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.

Via Matt Taibbi's blog, I discovered the website of artist Geoffrey Raymond. A dedicated portrait painter, Raymond creates drip paint portraits of Wall Street's wealthiest and most nefarious characters, then invites the public to write comments, or annotations, on them.

His portrait of Bernie Madoff, shown here (view hi-res version here), contains annotations such as: "'Behind every great fortune there is a crime.' --Honore Balzac," "It's a proprietary strategy. I can't go into great detail," and "Prick, you screwed your family, your friends, good people, sleep well!"

Raymond has solicited annotations from the public by standing on the street, attending events and through his blog. In an interview about his work, Raymond states why he chose to make his paintings using an interactive process: "One of the reasons I paint the way I do is the idea that I provide an opportunity for people to have a say in sometimes catastrophic events over which they have no control -- even if it's only a sentence or two on a painting."

Raymond further notes that the annotations give each painting a documentary quality, with insights into a particular period of time on Wall Street. He also likes the way the strokes of the pen look. I agree. With their contributions from the public, I think these paintings would be a good choice for display in an open setting. Next to the guillotine, perhaps?

In light of the current debate going on over the $80 billion pharmaceutical deal, I am posting the text of an email I sent earlier this year to my two Senators, Barbara Boxer and Dianne Feinstein, and to President Obama.

I wrote these emails to ask that my representative leaders and the President address the unbelievably high price of prescription drugs in the U.S. Several friends who I showed these emails to suggested I post them on my blog. I have chosen to edit out the names of the prescription drugs mentioned in order to protect some of my privacy but they are otherwise intact.

If you are from the U.S. and haven't contacted your representative to demand health care reform that provides for every American--instead of every health insurance and pharmaceutical executive--I hope reading this email will prompt you to do so.

Dear [Senator, President Obama],

I am a 44-year-old native Los Angeleno and one of your California constituents. I am writing to you about rising prescription drug costs and about an incident where the FDA detained prescription drugs I imported from Canada for personal use for two months.

I am currently self-employed and unable to obtain health insurance at any price because I have been deemed medically uninsurable in the state of California by underwriters. As a result, I have no prescription drug coverage.

I have two common, chronic medical conditions that I have managed with prescriptions since my teen years. Over the decades, I have endured financial hardships to pay for my prescriptions, and I am used to planning my finances around my prescriptions needs. However, in the past few years price increases have outstripped my ability to stay a step ahead of costs.

Taking the advice of one of my specialist physicians, I began to import my prescriptions from Canada to save money. I was hesitant to do so because of the unpredictability of shipping times. If a shipment did not come in time, I would have to scramble to obtain the drugs quickly from a different source, since very serious side effects could result from a missed dosage.

Nonetheless, with some advanced planning, I began importing my prescriptions from Canada. I was aware through reading "Consumer Reports" that the FDA's policy is not to pursue individuals who are importing prescriptions for personal use. So I was very distressed when my early October 2008 prescription order went missing, only to turn up in late December 2008 with an FDA action sticker on the package.

The FDA action sticker is marked "Refused - Return to Sender." Somehow the package managed to get to me, but I have not used the drugs inside because the package was clearly opened. In addition, the FDA Action Sticker includes this message:

FDA REVIEWED THE LABEL(S) OF THE DRUGS CONTAINED WITHIN THIS PACKAGE AND CONCLUDED THEY ARE UNAPPROVED PRESCRIPTION MEDICATIONS. SINCE THESE PHARMACEUTICALS ARE FROM AN UNAPPROVED FOREIGN SOURCE, WE CANNOT GUARANTEE THEIR SAFETY, DOSAGE STRENGTH, AND PURITY. HOWEVER, UNDER FDA'S ENFORCEMENT DISCRETION, WE HAVE PERMITTED DELIVERY OF THESE UNAPPROVED MEDICATIONS TO YOU. DESPITE YOUR RECEIPT OF THIS SHIPMENT, FURTHER IMPORTATIONS OF UNAPPROVED PRESCRIPTION PHARMACEUTICALS MAY BE REFUSED ADMISSION INTO THE USA.

