Funny Jokes and Serious Matters

Note: This is a guest post by my husband, Gary Bakst, M.D. While I may question whether the jokes are funny (Gary didn’t write them!), I don’t question the seriousness of the subject he addresses. Thank you, Gary.

Jewish Humor – here are some jokes that have been around longer than I have:

1. Why don’t Jews drink? It interferes with their suffering.
2. My wife will buy anything that’s marked down. Yesterday she brought home two dresses and an escalator.
3. A man can’t find a lawyer. He picks up the Yellow Pages and picks out a law firm-Schwartz, Schwartz, Schwartz and Schwartz. He calls up and says, “Is Mr. Schwartz there?  A guy says, “No, he’s out playing golf.” The man says, “All right, then let me speak to Mr. Schwartz.”  “He’s not with the firm anymore.”“Then let me talk to Mr. Schwartz.”  “He’s away in Detroit.  He won’t be back for a month.”“Ok, then let me talk to Mr. Schwartz.”  “Speaking.”
4. I’d like to help you out. Which way did you come in?
5. In New York’s Garment District, a little, old man is hit by a car. While he is waiting for an ambulance, a police officer tucks a blanket under his chin and asks him, “Are you comfortable?”  The man responds, “I make a living.”

It is that final joke that I am thinking about as I write this essay.  I grew up in a middle-class family and in a middle-class neighborhood. I remember when Linda and I struggled to make ends meet.  I realize that we are more comfortable today, but I still like to think that I am connected to the struggle of the average person/average family.  The reality is, every so often a patient says something that reminds me that I am not as connected as I’d like to believe.

They will tell me about the cost of an item – perhaps $10 – that is a big deal in their lives.  They are living on fixed incomes or small paychecks.  They have worked their whole lives but cannot afford things that I would take for granted.  While every expense is important, the one that we are most often speaking about is the cost of their medication.

This is a problem that has been mentioned often in the media.  But I don’t think that the real impact on so many people has been adequately discussed.  The stories I see in the news are about the most extraordinary examples.  They don’t convey the reality that I see people face numerous times every day.  The reality is, especially in the world of diabetes care, that we are in a time when there are great medications that can change people’s lives.  They can safely lower their glucose levels, protect their hearts and their kidneys, prolong their lives.

On the other hand, I have never seen a time in which so many people just couldn’t afford their medications.  It was not that long ago that medications were prescribed by doctors and filled at pharmacies and patients picked them up for no copay or small ($5-10) copays.  Now, the doctor writes the prescription and it goes to maybe a pharmacy, maybe a gigantic mail order facility.  The insurance company rejects the charge but doesn’t tell either the doctor or the patient why the med was rejected or what alternative would be covered.

Our staff spends enormous, frustrating hours, expensive hours, working on getting medications approved.  When a medication is approved – not necessarily the medication we had ordered but some theoretically similar drug – the patient is still left with frequently gigantic out of pocket expenses.

Some of this is related to the fact that medications are so much more expensive than they used to be.  The pharmaceutical industry is entitled to make their profits and needs substantial income in order to invest in the next generation of medications.  But too much of that profit comes from the US (as compared to overseas markets) and it seems like the average American is carrying a financial burden that is breaking their back.

On top of this, the insurance companies routinely reject claims, use intentionally opaque methods to keep us and our patients in the dark about what they need in order to approve those claims and even when they cover the medications, they leave too much of the charge on the shoulders of the patient.

Insurance companies typically use ever increasing premiums to herd patients into high deductible plans.  This means that you pay your premiums, but the insurance company may never spend anything on your care.  The situation is similar for those who receive their insurance through the Affordable Care Act (Obamacare).  While it is great that there is insurance that people can access, the insurance is often expensive and comes with high deductibles.  And, for those who get their insurance through Medicare, the development of prescription drug coverage (during the George W. Bush administration) is a great step forward but the coverage comes with that so called “donut hole” which means that you have to pay thousands of dollars out of pocket and then you can get back to where the coverage helps you out.

In the end, we are at a time of crisis in health care affordability and especially medication affordability.  Recognizing that I have no expertise in this topic beyond what I see every day in my office, I would make several suggestions that I do not hear from our politicians of either party.

1. I would end the policy of not allowing Medicare to negotiate with pharmaceutical companies regarding the price of medications. Medicare needs that tool.
2. Congress needs to pass a law limiting how much more any medication can cost in the US as opposed to the rest of the developed world. Perhaps up to 20% more but not the 300% more that we often see.
3. I would outlaw deductibles over $1000
4. I would limit how terrible any insurance policy can be and still be legal to sell in the US. If you are marketing your policy as insurance, it has to be helpful to people when they get sick or injured.
5. I would require insurance policies to offer adequate reimbursements to hospitals such that they can hire enough nurses to truly take care of patients. Patient to nurse ratios are becoming dangerous and patients will be harmed.
6. I would increase reimbursement to doctors and other health care providers for primary care services. This would continue the trend of reduced reimbursement for procedures and presumably make more doctors consider careers in primary care – not enough doctors are going into primary care.
7. I would require insurance companies to make public how much money they spend on items other than patient care and to make public their procedures for approval of tests such as PET scans and for medications and expensive treatments. It is time to remove the curtain and give doctors and patients a fighting chance to get patients the care they deserve.
8. Medicare is more efficient in translating money into care and I would require private insurance companies to make strides towards that benchmark in order to operate in the US.

There it is. That is my little manifesto.  The rantings of a comfortable doctor on behalf of his uncomfortable patients.  Now one last Jewish joke:  A Jewish grandfather takes his grandson to the beach when, suddenly, a gigantic wave sweeps the boy away.  Panicked, the grandfather looks up and prays to God, “Oh God, please bring him back.  Let him live.”  Just then, an even larger wave deposits the boy back on the beach unharmed.  The grandfather looks up and says, “He had a hat.”