Saturday, October 15, 2016

A Solution to make Everyone Happy

A recent article in Drug Topics talks about how pharmacists with a Doctor of Pharmacy shouldn't refer to themselves as "Doctor."

Dr. Ruth, Dr. Laura, Dr. Phil... all have the title "doctor," but you wouldn't ask any of them to diagnose a wart on your finger because they're not physicians. Yet, they have most certainly earned the title of doctor in their respective fields.

Ironically, we have a fumbling fool in the media, the ostentatious Dr. Oz. This actual physician is out there recommending utter nonsense, week after week, but no one questions his use of the title "doctor."

Don't get me wrong... I don't think pharmacists just out of school should insist that patients call them doctor. I don't think seasoned pharmacists should introduce themselves as doctor. It is, however, appropriate for a name badge, business card, or any official documents whether it be a hospital pharmacy, compounding, or community pharmacy. 

I have a technician who started using the title "Dr. FirstName" as my title a couple of years ago. I never asked anyone to call me that, but it stuck and now most of my patients call me that. I don't mind, and with these patients I earned the title with excellent counsel and advice.

Pharmacists with the PharmD degree are not physicians, but have earned the degree "Doctor of Pharmacy" and most certainly are entitled to the respect for having attained that degree, just like any other field with a doctorate designation.

What's interesting to me is that Pharmacy Times has published two articles about how PharmDs should not use the title "doctor" while promoting the advancement of having Doctors of Pharmacy obtain "provider status." Doesn't that seem rather contradictory to you? Yes, it does to me too.

So I have a proposition. Since so many out there that have a big issue with Doctors of Pharmacy being called "Doctor LastName," (as if there is something wrong with that) how about we as a profession adopt something more patient-friendly? After all, we are without a doubt the most accessible healthcare professional out there.

Drug Topics magazine wants us to find our own solution?

Ok, I have one.

I propose we adopt the professional title of "Dr. FirstName," just like my tech started calling me in the pharmacy, and just like so many of my patients call me now. I'm their clinical pharmacist, and they defer to me when wanting to know about their medications. I'm not a physician, but I am a professional in terms of drug-related matters. I'm Dr. FirstName, and that makes all the difference in the world to me and to them. Because of the use of my first name, it's not formal or pretentious, yet still establishes a level of rightly-earned respect and dignity.

I have a Bachelor of Science in Business Management and an MBA. For those that don't know, an MBA is a "Master of Business Administration." But I don't go around asking people to call me "Master." Certainly pharmacists are not physicians, but Dr. Dre is not a physician either. Nor is Dr. Ruth, Dr. Phil, or Dr. Laura. But you wouldn't call them by any other name, would you? It's a show of respect.

There is respect in a title. And in the case of pharmacists... especially RETAIL pharmacists, there should be real professionalism in the profession... and a title is a good place to start. When you tell pharmacists NOT to use their deserved and earned title, you're belittling the profession which ironically wants "provider status."

Retail pharmacy is already rife with a plethora of situations that reduces the credit of the title we have obtained. When pharmacists are expected to work long hours without a break, without a meal, without time to go to the bathroom, all in the name of metrics, that belittles us as a profession. And now we're expected to give up the one thing... the one title, that we worked so hard to obtain? I think not.

When pharmacy magazines tell us not to use our deserved title, it trivializes what we do. This is incongruous with these same pharmacy magazines that try to promote the career by obtaining the designation of "provider status."

I have to tell you, if Dr. Oz can go on television week after week promoting absolute nonsense and garbage, even to the point of having to defend himself before a senate committee, then I don't have a problem with people calling me Dr. FirstName.

Monday, January 18, 2016

Why Medicaid is WRONG for America

This is my first blog post. I hope you will stay with me as I might get long-winded.

I have chosen as my first topic the issue of Medicaid. This seems to be a heated discussion among many online. My perspective is from one as a pharmacist in a rather well-to-do town: Scottsdale, Arizona.