As a result of this incident, I resumed buying my prescriptions in the United States at the end of last year, at the lowest price I could find. But with the new year, I was distressed to discover that prices on my prescriptions went up considerably. Here is a current cost comparison of my prescriptions at Costco, where I now buy my medications, versus my Canadian provider:

[Prescription name edited]: Costco, $269; Canada Pharmacy, $149
[Prescription name edited]: Costco, $189.93; Canada Pharmacy, $31
[Prescription name edited]: Costco, $94.43; Canada Pharmacy, $34

Yearly supply: Costco: $6640.32, Canada Pharmacy, $2568.00
Yearly cost savings using the Canadian Pharmacy: $4072.32

I would like to point out that that the prescriptions I have cited are not "cutting edge" and are in routine use for common conditions. The pricing of these drugs is outrageous, even more so when one takes into consideration the profit margins of the major pharmaceutical makers.

One of the medications cited above is not even the best available for my condition, according to my specialist physician. The best available drug is sold in France and England for under $10 but is unavailable in the United States because it doesn't offer the kind of profit margins the pharmaceutical companies seek.

I am further scandalized that the FDA can take the time to stop my prescription packages at the border but can't protect the American population from contaminated Chinese food imports, or even contaminated food produced domestically. The FDA says they are concerned for my safety, but their track record says otherwise.

I urge you to take strong action now to control the costs of U.S. pharmaceuticals and to make them affordable to all Americans.

Sincerely,

Teresa Ortega

The other day The Boston Globe reported on a new project coming out of MIT that uses social networking data to predict whether a male Facebook user is gay or not. The experiment has been given the not terribly original name Project Gaydar.

Part of a new field of study called social network analysis, Project Gaydar examines a a male Facebook user's public connections or "Friends" on Facebook in order to determine the likelihood that he is gay or not. Other analyses have attempted to predict a person's political affiliation or drawn conclusions based on favorited books and movies.

Gays and lesbians have had particular concerns about privacy rights due to the history of criminalization and discrimination on the basis of sexual orientation in the U.S. Even gays who are largely "out" may prefer to keep their sexual preference private in select circumstances, such as applying for a job or while searching for housing.

Facebook, Twitter and other social networks do offer privacy settings that allow users some control over what other people can see. So there are some means available to protect information one wants kept private, including choosing not to post about certain subjects at all.

Several studies have shown that not posting about certain subjects--such as politics, sex, drinking, and your employer--is exactly what human resources departments in the U.S. expect from potential employees. According to a recent survey of human resources professionals, nearly half used social networking sites to help them screen candidates.

If you're gay or lesbian and looking for a job, you probably already know that you don't have much legal protection against discrimination in hiring or in the workplace. And if you're not gay or lesbian, you're pretty much shit out of luck, too. Any number of behaviors or lifestyle factors could place you on the "do not hire" list, including being overweight or smoking.

According to Privacy Rights Clearinghouse, potential employers can use investigative consumer reports to find out about a candidate's "mode of living." However, under the federal Fair Credit and Reporting Act, employers must notify job seekers of such background checks and some states place additional restrictions on such reports.

Now, with social networking background checks, no notice need be given. Human resources managers can log on to Facebook, Twitter, or any number of other sites and draw whatever conclusions they like about prospective employees (including wrong ones) based on friends, favorites, posts or casual comments.

In other words, your future livelihood may depend on whether you've declared yourself a fan of The Simpsons or once retweeted Pee-wee Herman. And yet, the online reaction to intrusive practices like Facebook background checks is mostly defensive advice like "don't post publicly," or "clean up your digital profile."

Freedom of association, freedom of assembly, and freedom of speech are rights provided for in the Constitution to all Americans. As part of those freedoms, we must demand the right to Friend and to favorite, to gather and to chat, to poll and to post without the threat of corporate surveillance restricting our ability to make a living or to participate fully in our digital public sphere.

