September 2011 Archives

In September of 2009 I blogged here about a letter I wrote to the President and my Senators about prescription drug costs. That post, called My Big Fat $7,575.00 Annual Prescription Bill, received a good amount of traffic, so I thought I would do a follow up.

When Congress passed the Affordable Care Act in March of 2010, it provided some relief for my immediate problem, which was the cost of my prescriptions. This post will look at how the act addressed my problem from a practical perspective, rather than a political perspective. There are many articles that address the politics of the Affordable Care Act, if you want to read about that. I'm focusing on practical issues because, as a patient who depends on drugs every day, that was what I needed to deal with regardless of whether I agreed with the politics behind the act.

As background, my situation as a patient in March 2010 was this: I was self-employed, had two pre-existing conditions that required daily medication, and I could not buy private health insurance at any price. I was paying full price for prescriptions inside the U.S. at an annual cost of $7,575.00 (for more detail on this, see my previous blog post). In addition to my prescriptions, I was paying whatever rate I could get for office visits to see my physicians (I usually received a 10% discount as an uninsured patient).

The Affordable Care Act established the Pre-existing Condition Insurance Plan (PCIP), a for-pay program that provides insurance to people like myself who have been refused individual private health insurance. The PCIP program is administered either at the state or federal level; it varies by state. California missed the established deadline for implementation of its PCIP program and several months passed before it was up and running. When California finally announced that applications to the program were available, I downloaded the paperwork and filed my application on the first day they were being accepted. Within a month, I had PCIP insurance.

Once my insurance card arrived, I used the information packet that came with it to add up how much I might expect to spend in the coming year on prescription drugs and health care services. Refreshingly, it was a simple matter to tally my drug costs under the PCIP program. There was a $100.00 deductible for brand name drugs, which I would breeze through in the first month with just one prescription. After meeting the deductible, brand drugs had a co-pay of $5.00. All generic drugs also had a co-pay of $5.00.

I was glad the PCIP program offered flat fee co-pays instead of percentage-of-price co-pays for drugs. It is much easier to budget with a flat fee co-pay. It means I don't have to keep track of the retail price of all my drugs, which may increase in price more than once over the course of a year. It also means I don't have to call pharmacies to track down the lowest price available for multiple drugs. Although PCIP does have a $100.00 deductible for brand drugs, I was pleased to see they did not create a higher co-pay for brand drugs.

To find the true cost of my prescriptions, I also had to add the cost of the insurance premiums that bought me that discount. The California PCIP program's insurance rates are based on age and locale. I found my age and location in the rate table and discovered my premium was $371.00 a month. Then I guessed at the services I would need in a year: two specialist visits, a physical, a pap smear, a mammogram and a flu shot. Plus I added in an extra doctor's visit and drug co-pay in case I came down with an infection. Most visits had flat fee co-pays and several fell under the category of preventative care, so there would be no co-pay.

When I added up the year's costs for prescriptions, co-pays on office visits, and premiums, the total was roughly $20.00 less than my previous year's drug costs. Comparing my previous year prescription costs to current year prescription costs plus premiums, my costs were a few hundred dollars lower under the PCIP program.

The bad news was that, overall, my health care costs were going to remain extremely high. The good news was that I was getting a lot more for my money. I now had insurance coverage and could take care of basic medical visits, get recommended preventative care and fill my prescriptions for the cost of what I paid during the previous year for drugs alone.

I worry a lot less now because I have insurance coverage. With insurance, I feel free to attempt to change or lessen my use of a specific medication under a doctor's care. Before, when I had no insurance, I was fearful of trying to switch to a less expensive or different drug in case a bad reaction put me into the emergency room, with costs I would have to bear myself. Less worry and less stress equals more health.

On August 1, the California PCIP implemented a premium rate reduction. My premiums went down from $371 a month to $306 a month. I am very happy the program has been made more affordable, because affordability is a continuing problem with health care, as is the overall fragility of the health care system. But as long as I am still eligible and have the money for premiums, I expect to continue with PCIP.

Cruising by the Car Show

Red hot rodOver the weekend, the Cute-Little-Red-Headed-Girlfriend and I went to a car show on the east side of L.A. This particular show was highlighting hot rods, but there were other types of cars on display as well. In particular, we saw a number of classic cars from the 30s. While we walked around the cordoned off streets where the cars were on display, a car-themed soundtrack played over loudspeakers.

I'm not an automobile enthusiast, but I feel connected to car culture from having been brought up in Los Angeles. I've toyed with the idea of buying a vintage car before, but never taken it past the fantasy stage. Practicality tends to win out with me when it comes to transportation. Nonetheless, I admire the way car customizers rebuild and remake vehicles according to their personal vision.