First let me give you a little background. I am a native of Arizona. I was born here, I grew up here, and two of my three college degrees are from Arizona. 

Pharmacy is a career change for me. I started out my career as a self-employed business person with a native American arts and crafts gallery in Carefree, Arizona. It was the family business and I took over one of my father's stores and paid him a hefty fee every month for the business until it was paid off. 

My father made a lot of money in the Indian jewelry business in the late 70s and 80s. By the time I took over in the early 90s, the collectors that made it such a lucrative business had started to pass on. New, young collectors were not taking their place. Native Americans changed their styles and used a variety of different stones and looks to interest new buyers and collectors, but the business still waned. I decided as far back as 1999 that it was time to get out of the business. 

Having been in the business world, it seemed logical to get an MBA. At the time I completed the MBA program at ASU, they were ranked 12th in the nation. It was also just after 9/11 happened and NO ONE was hiring, especially not MBAs.

That's when I exited the Indian jewelry business and decided to pursue what I thought was a recession-proof career -- pharmacy. It was something I had interest in many years ago but didn't think I could actually do it. Well, it was hard, but I did it, and I graduated in 2007. I was older than most of my classmates, but not by much... and I wasn't the oldest in the class. There were many others changing careers too.

I started working right away in retail pharmacy for a major grocery chain pharmacy right in Scottsdale. I worked my butt off and discovered the big differences between what they teach you in school and the real world of pharmacy. 

What I've noticed here in Scottsdale (and everywhere) are the increasing numbers of patients going on state-funded Medicaid. It has given me a first hand view of the system, and more specifically, the patients that are on Medicaid. I'd like to discuss what is Medicaid, and secondly why it is bad for America.

Part 1: What is Medicaid?

"Medicaid was created by the United States government to provide health care to people who have low incomes and cannot afford health services or health insurance on their own.

Each individual state manages their Medicaid services and programs. Whether or not you or your family is eligible for Medicaid depends on several financial criteria, such as your employment, how much you make, and how many dependents you have along with other requirements." See this link on Medicaid.

Let's reexamine that first paragraph. It's for people who have LOW INCOMES and CANNOT AFFORD health services on their own. I have no problem with that. But what I see at the pharmacy doesn't make sense with that. What is the low income they're speaking of? 

"Under the health care law more people can qualify for Medicaid based on their income. Newly included is anyone who makes less than 133 percent of the federal poverty line, which is $15,521 for an individual or $31,721 for a family of four."

I don't have a problem with these numbers. They're very low and people who earn this little should qualify for assistance until they climb out of their predicament. Let me make this clear to you from the beginning: I don't harbor ill will toward helping people who really need help. I have a problem with people taking advantage of the system.

Some simple research sheds light on the issue. The problem that in THIS neighborhood the average sales price of a 4 bedroom home is $385,000 with an average mortgage payment of $2,000. There are apartments, or course, with one bedroom units starting around $800 a month. This is an expensive zip code.

So the problem is that the Medicaid requirements and the expensive zip code does not make sense together. When you see people come in month after month to pick up several medications with zero co-pays that live in or pay for expensive properties, have expensive jewelry, key rings that indicate they drive expensive cars, and make phone calls with expensive cell phones with expensive cell phone covers... well then you begin to realize it really is more than a coincidence.

When you talk to other pharmacists in similar neighborhoods with similar problems, then you really begin to wonder the hell is going on here. When you see people with a large Starbucks drink in their hand while picking up their "free" medication... you wonder. When they suddenly have $200 cash to pay for a narcotic not covered on my Medicaid... you wonder. My conclusion is that there is a shift of the mindset of American. I'm not one for conspiracy, but in my microcosm of healthcare I have seen some definite repercussions of this shift to dependence of the government. 

Recently I was sitting in the parking lot early one morning watching the sunrise and waiting for my shift to start. Ahead of me some crows had discovered a discarded McDonald's bag and had surrounded it. 