My old buddy Joe called me on my recent birthday (October 12, if you're wondering) and recorded our conversation for his podcast, Bored Beyond Belief.

For reasons that escape me, Joe decided to edit out all of his portion of the conversation, so the podcast is almost all me chattering, even though Joe prompted me with questions he planned for the podcast. Those questions included:
"Are you really going through menopause or are you just having sympathetic menopause with your girlfriend?" and "Have you pushed any children in public lately?"

If you don't have time to listen to the podcast, Joe did a fairly good job of summarizing my thoughts on his blog. Although we started talking about menopause, somehow the conversation drifted towards feminism and politics. We end with a discussion that reveals my secret identification with one of the witches featured in the comic book Fables, Frau Tottenkinder, pictured here.

Also, thanks to all those who sent me birthday wishes via Twitter or Facebook.

I guess it's inevitable that any woman who approaches the U.S. executive office is going to be called Wonder Woman, including Sarah Palin. However, many people, including Lynda Carter, have expressed dismay that Palin is being compared to Wonder Woman and see her as undeserving of the name and what it represents.

I thought I would offer some recent textual evidence from Wonder Woman #20 to highlight the differences between Palin and Wonder Woman on one issue in particular: the treatment of wolves. Without getting too graphic about it, Palin supports the aerial killing of wolves within her own state, Alaska. The practice is said to be inhumane because it can extend the animals' suffering in death.

In the story "Ends of the Earth," written by Gail Simone, Wonder Woman is first stalked and then attacked by wolves. Wonder Woman addresses the wolves directly in the above panel, saying, "Hunters of the claw and fang, I beseech thee. Do not die this night. Go. Leave!"

When Wonder Woman realizes the wolves are diseased and unable to respond according to their instincts, or "animal reason" as she calls it, she uses her lasso to calm them. In response to the wolves' request to be released from their agony, Wonder Woman regretfully kills the pack with her sword out of mercy.

I like this part of Simone's story because it illustrates Wonder Woman's beliefs and, to my mind at least, makes them plausibly consistent with an all-female culture such as the Amazons. Of course, that doesn't mean that men can't love animals or that some woman aren't barracudas.

To those of you who've been checking this site regularly the past few days wondering if I'm going to be posting about the Burbank 2008 Xena Convention or the 2008 Lucy Lawless at the Roxy concert, the answer is yes, I will. However, I'm feeling less than stellar this week (for reasons I won't bother you with here), and as a result, I won't be doing the battery of pre-event posts that I've done in the past. You can expect my usual concert report with photos later this weekend.

In the meantime, here are some good Xena-related links to kill time with:

• My fellow AfterEllen.com scribe Christie Keith is live-blogging the convention. So that her site doesn't get creamed by the Xenite hordes, Christie's posting her updates at AfterEllen.com instead of her personal blog. But I notice she's posted a few Xena tidbits over at her personal site, Dogged Blog, as well. Hope you upgraded your server, Christie.


• There's some great pictures from the totally righteous Xena Fan Support Day on the WGA picket line at MaryD's site, Twink's site and LAist.com.


• Because it had to happen sometime: LOLxena. I found this site via XenaCast. You can see I've made my own LOLrenee picture for this post. If you're a fan of the LOL phenomena, the LOLxena site also has a lengthy blogroll of LOL sites. I especially enjoyed the blog on LOLchaucer, which also featured lengthy posts on topics ranging from Britney Spears ("STOP YOUR SCLAUNDRES OF BRITNEY!") to Brokeback Mountain ("I WOLDE I KNEWE HOW OF THEE I MIGHT BE QUITTEN!"). You kind of need to know some Middle English to appreciate it. However, I feel confident that there's some degree of overlap among Xena fans, lulzspeakers and Middle English buffs.

Specifically, has the Pope read Ex Machina numbers 32 and 33? I wonder, because the very day after I had put down issue #33, in which the man-machine hybrid Mayor Hundred undergoes a forced exorcism by the Pope, I read the news that Pope Palpatine--or whatever his name is--will be introducing new "exorcism squads" to fight the rise of godlessness and the occult.