The Cute Little Red-Headed Girlfriend said to me as we walked around, "There's so much love that goes into these cars." I know it sounds kind of hippy-dippy to say so, but I did feel like I could feel the affection the owners had for their cars and for their community of fellow car lovers. Like many other enthusiast communities, the car customizers appeared to have adopted several causes and were trying to raise money for them while they enjoyed themselves at the show.

Chevy Bel Air dashboardEarlier this year, I moved from the west side of Los Angeles to the east side. My intention was to move someplace where I wouldn't have to drive as much. I was tired of dealing with the gridlock on the west side, and rising gas prices also factored into my thinking. Using Walk Score, I was able to evaluate neighborhoods to determine which ones would enable me to walk more and drive less.

Since moving, I have cut down on driving a great deal, and it's improved my quality of life tremendously. This change in my daily habits was on my mind as I viewed the cars on exhibit. And it's not just me that has made a change. Slowly, Los Angeles is developing a public transportation backbone. It's inadequate, yes. But it's far enough along that one can begin to imagine the city as something other than car-dependent.

It's strange to feel nostalgic for something--a car, a lifestyle, a time in history--and at the same time recognize that thing's faults. It's odd to feel love for something you know will never come back. I have great attachment to certain stretches of highway in Los Angeles. Trajectories of speed and scenery that can only be experienced by car. Time and traffic have rewritten those roads, and slowness has erased their magic. I'm choosing to look forward to whatever comes to take their place.

The Missing Were-Women

Bare-chested werewolf under a full moonI was perusing the t-shirt offerings over at The Mountain awhile back when I ran across an image that made me pause. It was an image of a werewolf in a typical pose, at the moment of turning. The creature's head was that of a wolf, while the body remained a man's body--though a hairy one. The creature's shirt was in tatters, a sign that the animal self was ascendent.

I wanted a shirt with that image on it, but I wanted the creature to be female. And I realized I'd never seen a female werewolf posed like that, so I did the obvious thing: an image search. The results didn't provide me with exactly what I wanted. The images I found tended to look too much like a woman or too much like a wolf. I was looking for the hybrid state.

While I was clicking around the web, I ran across an article on female werewolves on the website Jezebel. The article mentions an issue I'd considered myself: why weren't there any female Lycans in the Underworld movies? Apparently the female star of the Underworld series, Kate Beckinsale, had answered this question during an interview with MTV.

"Because that could be really horrifying," Beckinsale explained. "Hairy, thuggish women." Well, yes, that's exactly the point. That's why I want to see them.

The Jezebel article also turned me on to Elizabeth M. Clark's college thesis, Hairy, Thuggish Women: Female Werewolves, Gender, and the Hoped-for Monster, a large part of which I read online. Clark analyses monster films with female werewolves, which she calls examples of "the masculine-female-grotesque."

The thesis contains many photos from the films discussed, along with Clark's analysis of those physical aspects of the female werewolf shown on screen. For the most part, the films avoid showing "hairy, thuggish women" either through their shot choices or by showing only creatures that have been fully transformed into wolves. The exceptions Clark notes are worth reading about, though.

A bare-breasted woman and a wolfWerewolves came to mind again recently while I was reading Wayne Koestenbaum's new book, Humiliation. The book has received mixed reviews but I bought it on the stength of an endorsement from John Waters, which goes a long way in my book. I just started reading it but based on how frequently Liza Minnelli's name has come up in the first chapter I'm prepared to say I like the book.

Koestenbaum writes, "Humiliation--as experience--resembles a fold.[...] The self-abased soul undergoes an inner contortion.[...] Through the action of folding, the outer and inner realms change places.[...] This fold (the self become a seam) is the structure of revulsion."

This description of humiliation as a fold, a contortion, a pulling of the inside outside, made me think of the werewolf's transformation. What Koestenbaum calls "the self become a seam" is that hybrid state where human turns into wolf. This scene of humiliation is also the scene of horror and revulsion we know from so many movies.

In some recent werewolf stories, lycanthropy is equated with disgrace or humilation. In the Harry Potter series for instance, Professor Lupin, a werewolf, feels shame regarding his condition. And in the Underworld series, the Vampires keep the Lycans enslaved for centuries.

How interesting that women, the sex so intimately connected with the state of humiliation, should be held back from being seen as lycanthropes. It would be, I suppose, "really horrifying," to use Beckinsale's words, to see this most debased creature.

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