What's interesting is that by far the majority of crows were in the periphery just watching. More were in the tree above just watching. One or two crows would go into the bag... doing the work of scavenging, then when leaving the onlookers would try to take away the fry that the worker crow EARNED by working for it!

It occurred to me that our society is getting to be more, and more, and more like this flock of crows. As the Medicaid and other handout groups increase in ever larger numbers, we're left with a smaller set of people who actually work for what they have, surrounded by people who want the workers to work for them.

I'm not even sure that most of these people are aware of what's happening. They've slowly become so dependent on the government (and other's people's work) that they not even be aware that what's going on is wrong. Is it a planned dependence? Or did it just develop over time. You decide.

While you're deciding... take a look at this old blog post by a blogger named Crazy RxMan. It pretty much sums up what I've thought as well. 

"When the public becomes dependent on government assistance, they lose the drive and tenacity to pursue income on their own. Why would you work hard for something if it is just going to be given to you?" 

Part 2: Why Medicaid is bad for America?

Let's take a look at Medicaid:

1. You're getting something for nothing. Others pay for it.

2. The taxes collected to pay so you can get something for nothing are not donations or charity . This money is taken OUT of my paycheck and given to you. This is wealth redistribution.

3. Wealth redistribution is a form of socialism. 

This is what I see in the pharmacy. I work in a nice neighborhood with expensive homes. Since 2008 I have seen more people IN THIS NEIGHBORHOOD go on Medicaid each year. Supposedly, the system (in my state) is based on income, not assets.

What I see are people who are driving luxury vehicles, living in very wealthy homes, and somehow qualifying for Medicaid to pay for their medication. What's worse is that these people KNOW they're taking advantage of the system and they don't care. Why am I forced to have a portion of my paycheck taken away from me to pay for medication for people who are unwilling (that's NOT the same as UNABLE) to pay their own way?

"In any system, there will be fraud," you tell me. That's certainly true, but with Medicaid it is rampant. The big problem is that once you fall into this mindset... this Robin Hood sense that everything should be "fairly" divided, you also open up a continued false sense of entitlement. (see here). Along with that is an attitude... the attitude among Medicaid people is getting... FEISTY, for lack of a better term. When something is free, it becomes taken for granted, and then it becomes expected (just like the Yellowstone bears). I can't tell you how many times I've been barked at by a Medicaid patient at the window, yelling at me because Medicaid said to charge them $3 or $5. "But it's SUPPOSED to be FREE!" they will wail.

There's also an attitude where they think because they don't have to pay, it should be available to them immediately. Medicaid patients are not patient. They get it for free and they expect it to be done immediately. If a narcotic is too early, they scoff. If we don't have their favorite manufacturer, they complain. A twenty minute wait is unreasonable. Keeping track of their own Medicaid information is also unreasonable. "Can't you just look it up on the computer?" they will say, angrily.

When discussing this with people, a common theme I hear over and over is that I'm selfish and uncaring because I want to keep what I earned. Why am I selfish for wanting to keep what I earned? Why is the crow selfish for wanting to keep the french fry he dug through the bag for? Why is that wrong? Seriously. Why?

If you've noticed, there are plenty of wealthy liberals that promote socialism... to a point. If you'll notice, none of them have given up all their wealth (or for that matter, even a significant portion of it) to join the working class to work with other liberals side by side. No, they support OTHERS being taxed, OTHERS getting their wealth redistributed, but not their's. As long as it is someone else's money, they're ok with it. But as Margaret Thatcher pointed out, the problem is that you eventually run out of someone else's money. What then?

If you're like me, you're paying a lot of taxes. I already give. I give plenty. Yes, I earn more than most people earn. I also went to school to earn that degree and I also pay more each month in school loans than most people pay for a house payment. I'm already taxed excessively. What I earn and what I take home are two vastly different things. I'm already paying. Why do I need to pay more? How dare you suggest I'm not paying my fair share.