This "Say No to Satan" campaign will be led by the Chief Exorcist of Rome, Fr. Gabriele Amorth. It's too bad that the AMPTP is allowing the writers' strike to drag on; I think these exorcism squads could be the subject of a S.W.A.T.-style drama, with special guest targets like Christopher Hitchens and J.K. Rowling.

Perhaps the timing of Ex Machina's storyline and the Pope's announcement was just synchronicity (a godless concept, I'm sure), since I just encountered an instance of exorcism in the novel I'm currently reading as well. The novel, Trance by Christopher Sorrentino, is set in the 70s and includes a passing reference to the bestselling book, The Exorcist, which it describes as being about authority figures trying to change a young girl's personality.

I mention this third instance of exorcism because it dates from a time period, the early 70s, that has many interesting similarities to the current period in U.S. culture and politics. Why is this significant? Well, as Fr. Gabriele Amorth states in an excerpt from his book, An Exorcist Tells His Story, there are times in history that are more oppressed by Satan. I find it fascinating that Amorth points to another period often compared to our own, the period of Rome's decline:

Even if this battle against Satan concerns all men and all times, there is no doubt that Satan's power is felt more keenly in periods of history when the sinfulness of the community is more evident. For example, when I view the decadence of the Roman Empire, I can see the moral disintegration of that period in history.

Amorth sees "decadence" as the point of connection between today and the end of the Roman empire. I'm sure he'd find the early 70s, once dubbed the "me decade" for its individualistic (or narcissistic) concern with human potential, were morally decadent, although Amorth is quite approving of both the book and movie versions of The Exorcist, artifacts of that era. So there is one conservative interpretation of a connecting thread between these three periods.

One doesn't have to stretch to see political connections between the 70s in the U.S., the U.S. present, and the late Roman empire. The continuing debate over presidential impeachment, the comparisons between Nixon's and Bush's approval ratings, and the presence of former Nixon administration officials within the Bush White House make that part of the equation a no-brainer.

The last several years have seen a profusion of dramas and documentaries about the rise and fall of Rome in which comparison to the present is implicit. The HBO series Rome, which recently covered this subject matter, took its inspiration from the famous 70s series, I, Claudius. One of the most pointed documentaries I have seen linking the Roman empire to present day designs on empire is the four-part BBC series billed as "an alternative history of Rome," Terry Jones' Barbarians.

A mashup of these three periods in history results in quite a vision of the powerful under pressure: Pope Benedict XVI herding the diminishing faithful under increasingly authoritarian doctrines; the Romans deploying their army and an arsenal of rarefied torture techniques to subjugate the far-flung nations and peoples under their rule; Nixon's stonewalling under the scrutiny of the press; U.S. neoconservatives' brute use of propaganda to deflect and contain criticism.

But now let's turn away from the powerful and towards the voice that must be silenced, exorcised, disciplined, or reprogrammed. There's Regan, of course, the possessed girl of the Exorcist. Women often stand in for the demonic in patriarchal religions; she is a demon's most conducive host. (And a casting natural: women played the role of the devil in the Catholic horror films The Exorcist and in The Passion of the Christ.)

But more importantly, women are the voice of hysteria, and it is their image in popular culture that the voice of society's hysteria can be heard. Women like Linda Blair's character, Regan, who are seized and possessed by the public. Women who are, to be sure, interesting in their own right, but become sensations for their ability to stage the public's fear and anger, to vomit the culture's resentment and loathing into the face of unjust power and authority.

There are other women in 70s popular culture who serve as vehicles for public hysteria: kidnapped and converted Patty Hearst, whose free will became a national obsession; abused Sybil, whose shockingly multiple personalities seemed to mirror the emergence of variant and controversial lifestyles existing outside the confines of the traditional and fragmenting family unit.

Rome in its decline had many female virgin martyrs--thousands, according to legend--whose crimes of declaration inspired many creative applications of torture. Today, we have Britney Spears and Lindsay Lohan, celebrities whose main role appears to be acting out the culture's embrace of and revulsion towards material excess. It is a cycle of hysteria that, like Regan's head, spins round to look you right in the eye.

