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As some of you know, my cat has been diagnosed as diabetic and requires insulin injection. He was prescribed Lantus, which is a long-acting insulin called “glargine insulin” that slowly infiltrates the body from the injection site during the course of the day rather than hitting in one big insulin hit. This is sort of the Gold Standard of insulin, controlling blood sugar far better than anything other than an insulin pump. Sometimes you can bring a cat with Type 2 diabetes back to non-insulin-dependent status by using this stuff to regulate his blood sugar until his body readjusts to operating with normal level blood sugar. Tapering off then lets his pancreas take over insulin production again and you have your cat back, albeit with severe dietary restrictions to keep his weight and blood sugar down. Yeah, that doesn’t really happen with people, but cats are weird.

TMF probably isn’t going to be in that cat-egory because his blood sugar was so high, but my vet said it was worth trying. my vet said “Okay, it’s expensive, but this is the gold standard and a $180 vial will last you several months.”

Well, it was a $180 vial in 2014, the year before its patent expired. Today it’s a $290 vial.

What happened? Competition happened. Two competitors entered the market, releasing two competing products, Basaglar and Toujeo. So, what happened? Why did prices go up rather than down the way the free market maniacs are always claiming competition will do in healthcare?!

Well: The maker of Lantus has a fixed amount of profit they want to make from Lantus. If volume goes down — which happened with competition — then they raise the price to make that amount of profit. And the competitors have similar price desires, so try to compete based on something other than price –Toujeo is more concentrated than Lantus (more doses per milliliter). Or if they’re wanting to compete on price, they price 10% below the market leader, because that’s what maximizes their profit (see: Basaglar). Every time Lantus raises their price to meet their profit goals, the other two raise their prices in lockstep to maximize their *own* profits.

So competition nearly doubled the price of my cat’s insulin within three years.

So much for that healthcare “reform” nonsense about “competition reduces prices!”. It just doesn’t seem to work that way in the real world, at least not for healthcare.

– Badtux the “Free Market Orthodoxy is religion, not fact” Penguin

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The good news is that I’m not diabetic. The bad news is that my cat is.

Poor patchy kitty

The Mighty Fang has been poked, prodded, and otherwise miserated for the past three days to determine why he was drinking and urinating by a ridiculous amount. The final verdict: His blood sugar was way high in the blood test, at a point where a human would have already ended up in the hospital. He was also spilling a lot of sugar into his urine, indicating that it wasn’t just a momentary stress high, though the blood test was so high that was pretty much out of the question anyhow. The good news is that we caught it early, before there was damage to his retinas or kidneys or liver, and before he crashed.

So besides changing his diet to a low-carb diet (accomplished by changing his cat food to canned Nutro Natural Choice, which he loves) we’re starting out with a small dose of insulin twice a day. The photo above is his breakfast after this morning’s shot, which I gave under the vet’s direction. Yeah, the vet shaved a couple of patches of his fur off to give me easier targets to shoot at. Poor baby, he’s looking so patchy! Talking about insulin, that brings us to Big Pharma conspiring to hike the price of insulin. Three drug companies control 100% of the market for insulin, and conspire with each other to hike prices in lockstep. The best insulin on the market right now is one called Lantus. It’s a long-acting insulin that is much smoother than the older insulins, your blood sugar (or your cat’s, in my case) stays steady for far longer, requiring less monitoring and fewer injections to get a stable blood sugar level. My vet warned me that it was expensive. “You’re going to pay $180, $185 a vial. The good news is that he’s a cat, so a vial will last a couple of months.”

So here is what I paid for one vial of insulin: $293.99. When I showed him that bill, my vet was like, “What? That’s insane!”

“But we don’t charge full price!” said the drug companies above. Bull fucking shit. “But we offer discounts!” Not to cat owners, they don’t. There was one $20 discount coupon I could have taken if I’d know about it. That’s *it*.

