Pricey little pill.
Ron’s series continues. Today’s focus is Big Pharma:
When General Motors Corp. CEO Rick Wagoner has nightmares, they might be about Toyota. Then again, they might be about Mae Gumbinger.
The 79-year-old wife of a GM retiree in Port St. Lucie, Fla., takes 15 prescription medicines each day. She takes Plavix to thin her blood and Mincandis to lower her blood pressure. She swallows Namenda and Aricept for her memory, Clarinex for her allergies and Nexium for her stomach. One pill helps her sleep, another pill cuts her pain, and six more prescriptions are supposed to help with a skin condition she’s had for years, though she can’t remember what the skin condition is and she’s pretty sure the drugs aren’t helping.
General Motors will pay about $16,000 for drugs this year for Mae and her husband, GM retiree Ralph Gumbinger, the equivalent of giving the couple a new Chevrolet Malibu.
The story is full of little jaw-droppers; every story about GM is full of jaw-droppers. Most Americans simply don’t understand just how big this company is, which is the underlayment for a certain what-can-you-do attitude you find around here among GM workers (most people) and those whose fortunes are tied to it (everyone). The company is the Nimitz, a giant aircraft carrier plowing through heavy seas. It can take a few torpedoes. If it can’t exactly turn on a dime, well, it’s unsinkable too.
Or so people believe. Please, no Titanic jokes.
Anyway, those jaw-droppers: GM spends $17 million a year — $17 million! A year! — on erectile dysfunction drugs. Sixty percent of the money spent on antibiotics is flushed down the toilet, because they’re prescribed for conditions that don’t respond to antibiotics. In 1999, seven years ago, half of GM employees were getting name-brand drugs, even when generics were available. The introduction of a generic equivalent for Zocor, a cholesterol-lowering statin drug, presents the opportunity for GM to save $100 million a year.
(Again: $100 million. For one drug. This is one big company.)
The passage about Zocor is unclear, but seems to imply that workers have a choice to switch to the generic; “education and financial incentives” are the plan to get more of them to do so. How about this for a financial incentive: Switch to the generic or pay for it out of your own pocket, bub. I’ve had drug plans like that, and I know they’re out there. The day Zocor went off-patent earlier this year, pharmacy benefits managers all over the country were on the phone to the generic drug plants in India at 12:01 a.m., wondering when those pills were going to start rolling out, and how soon could they get them. When $100 million is at stake, you play hardball.
Unless of course, the choice is part of a labor contract, which is entirely possible. Defiance, Ohio, my husband’s hometown, is a GM town, and its retirees are common in my mother-in-law’s social circle. They whine like toddlers over the idea of a $5 co-pay for prescription drugs, because they used to pay nothing, and now they have to pay something.
As this NYT column points out, Most families in the 1950’s paid their medical bills with ease, but they also didn’t expect much in return. After a century of basic health improvements like indoor plumbing and penicillin, many experts thought that human beings were approaching the limits of longevity. “Modern medicine has little to offer for the prevention or treatment of chronic and degenerative diseases,�? the biologist René Dubos wrote in the 1960’s.
But then doctors figured out that high blood pressure and high cholesterol caused heart attacks, and they developed new treatments. Oncologists learned how to attack leukemia, enabling most children who receive a diagnosis of it today to triumph over a disease that was almost inevitably fatal a half-century ago. In the last few years, orphan drugs that combat rare diseases and medical devices like the implantable defibrillator have extended lives. Human longevity still hasn’t hit the wall that was feared 50 years ago.
Most of those retirees, once upon a time, would have taken their gold watch, shuffled off to Florida, played a little golf and quietly expired by their 70th birthday or thereabouts. Now they’re living to vast old ages, helped along by technological and pharmaceutical wizardry. Now it’s time to pay. Especially if you’re taking drugs for restless legs syndrome.
Oh, well. Don’t want to bore you all silly.
Last Saturday was a fine, sunny one, and I spent my Saturday bike ride stopping at garage sales. (Does this negate the aerobic exercise? I choose to believe it doesn’t.) Scored a nice cut-glass wine coaster and a silverplate serving piece, seen here:
It holds a 9-by-13 baking dish; you can practically see the potatoes au gratin in it now, can’t you? It was black with tarnish, and as you can see, a little elbow grease works wonders. I paid $6 for the two items, and overheard a conversation among the proprietors:
“Can you imagine? He offered me a dollar. I told him, ‘I would rather throw this away than let you have it for a dollar!’ He made me so mad.”