Today, there was an international show of support for the writer's strike, with demonstrations held in Australia, Canada, England, Ireland, France, Mexico and New Zealand.

There's been tremendous fan support for the writers on the web, but it's also good to see that people understand that the writers' fight for fair pay is every worker's fight.

If you haven't done so already, you can sign a petition in support of the writers.

I'm making up for the time since my last post with a catch-up post, summarizing my experience over the last few weeks. I decided the easiest way to do this was to divide the major events in my life into two categories: those keeping me sane and those driving me towards the brink. Here are my highs and lows of the past month:

Keeping me sane

• The Force is with me. The sister and I went out one night together and bought matching Sony PSP Star Wars Bundles. We had both held out on the system until now; she wanted it for Final Fantasy Tactics: War of the Lions, and I wanted it for Castlevania: The Dracula X Chronicles. We both love Star Wars, and Star Wars Battlefront: Renegade Squadron, the game that came with the bundle, proved to be more fun than I expected.


• Karma junkie. Under the Bush administration, I've become impatient with reading the news. I want my news straight up these days, that's why I depend on Max and Stacy's daily Karmabanque podcast. They don't futz around with the intricacies of party politics. They just give me what I want to know, raw: who made how much money killing, oppressing and impoverishing who. Their Gulag Wealth Fund provides a shorthand method of tracking what's really going on.


• Screamin' like a banshee. Joe sent me the CD of Siouxsie Sioux's new solo album, Mantaray, for my birthday. It's pretty gorgeous. Years ago, I remember hearing Siouxsie and the Banshee's song "Desert Kisses" when Kaleidoscope first came out and thinking to myself, "This is kind of lesbian." That's also been my reaction to almost every song on Mantaray. In this case, however, Siouxsie's said a few things in the press to confirm that interpretation.


• Girly stuff. I really, really like the Cute Little Red-Headed Girlfriend's Elmo panties. The hot pink ones, with "Love Me" written in bubble letters above the picture of Elmo on the crotch. I know, I know. TMI.


• Aspirational television. I have been totally hooked on the show Damages. Week after week I've watched in awe as Glenn Close opened my mind to immense new vistas of bitchiness. Through the character Patty Hewes, Close has brought me to understand levels of bitchiness I never even knew existed. I ask myself: can I possibly aspire to such intensely bitched out behavior in my lifetime? Am I up to the challenge? Thank you, Glenn Close. You have raised the bar for me.

• Where there's fire there's smoke. The air in Los Angeles after the Southern California fires has been an abomination--a miserable, foul toxic brew. There is just no way to explain to you how bad the air feels, tastes, smells. The best word I can come up with to describe it to you is: chewy.


• I was robbed. Anyone who has had a girlfriend knows there's a brief window of time after your girlfriend has swiped some an item in your wardrobe when it's possible to get that item back. If you act forcefully within this time period, taking back the item in question, one can retrain the girlfriend, much as one would an errant puppy: "No. Put that down. Put it down. No! That's not for you!"
  However, if one misses this brief window, one has no option but to give the item up. And so I say now: "Goodbye, faithful bedroom slippers! Fare thee well."


• Another one bites the dust. Johnny Bacardi is leaving the blogosphere after five years of publishing The Johnny Bacardi Show. But all is not lost, as he can still be found on livejournal and at his Elton John blog.


• La nausee. While shopping in the Container Store with the Cute Little Red-Headed Girlfriend, I suffered an existential meltdown as I was confronted with the full extent of my own lack of organization. I shuddered as the world was revealed as just so many things in need of being boxed.


• Don't tell mama. I missed Lucy Lawless's show in Chicago, a fact of which I am not proud. But I poured over the pictures and commentary from the event, and I contributed this lovely wallpaper derived from the show, which I encourage you to download. I will be there both nights of Lucy's Roxy shows in January. Email me if you want to meetup.