So why don’t I get a vial of that old school insulin that costs $5/vial? Well, Big Pharma isn’t charging $5/vial for it. They’re charging $80/vial for it now. And it sucks, it’s really hard to get good control with it. And the better insulin, Humulin, that was introduced in the early 80’s for $10/vial? They’re charging $237 for it now. And it’s not as good as Lantus. It’s barely better than the older pork insulin (“Vetsulin”) that is available for $80/vial. And they’re charging $237/vial for it.

How fucked up is our healthcare system that I’m seriously looking at Canadian pharmacy sites… for my CAT?!

Oh, my good news? Well, glucose levels in cats need monitoring just like in humans. It turns out you use exactly the same supplies to do it. It turned out that Walmart sells their own branded version of one of the most highly rated blood sugar testing devices on the market, it requires a tiny blood sample and is as accurate as anything else (i.e., not particularly, but good enough for cats). This evening I got back from Walmart with a boatload of diabetic measuring supplies — lancets, lancet devices, and of course the test meter and the metering sticks, which have an enzyme in them that then reacts with the glucose in blood to set up an electrolytic reaction whose resistance is measured by the device to come up with the final result. The next task was to figure out how to use them. To do that, I wasn’t going to torment my poor cat and his ears — I volunteered myself as the guinea pig instead.

It took me several attempts to figure out how to use the lancet device to prick my fingertip. Then the next attempt didn’t result in a big enough blood droplet to test. Then I realized I needed to press harder on the lancet device before hitting the button, and did so, and blood didn’t really come out well but with some stroking of blood towards the hole a nice bead happened and I touched the tip of the meter strip to it, it sucked it in, and the meter gave me a value that was totally normal. Yay, I’m not diabetic! At least not yet! Stick gauze over the hole, wait a while, done.

Okay, but how the heck do I do this with the ear of a cat?! I need to watch those videos again, grr. Because I can’t see how I can manage to prick TMF’s ear using this device, because his ears are really thin and sort of floppy. The meter works well, doesn’t require much blood at all (turned out the bead I made was way more blood than the meter needed), but the pricking looks like a real prick of a problem. It looks like I’m going to have to watch more videos, ask people on the diabetic cat forum what setting they use on the pricker for their cat’s ears, and otherwise do more research before subjecting The Mighty Fang to my unkind ministrations. Because somehow I suspect The Mighty Fang will be less tolerant of fumbling than I was myself :(.

– Badtux the Diabetic-cat-owned Penguin
Oh yeah, obligatory slam against His Fraudulency Donald the Trump — he said he’d let people import drugs from outside the country and would let Medicare negotiate drug prices. Well, it turns out that campaign promise was as fraudulent as everything else about Deadbeat Donnie. SIGH.

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I mean, let’s look at the NRA propaganda. According to that propaganda, you need guns to protect yourself. If you don’t have guns, you die from criminals that just strike out of the blue.

Well, you need healthcare to protect yourself too. If you don’t have healthcare, you die from viruses and bacteria (and occasionally bullets) that just strike out of the blue.

Is it that viruses and bacteria aren’t as photogenically dusky as the criminals that the NRA propaganda posits? Curious penguins are… curious!

Meanwhile, most of the victims of the Las Vegas shooting are going to have to declare bankruptcy due to medical costs. They’re going to lose basically everything because guns are more of a right than healthcare in America.

The plight of the Las Vegas shooting victims is sufficient to point to one thing that Obamacare got wrong: Insurance is not healthcare. Most of the victims do have insurance. But: They were visiting Las Vegas. They got scooped off the pavement and hauled to the nearest ER that had space for them — an ER that almost certainly was not an in-network emergency room. So their insurance won’t cover the cost, or will, at most, cover 70% of the cost for those insurers who have really good out-of-network coverage. And that’s 70% of the in-network cost. As we all know, providers charge much more than that negotiated in-network cost when out-of-network (uninsured from their perspective) people drop in on them out of the blue. Often as much as ten times the cost of care.

But there is no right to health care here in the USA, and there is a right to guns here in the USA, so hey, all those people whose lives were ruined by bullets? They just need to suck it up, right? Right?!