This is not a useful attitude to have in business, is it? Certainly not in garage sales. The bargain in a garage sale is simple: You offer crap you don’t want anymore, in hopes that others will not consider it crap, and will pay you a little bit of money for it. “A little bit of money” — this is the garage-sale bargain, at least my garage sales. You can set your prices wherever you want, but you’d better be willing to come down a little. Many don’t seem to understand this. Case in point: I stopped at a sale not long ago, and immediately spotted a small nightstand. I can use one of those. It was from the L.L. Bean cottage collection, and was brand-new, still wrapped in plastic. A hand-lettered sign said: “Amazing bargain! Was $299, now $199!” Which seemed pretty damn high, but OK, let’s take a look. I opened the drawer, which slid out smoothly, and revealed the original price tag: “WAS $299, NOW $199.”
In other words, someone made a bad purchase, couldn’t use it, and now wants to get their money back. All of their money back. You’ve got to be kidding.
The silver piece was priced at $5. I offered $4. She agreed. Now it has a new home and Thanksgiving to look forward to. I bet that nightstand is still in the original seller’s basement, waiting for the next inflationary spike to make $199 look like a bargain.
Not happening. There’s a generic equivalent now: Ikea. It’s the 21st century, and it’s every man for himself.
(Order your Amazon through me and I earn 4 percent. Click the “powered by Amazon” logo.)
brian stouder said on September 27th, 2006 at 10:20 am
There’s a generic equivalent now: Ikea. It’s the 21st century, and it’s every man for himself.
The GM articles are excellent; very enlightening, and sobering. One of the inescapable aspects of the GM story (at least to me) is that GM apparently was handing out blank checks, and was making no (or woefully inadequate) provisions for how to cover them.
How many articles have we read over the years about very tough negotiations and “give-backs” and all the rest? And in all that, STILL no one on the corporate side ever twisted arms about “generic” prescriptions (to name just one thing that is worth billions of dollars)?
One can understand that times were different when the contracts were originally signed; it can also be said that the cars they built were very different.
Everything changes over time – and it strikes me that the effort to NOT change GM’s self-insurance benefits (aka Santa Claus’s bottomless bag of toys), even to the exclusion of generic prescriptions, is akin to barking at the moon, or cursing at the tides
Randy said on September 27th, 2006 at 10:44 am
My father receives extremely generous health benefits from Kraft Foods. He and my mom are on a variety of medications, and they receive several thousand dollars of coverage for these, along with dental and other benefits.
But here’s the thing: my dad worked for Kraft for two years, part-time! It was his last job before retirement, and they’re giving him benefits like he was there his whole life. Crazy.
Be careful when considering shares in Kraft, or whoever owns them…
brian stouder said on September 27th, 2006 at 11:06 am
Say – a digression; what is a “Public Editor”? An ombudsman? Or would this person more rightly be described as a PR flak?
check out this piece, about (Pulitzer prize winning) NY Times reporter Linda Greenhouse
http://www.msnbc.msn.com/id/15026618/
the ‘public editor’ says that, although he never got a single complaint about her reporting (ie – what they pay her for), still
““It’s been a basic tenet of journalism … that the reporter’s ideology (has) to be suppressed and submerged, so the reader has absolute confidence that what he or she is reading is not colored by previous views�?
Really?
Joe Kobiela said on September 27th, 2006 at 11:26 am
Being a auto worker I think I can talk a bit on this subject. When things were good the big three made buckets of money, and instead of investing in the future they spent like drunken sailors buying company’s they had no bussiness buying and giving out huge bonuses to upper managment. Mean while down on the shop floor the guy sweating away, actually making the product wanted a little more for his effort, so when contract time came he told the boss, Look lets float a little of that cash down here or will just stop making the cars, So the big three gave us little guys a bit more and we continued to work and make the cars.Fast forwards to now, Things are bad, boss says look we have to cut back so say good buy to your pension and health care. We say fine we will help out, and buy the way how much are you in managment cutting back??? Answer, WHAT US CUT BACK YOU MUST BE JOKING, See the problem?? I am working for less than I made 15 yrs ago doing the same job, my stock is worth zero due to bankruptsy and yet my CEO wants a 16,0000,000.00 buy out because he said his pay was tied to stock opptions he wont get so he told the judge, he should be paid in cash.
They can screw me but they can not make me like it.
Joe
nancy said on September 27th, 2006 at 11:44 am
Joe, your problem is legion here. When Delphi announced its bankruptcy-related cutbacks, which involved making salaried workers take a 50 percent pay cut, they also quietly disclosed they’d be paying fat bonuses to certain managers. They didn’t want the brass running for lifeboats when the ship needed to be pumped out.
One writer here said the thinking was, “What’s the harm? How could the rank and file hate us any more than they do now?”
