is laundry of bedding and clothing — not the cats.  I don’t have a washing machine and the nearest laundromat is thirty miles away.

The one I visited this time was so degenerated that only four tubs worked — I usually use five.  One failed to drain and, alas, it was the one with the heaviest flannel sheets — which I could hardly lift when saturated, much less wring with arthritic hands.  Luckily the profoundly cold weather has broken so the temp was in the low Fifties because a Chinook wind is blowing.  I slung the sopping stuff onto the clothesline where it at least dried out enough to be draped on the furniture for the last stage, merely damp.  Fleas would have drowned.

The next problem (aside from the temps of twenty below zero F) was that the main town water supply, which goes past my house, broke in the usual place, the corner between my block and the Lutheran church.  This happened in the night and drained the contents of our spiffy new watertower for the second time, this time into the streets.  In order to find and mend the break, it is necessary to dig, but the ground must be thawed first, which means blasting it overnight with propane.  In this case, the break was not where they expected it, but upstream and sending water through the ground next to the pipe.  More thawing, more digging, more days.  Water was rerouted around my block, so only my block had to make dry camp.  The mayor opened city hall so people could get water jugs filled there, but I knew nothing about that.  As soon as Corky had water, he filled my two big jugs.  I bought a couple of packs of drinking water, which is always in the stores because some people think Valier water tastes funny.  This is good training for a major disaster, like maybe a huge earthquake triggered by frakking.

As soon as I realized there was no water, I whipped over to the Mom and Pop store to buy water.  But I should not have driven through the standing water in the street.  My pickup went crazy.  Then it seemed okay but went nuts again when I tried to go out to the trash roll-off.  Peter, a kind Hutterite young man, pulled me out of the drifts and into town.  After drying overnight the pickup worked.  The diagnosis is a wet distributor.  The answer is to take the cap of it off, spray everything with WD40, which drives out water, or even use a cloth to dry things.  Yesterday the pickup was running and I took a load of trash out to the roll-off.

In the meantime I was using up stuff from the back of the fridge and dumped a half-cup of old poppyseeds into a bowl of biscuit mix.  Seemed like a success until a poppyseed got stuck under a gum and raised a huge abscess that lasted through all the rest of this stuff but has finally subsided, I think because the seed finally festered out.

Running parallel was war with pharmacies.  The Shelby one in the ShopKO store has a new pharmacist but still has their old policies (controlled by corporation rules and insurance regulations) that one cannot renew a prescription until four days before the old one runs out and the pharmacy cannot keep on hand enough meds to be sure of renewing a prescription completely.  Over and over, they would give me a half-dozen pills to keep me from dying but promised to send the rest by mail.

I got indignant and moved to the Cut Bank Albertson’s pharmacy.  They turned out to be really OSCO and no different except that they never remembered to send the remainder of the pills.  Anyway, there was a three-day weekend and the weather kept me from driving.

So twice in this month I’ve gone for nearly a week without my prescription.  I hadn’t thought about the implications of corporate pharmacies.  There are three county seats about thirty miles from me.  Great Falls, which is a very small city, is the closest major shopping hub on this side of the 49th parallel.  Lethbridge, Alberta, is a little bigger but in Canada.  My passport has expired and I can’t afford renewal.  To get that done I would need to go to Conrad on certain days.

This time I switched my pharmacy account to Conrad.  It is a locally owned business and when one gets prescriptions filled there, a special niche is established in which they keep your meds in amounts that will cover you for the next period out.  They don’t run short, and they WILL mail meds.  They are in “my” county (Pondera Co. — Pend d’Oreille, earring in French).  Since I went to get my meds, that’s the reason I used that wretched laundry.

So yesterday, just as I settled into my re-boot after lunch nap, I got a phone call that seemed to be from some Montana state oversight person checking up on pharmacies.  She wanted to know if my pills were working, if I were taking them regularly, chatchatchat, until I began to smell a rat and asked bluntly who she was working for:  Osco/Albertsons in Cut Bank.  What she really wanted to know was why I left Osco and her intent was to persuade me back.  I gave her an earful and told her I would NEVER use that pharmacy again because I do NOT want deceptive nanny-ladies calling up to quiz me in a way only my doctor should.  I was yelling.