– Badtux the Healthcare Penguin

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So, today the Republicans held their one and only hearing on the latest Trumpcare atrocity, which would basically defund Medicaid, kick most older Americans off of their Obamacare health insurance, and otherwise kill lots and lots of Americans. So a bunch of disabled people in wheelchairs showed up courtesy of the Medicaid funds that keep them alive to protest the fact that Turtle Mitch’s cuts would kill them.

The Capitol Police dragged them all away, in some cases hauling them bodily out of their wheelchairs and dragging them down the hallway by their feet.

What brave manly men our Capitol Police are, man-handling crippled people like that in order to protect Turtle Mitch and Orin Hatch from the unseemly sight of the people they want to murder!

And what did our brave Republican Senators think about all of this? Well… they seemed bored. In fact, Sen. Bill Cassidy actually yawned as disabled people were ripped out of their wheelchairs and dragged away. Ho hum, just another person he wants to kill whining about not wanting to be killed. Nothing to interest a cold-blooded lizard person from planet Sociopath. Nope, nosirree, those aren’t fellow people, those are just prey as far as our cold-blooded sociopathic lizard overlords are concerned.

Symbolism more suited to what Trump’s America has become — a hard-hearted place where anybody who has the bad luck to become old or sick or disabled should just die, already — could not be devised by any number of Democratic think tanks. This is America, y’all. This is America — cops dragging disabled people out of hearings rather than letting their voices be heard. Because the disabled aren’t people, as far as the sociopaths leading our nation are concerned. The disabled — and hell, pretty much all of us — are prey.

– Badtux the Sociopath-smellin’ Penguin

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So, Bernie Sanders just introduced his latest single-payer healthcare bill, and most of the serious Presidential candidates for 2020 have signed on. My kick-ass Senator, Kamala Harris, has signed on. Elizabeth Warren, another kick-ass Senator, has signed on. Kirsten Gillibrand, *another* kick-ass Senator often mentioned as a possible Democratic Presidential candidate, has also signed on.

And the reaction of Clintonistas?

“You liberals are doing it wrong!”

We’re not telling people how we’re going to pay for all of this, they whine. We must have a detailed policy proposals with 1,000 page policy papers describing every detail, they whine. At which point, I gotta say: Wha?

Look, Clintonistas: You fucking lost. You lost to an orange-hued baboon that proposed building a 2,000 mile wall and proposed a funding mechanism (“Mexico will pay for it!”) that was so stupid that only an idiot (or 48% of Americans, but I repeat myself) could believe it. You lost to an orange-hued baboon that proposed deporting 15 million workers without any hint as to how to replace them in the workforce given that we don’t have 15 million unemployed Americans. You had your fucking chance, people. You had your 1,000 page papers out the fucking wazoo on your candidate’s web site. And she fucking lost, okay?

Have Democrats learned something? Yeah, they’ve learned that embracing mediocre incrementalist “third way” proposals like Hillary Clinton did is how you lose elections. This was an election that shouldn’t have even been close, you had a political pro against a complete amateur, you had a candidate with experience and poise against a reality show host most noted for being an ass on the public airwaves, you had a candidate with detailed policy proposals against a candidate who fucking handwaved everything, and your candidate fucking lost. Trump went big with “build that wall!” and “drain the swamp!”, and he beat Hillary everywhere that it counted. Unless you go big, you go home. Figuring out the details is something that happens after you get elected, first you have to get elected.

So yeah, Democrats learned something. Well, some Democrats learned something. Mainstream Clintonian “Third Way” Democrats with their thousand-page position papers and detailed cautious and incrementalist policy proposals… not so much.

So these Clintonistas say that “Free College for All” and “Universal Health Care” without attempting to determine how to pay for those things or even how much they might cost are false promises which usually means not following through on those promises because they’re unrealistic. Here’s the thing. First of all, if you don’t get fucking elected, you can’t do a goddamn thing anyhow. People like free shit, so just handwave paying for it, already. Don’t scare people with details they really don’t give a shit about. Second, we know the money is there to pay for universal health care, because we’re already paying for it, just in the most inefficient way possible, thanks to emergency room visits and other such things caused by lack of access to primary care. And we already know that the money is there to pay for college for everybody who qualifies for college, because we’re already paying for it, just in the most inefficient way possible (and in a way that basically lands a lot of young people into what’s little more than slavery, forever giving virtually all of their money to debt collectors). If there’s one thing that government is efficient at doing, it’s collecting taxes — there’s a *reason* why we fund roads through taxes rather than tolls. Setting up the street in front of my house as a private toll road would be horrifically expensive given that it has maybe ten cars per hour go down it. Collecting the taxes at a far smaller number of gas stations and via my registration fees for my car is far cheaper than that.