Dwight Brown said on September 27th, 2006 at 2:02 pm
“Oncologists learned how to attack leukemia, enabling most children who receive a diagnosis of it today to triumph over a disease that was almost inevitably fatal a half-century ago. ”
I remember watching a PBS special a few years back that talked about this at some length. I still get kind of moved thinking about it: we’ve gone from “almost inevitably fatal” to…well, I don’t know what the cure rate is now, but I believe it is pretty darn high.
And I keep thinking about those doctors 50 years ago, who were basically watching these small children dying, trying desperate treatments (because, hey, something might work, and they’re going to die if it doesn’t). I wonder how many thought to themselves “If I was just a little bit smarter, could I cure these patients?” I’m not a doctor, but I think it wasn’t a question of smart: it was a question of having the tools to make the tools that could make the cures.
I know I couldn’t do the kind of work those doctors were doing back then. Or, from a more contemporary viewpoint, in the early days of AIDS. Not only am I not cut out to be a doctor for a lot of reasons, but I don’t think I could stand there, watching patients die, and asking myself the “If I was…” question.
I don’t know how the people who do this endure.
Danny said on September 27th, 2006 at 8:51 pm
You know, sometimes I am just not the sharpest tool in the shed. I just got you play on Alanis Morissette’s song “Jagged Little Pill.”
Duh.
Pam said on September 28th, 2006 at 9:16 am
If the Gumbinger’s in Port St. Lucie were on my corporate plan, they would have seen their share of the pharmacy tab jump to $2,100 annual out of pocket expense before the co-pay of $6 kicks in. And depending upon your pharmacy tab, that total amount could be due in January, not spread out over the entire year. The $6 looks pretty good then. It’s expected that the $2100 share will go up next year and the year after. The medical side saw similar jumps. I used to work with a man who took so many pills that he didn’t know what half of them were for. And many people who do this need to take pills to sleep and pills to wake up because the pharmacy load screws up their biorthymns. After he retired, he weaned himself off almost all the pills and can finally sleep without the aid of a pill. While I think that workers should share more in the expense of health care, I agree with Joe K. above, that we’re not seeing equal pain at the CEO level.
Jen said on September 28th, 2006 at 11:10 am
We need GM and other such large organizations to be telling it like it is to government leaders. Americans have been trained to think that they should have perfect autonomy in making choices about healthcare even though, in many cases, they lack the information needed to make medically sound choices. And doctors have, historically, relied too much on their clinical judgment and experience rather than tested paractice guidelines.
All that is changing now. The cost is out of control, and, although the mortality rates for AIDS and leukemia have dropped dramatically, there are many indications that the quality of care most people get–as opposed to what is available–is poor. It’s incompatible w/ established standards of practice; it’s riddled with medical errors that lead to needless deaths; and, compared to some other countries, it produces poor results.
Somebody needs to have the political courage to tell the American people and the health care establishment that we need to change. We are paying too much and getting too little.
Jim in Fla said on September 28th, 2006 at 12:01 pm
On the other hand, it occurs to me that most of the medical advances we’ve see in the last half century came about because somebody (or some company) believed they could make a boatload of money developing a cure. Without the financial incentive, polio, leukemia, aids and many other diseases would probably still be an early death sentence.
mary said on September 28th, 2006 at 1:31 pm
I have a nephew who watched his best friend die if pediatric leukemia at the age of 10. Joe Menardi, we still remember you. He decided then to become a doctor, and now he’s an oncologist, specializing in leukemia. He went to Ivy League schools on scholarships: Dartmouth, Columbia, Yale. I’ve never seen such a driven person. He’s doing exactly what he said he would do thirty years ago. I feel like such a lame slacker by comparison.
brian stouder said on September 28th, 2006 at 3:02 pm
I feel like such a lame slacker by comparison
well, the world needs people like him to slay medical dragons (or at least give them a good fight) – AND people like you, who can go toe-to-toe with (reputed) corporate ones, such as Leona Helmsly
mary said on September 28th, 2006 at 4:09 pm
It’s not the same, Brian. He’s doing bone marrow transplants and saving lives. I was just playing chicken with a plastic surgery victim.
brian stouder said on September 28th, 2006 at 4:57 pm
Mary – I know what you mean. I remember years ago – in my ‘religion period’ (to take a line from Little Big Man) the realization dawned on me that one is never really doing as much as one could.
The whole concept of the “Third World” sort of illuminates that defensive apartness. Church-goers could give up their western life-styles, and run missionary schools in the east Africa; Doctors could volunteer to work in Paraguay; regular workaday schmoes (like me) could work every day and every weekend, at whatever local cause needs the help.
I think very few of us do all we can do; and likewise, not many people are flat-out doing nothing.
By way of saying, I suspect the world is a better place for having you in it