Socialism calls for "redistributing the wealth" by taking from the "rich" to give to the poor. It imposes taxes that punish those who have been able to take greater advantage of their productive talents, capacity to work or thrift. It uses taxation to promote economic and social egalitarianism, a goal that will be fully achieved, according to The Communist Manifesto, with the "abolition of private property."  See here.

Those who promote socialism like to use catch phrases. One that I hear quite often is "the greedy rich want to stay rich." So, let's think about this for a moment. People that have money from earning it are somehow greedy, but those that want to take money away from other people and distribute it among other people aren't greedy? You want to take money out of my pocket without doing anything to earn it, but that's not greed? Do you really not see the problem here?

"Economic growth and shared prosperity are best cultivated under economic systems that rely on the market, while at the same time regulating the market to prevent monopoly and malpractice, and providing education, health, infrastructure and security to their population. Such an economic system can only survive in a durable fashion in a politically inclusive society, blending individual freedom and democratic decision-making.

Socialism is consistent neither with such an economic system nor with its political underpinnings, and consequently, the track record of socialist countries to create prosperity has been pitiful." See this.

When you work for something for yourself, and I mean really work for it, you feel like you've earned it. You worked hard to get it and now you feel like you own it. Remember back to the first job you had. My first real job was in a restaurant in 1977 in a small tourist town. I was only 13 but looked 16 so my father was able to get me a job. 

My title was the cook's helper on the breakfast shift. I had to make waffles, butter toast, and keep the cook supplied with whatever he needed to prepare the various breakfast orders. It didn't stop there. I also had to prepare foods for the afternoon and evening rushes, AND for the next day. The BIGGEST thing I did was peel 150 pounds of potatoes every day for home fries the next day. And all this took place in a shift from 6:30 am to 2:30 pm. 

Every day I worked my butt off. I had every Tuesday off and every other Sunday. My hourly salary was $2.75 per hour. I was told if I worked the entire summer I would get a bonus of $0.25 for every hour I worked if I stayed the entire summer. I did stay and I did get that bonus check at the end of the summer. At the end of the summer I cleared about $1,500. To a 13-year-old in 1977 it felt like I was a millionaire.

I earned every dollar. No one did the work for me. I did the work, and I was paid for every hour I worked there. I didn't ask to paid for not working. I didn't expect anyone to just give me money. I EARNED it.

Unless you've worked on your own, and most people have, you won't understand this concept. These days people expect to be given money by family, the government, their church, other benefactors... for doing absolutely nothing to EARN it. There's a sense of entitlement... a feeling inside where the person tells themself "I deserve to get paid for doing nothing." And why do they feel this way?

Some people feel like something is owed to them because of something that happened with their ancestors 150+ years ago. My ancestors were slaves, which makes me feel bad, so I deserve money for the way they were treated.

Other people are told by government agencies that because of their situation, their health status, inability to work, or because of their income they "qualify" for "assistance." And you know what, people have bad luck on occasion. I've certainly gone through my own years of bad luck. I've had family help me. I've had the church help me. And I'm very grateful and paid back my debts. But I never expected anyone to pay my bills forever.

The other aspect about this is that to pay for these government assistance programs, the money has to come from somewhere. NEWS FLASH -- money doesn't grow on trees. Every dollar in food stamps and Medicaid... it comes from TAX PAYERS. Medicare used to be entirely funded by the people that pay into it. You pay now in taxes, years later you get back for what you paid in. That's a reasonable idea AND the way it was originally set up. Unfortunately, Medicare expanded to where other government entities couldn't keep their hands out of that pile of money and now it takes MORE taxes than ever before to keep the people who paid into it for years able to draw it back out. What's more, the government has mismanaged and played around to the point where Medicare isn't what it used to be. What your grandpa Bill paid for over his lifetime and should receive based on what he paid into the system isn't what he's getting back now that he's retired. It's a government-run Ponzi scheme of epic proportions and WE ALL LOSE.

And while Medicare and food stamps are a big issue, my big issue is Medicaid. That's the part of the entitlement fiasco that I see every day I work.