The Apple Support people were in Las Vegas.  All this stuff — indeed, life itself — is pretty much a gamble.  Three cats are sneezing and snoozing, now that the weather is warm enough to release god-knows-what.  I thought Finnegan had died in the night, but he finally roused for breakfast.  Tuxie is throwing up.  Momo, formerly Mimi, can’t be touched but accepted bits of my frozen waffle.  I never had human children.  Good decision.  But there’s really no escape.

MORE PLAN D

The most important revelation in my investigation of Plan D is that it is NOT required.  I can simply choose not to subscribe.  That moves the consideration to a whole new level.  Also, according to the 2013 rules, a person who receives Extra Help can change companies anytime -- not just before December 7.  

The most discouraging aspect of this search has been that no matter WHOM I ask for help and advice, what I get is a pitch for or against “Obamacare” -- which is irrelevant.  They told me when I was doing public relations with the media that if someone asked me a question I either could not or did not want to answer, I should answer a question that was similar but not the same.  I hear this strategy among politicians and even doctors again and again.  Sometimes they don’t even do “similar.”  Just change subjects.

I will not depend only upon the advice of doctors about which drugs I should take, the same as I will not depend upon insurance companies to tell me which policies I should engage.  The influence of big pharma, the many instances of flawed studies and reversed recommendations, my hospital chaplaincy which gave me access to patient files and physician reviews, and my brief brush with statistics, have all told me that medicine is NOT magic, that what cures one person can damage the next, and simply perpetuating oneself is not the best goal.  I barely managed to resist the craze for estrogen replacement at menopause.  Everyone talks about testosterone as psychoactive -- try switching in and out of estrogen!  It’s being thirteen again.

So, where am I?  Personally, I mean.  What Plan D should I choose?

1.  QUALIFICATION:  I'm under the poverty line as currently defined.  It moves yearly.  I’m on the boundary and could be pushed out in a different year, but now I get Extra Help.

2.  DIAGNOSIS:  My only conditions are “metabolic syndrome” and “ocular migraine”.  That means age and behavior driven glucose and blood pressure levels that are marginally too high as well as tired eyes from obsessive reading and writing.  These are all best managed with diet and exercise -- very minimal medication.   But these latter must be monitored with formidably expensive lab tests.  Much of medicine now is based on these tests rather than direct observation of the body.  For a five minute conference with a nurse-practitioner, a blood draw, and multiple panels of statistics that showed the same figures as last time, I was billed $546, all paid for by Plan B.  NOT Plan D.  

At this “checkup” I asked for the new “shingles” vaccine but there was none on hand in the clinic (which means a new billable visit to get the shot) and no one knew whether it is covered or under which plan.  Ideal levels of glucose vary in the minds of various physicians.  Some say that slightly older people should maintain slightly higher levels.  Others think that lower is always better and will push a person close to the danger level, I discovered from experience.  One cannot relax vigilance. 

3.  DEDUCTIBLE:  This is the amount a person is expected to pay before the insurance  begins to pay.  On the list I’m looking at, most companies specify a little over $300, but if one is classified as “Extra Help” (meaning poor) then the deductible drops to maybe $65.  Some companies offer NO deductible. This is a good thing since the total cost of my drugs for the whole year is less than $300 -- at non-negotiated prices.  The cost of my YEAR’S drugs  if the insurance company has negotiated special very low prices for the meds is little more than $65.  Of course, the insurance companies owned by drug store chains have a lot of leverage for deals -- probably as much as a small African country.

4.  CO-PAY:  Some policies ask the patient to pay part of the cost of drugs, separately from the issue of what is deductible.  Co-pays, like deductibles, can be arbitrarily changed by the insurance company on the first of every year AFTER you have had the chance to change policies.  There is some kind of relationship which is meant to allow the insurance company to preserve its profit.  BUT a person with Extra Help can change any time.  No advisor knew this, though it’s in the Medicare book, which is about the size but not the helpfulness of my MAC OSX operator's handbook.