So in my opinion it’s fair to say “we’re already paying for that, we’re just going to do it in a fair and efficient way” and leave sweating the details until after being elected. And they’re unrealistic promises only because rich fucks don’t want to give up any of their billions that were earned by the labor of their 180 million peasants in order to provide basic services for those peasants. Hey, just serfin’ USA, yo. (In case you wonder what I’m talking about — the Walton family would make $0 if it wasn’t for all the checkout tellers and store stockers and truck drivers who make it possible for their store to sell stuff, yet, the Waltons get all the money and the people who make it possible for the stores to operate get to go on the government dole to make ends meet).

– Badtux the Serfing Penguin

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Researchers find that 40% or more of residents of a neighborhood in Lowndes County, Alabama, have or have had hookworm.

This is a disease of extreme poverty that results in anemia, confusion, extreme lethargy on the part of its sufferers. The end result was generations of Southerners stereotyped as lazy and dim-witted. It was eradicated, people thought, by septic systems and shoes. But now it’s back.

And don’t think this is just a disease of poor blacks. Some of my white relatives in Louisiana are living under similar conditions where they regularly come into contact with raw sewage pouring out from underneath their decrepit trailer homes. Really, they were living under more sanitary conditions before they got indoor plumbing — outhouses, at least, didn’t drizzle raw sewage onto the ground. But the Public Health Service that eradicated hookworm by building twenty million outhouses in the 1920’s and 1930’s is long gone. As are the outhouses, and people for some reason don’t want to go back to using outhouses, they insist on using the toilets that deposit raw poop straight onto the ground outside their decrepit trailer homes.

There are two other alternatives that at least sort of resemble a toilet in that you don’t have to go outside your house in the middle of winter and sit on a cold outhouse toilet seat — composting toilets, and the Incinolet. The wiring in many of these homes won’t support an Incinolet, and nobody is pushing or subsidizing composting toilets as a solution. Not to mention that composting toilets are rabidly opposed by the poor people who would use them, “we want to just sit down on our toilet and flush like you rich people, we don’t want to have to mess with throwing dirt in with our shit and turning a handle and such.” That’s if they even know composting toilets exist — most don’t, because we no longer have a Public Health Service that is focused on sanitation, and county health departments only fine people, they don’t educate people, so nobody contacts the county health department asking what they should do.

And the result of this Libertopia, where nobody enforces sanitation laws or helps poor people comply with sanitation laws, is the return of a parasite that plagued the South for centuries and led to all the stereotypes of lazy stupid Southerners… yay, Libertopia! But maybe that’s the point. If you keep them lethargic they won’t rise up in rebellion. If you keep them dazed and confused, they won’t vote for the Democrats who could help them. Why, if you’re a Republican, a hookworm epidemic or a brain-invading parasite epidemic is exactly what you want! Yay!

– Badtux the “Libertopians are idiots” Penguin

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The stupidest argument I’ve ever heard about Medicare For All is that it will “raise taxes”. Look. I’m already paying a healthcare tax. I’m just paying it to a private insurer that skims 20% off the top for their profit, rather than to the Centers for Medicare and Medicaid Services that skims less than 1% off the top for their expenses.

Frankly, I don’t care who takes that healthcare tax out of my pocket — whether it’s government or a private insurer. I just want the least amount pulled out of my pocket. So, hmm, so you’re saying I could save 19% on my health insurance costs with Medicare For All versus private insurance? And I’m supposed to dislike that because it’s a GOVERNMENT tax rather than PRIVATE tax? Erm. WTF?

— Badtux the “Math is hard, apparently!” Penguin

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