So what's wrong with Socialism? Again, let's start with a history brief... this country is the UNITED STATES. It was founded on FREEDOM. Freedom of life, liberty, and the pursuit of happiness. Our country is based on CAPITALISM. Capitalism is:

" economic system in which investment in and ownership of the means of production, distribution, and exchange of wealth is made and maintained chiefly by private individuals or corporations, especially as contrasted to cooperatively or state-owned means of wealth." See: LINK 

In Capitalism, you can run your own business, however you want, any way you want, as long as you obey the laws and don't hurt anyone. You're FREE to choose and YOU enjoy the benefits of your labor. At my summer job at the restaurant, I exchanged my time to help out in the kitchen and peel those potatoes for a weekly paycheck. The owner of the restaurant paid all his employees to work the restaurant. He paid the suppliers for the raw foods we turned into meals. He paid the electric company to heat the oven and provide the lights. He charged people to eat the meals and the difference between all the money he took in and what he paid out was HIS profit. It was HIS restaurant and he was FREE to spend his profit how he wanted... he was FREE to pursue his happiness how he wanted for his work in managing and directing the restaurant. NO ONE made me work. It was my decision to trade my time for the paycheck. I was not mistreated. I did not complain that his paycheck was higher than mine, or the cook. The cook worked a lot harder than I did and he was paid more to do his job. This IS Capitalism, and it has been the source of revolution for advancement for the ENTIRE WORLD.

Because people were free to pursue... free to create any business they wanted and reap the benefits, discoveries were made. Electricity was harnessed, as was gasoline and coal. The train was invented which created the ability to move goods quickly across the United States at lower costs. People pursued their dreams and reinvented farming, thus creating easier and faster ways to get food available to people everywhere. Chemists were able to get reimbursed for their hard work with chemicals, this paving the way for modern drug therapy and medicine. 

If you've every been sick, there's a good chance you've had a "Z-pack." That's the nickname for Azithromycin, a broad spectrum antibiotic created for a wide variety of bacterium in the human body. It's saved many lives as have other antibiotics. This medication was not created by someone who just wanted to better mankind. This was created by people who wanted to be reimbursed for their hard work. Wanting to be reimbursed for your hard work doesn't make you greedy. It doesn't make you selfish. Seeking after a reward for your hard work doesn't make you selfish.

What does make you selfish is when you live in a nice home in a wealthy Scottsdale neighborhood and expect other people to pay for your medications. That's selfish.

Do you use Google every day? How about Facebook? Or Twitter? None of these popular applications were invented for "fun." They were all invented to make a profit. The masterminds of these applications had no idea they would be as popular as they became. Some billionaires, such at Bill Gates, realize they have more money than they'll ever need and they seek to give back to the community. That's THEIR decision, and it would be ridiculous for any government agency or a young college girl (Keely Mullen) and that their money be taken from them. (See VIDEO). 

It would make me very mad to think of this mentality. Suppose I had returned from my summer job in 1977 and someone in the class heard about my earning $1,500 that summer. No one else in the class had a summer job. So that's not fair. You should evenly distribute your $1,500 among the classmates. That's only fair, right? 

But I EARNED that money! I peeled all those potatoes! I don't mind giving what's necessary for the police that protect us all and the roads I used to get to work, but NOT ALL OF IT or any unreasonable amount! That's crazy!

And as crazy as that it, imagine the tax rates you pay now! How much of your paycheck disappears every week. Money YOU EARNED is taken away from you. Not a reasonable amount to handle the infrastructure of our nation... no, it is UNREASONABLE and you have such little say as to how it is spent!

As preposterous as this little example sounds, THERE ARE PEOPLE running for president and people among us that think that is perfectly reasonable.

Fraudulent use of Medicaid is wrong. Unfortunately, it is only a symptom of a much larger problem... a problem that is being fueled as the future mindset for America. To me, that's dangerous in a number of ways.

Saturday, December 19, 2015