5.  MONTHLY PREMIUM:  In the beginning this was the essence of the game: put your money in the pot and gamble on whether you’ll need it.  Now it is the subject of negotiation and accommodation.  If you are poor enough, you will get Extra Help with your premium.  Extra Help also lowers your deductible.   Medicare “Extra Help” will not necessarily pay all your premium, but Montana (among other states) will pay what’s left, so possibly the total covers ALL the premium.  But don’t get to assuming there is NO premium, which is sort of my mistake.  Someone has to cover it and you’d better check out who is doing it or risk -- as I did -- neglecting $8.50 payments until it has become a $450 debt.  Since the insurance company made no fuss about it, I suspect there is some mechanism for the government to compensate for deadbeats like me.  (I AM paying off this debt.)  Plan B payment is simply deducted from your SSI check before you get it, leading to the illusion that there is no premium.

6.  GAP COVERAGE:  Another negotiating chip: as soon as this phenomenon was invented, it could be widened, discounted, redefined.   The idea is that if over time you exhaust a certain amount of insurance coverage, you are suddenly not covered.  Then at some late date you’re covered again.  Makes no sense to me.

7.  ACCEPTANCE OF GENERICS:  Some plans require generics, others require name brands.  There are enough small differences in formulation that some people don’t benefit from generics or vice versa.  Another wiggle point that benefits Big Pharm.

8.  ACCEPTANCE BY DOCTORS:  Some docs will accept whatever Medicare pays and others won’t.  There’s a strong sense of entitlement on the part of the docs as well as a tendency to want to push the easy stuff off onto, for instance, nurse/practitioners.  When all they do is look at test scores and then follow the indicated formula, there’s not much difference, but there is a definite culture diff between the two levels of education as well as culture diffs within the medical profession, esp. if you include O.D.'s with M.D’s.  Only one nurse-practitioner, a man, has ever given me a checkup by really looking at me, checking reflexes, feeling my feet and so on.  Maybe one-third of docs (male or female) have done the same.  But the bills for service were the same.

9.  SPECIFIED FORMULARY:  Whole separate booklets specify what meds the insurance company will pay for.  I don’t get it.  I guess some treatments are considered ineffective or dangerous.  One suspects thumbs on scales.  Why the fancy word: “formulary?”

10.  LEVEL OF SERVICE:  The constant complaint when it comes to drugs issued by free clinics, whether it’s the Indian Health Service or a public health HIV-AIDS service, is that the drugs arrive after long waits, inaccurately provided, handed over with contempt, sometimes not in stock, and so on.  Of course smart drug store chains high-light good service since it is something they can require of their employees without extra investment of money. But somehow service provided to people who are needy is often given with contempt.  Isn’t it reasonable to give needy people MORE kindness?

11.  CONFLICT OF INTEREST:  And here’s where I balk and begin to think of just going without Plan D.  Big Pharma is involved with the politics of government health care and insurance -- like CareMark drug chain owns SilverScript.   Also, it is forbidden for insurance salesmen to pitch their plans to Extra Help people -- so who are all these “agents” who call instantly if I pull up an insurance company on the computer?  They are “licensed” -- that means nothing.  Maybe passed a test.  Semantics.

12.  SCARE-MONGERING:  Every person is in danger of dying at every moment of their lives.  A flaming piano could drop out of the sky on you before supper.  It’s not likely, but it’s possible.  We all are held taut between wanting to risk for the possible benefits and even for a possible increase in skill and experience, but wanting to stay safe enough to risk again on another later day.  Everyone has to find their own trade-off.

So I have to think about the likelihood of me needing much more expensive drugs in the future: cancer, heart, trauma.  I get a coupon for being such a clean living non-risker.  I also have good genes, for which I thank the precluded ancestors of myself who lived such hard, dangerous and probably defiant lives that they were killed early, thus removing their faulty genes from my pool.  There’s also something to be said for my mother who believed in cod-liver oil, farm food, and donkey labor by kids.