Sunday, December 09, 2018

Just the facts, ma'am


On our last day in San Miguel I decided to walk down the hill to the pharmacy to get a refill of my Atorvastatin, the medication formerly known as Lipitor. For some reason, I like to have an extra prescription period of all my drugs just in case. In case of what I’m not sure. Maybe the Chinese will stop exporting the drugs we know and love. I have a cushion of ninety days on my other two meds but not my cholesterol fighter.

There was something faintly clandestine about my mission. I had no prescription though I did have the pill canister. I skulked into the farmacia, took a big breath and whispered, “¿Puedo comprar esta medicina?”  The pharmacist gave me a furtive glance, went into the stacks and returned with a 90-dose box of the stuff. I asked, “¿Cuanto?” She told me, “171 pesos.” That’s $9.00 to you, gringo. Then came the dawning. A month earlier I had posed the same question at my local Walgreens and was told $342. I passed. I did not pass at $9.00.

When I had my annual check-up this week, I told the story to my primary care physician who launched into a dissertation on the price of drugs in Los Estados Unidos and the hammerlock Big Pharma has on drug prices and our complicit congress. Back in 2003 when the Republican congress created the Medicare drug benefit it allowed drug companies to set their own prices and denied the right of Medicare to negotiate lower ones for its 40 million clients. Makes perfect sense if you're in somebody's pocket.

Between 2006 and 2016 drug companies spent $2.3 billion, yes that’s a ‘b’, on lobbying and made $30 million in contributions per election cycle to both political parties. It's roughly 60% to Republicans and 40% to Democrats for the bean counters among you. In 2017 alone drug companies and their trade groups spent $171.5 million on lobbying and deployed 882 lobbyists into the backrooms of congress. So, we can predict with high confidence that drug prices will continue to rise despite pledges from both houses of congress and from the White House to rein in prices and though 80% of Americans believe that drug prices are unreasonably high. The means to rein in costs exist, of course. The will to do so does not, of course. Did you know that the drug companies employ consulting firms to tell them how high they can raise prices before patients can’t or won’t pay?

The standard drug industry excuse for high prices is the cost of research which proves to be a specious argument since the industry spends far more on marketing than on R&D.

I know this. There’s something seriously awry when you can get a garden variety medication like Atorvastatin for $9.00 in Mexico and pay $342 in the US.

Sunday, December 02, 2018

Act your age

This rangy dude had nothing to do with the post except maybe sorta the aging part

You have good trips and not so good trips. This one was “más o menos.” San Miguel didn’t live up to our ten- year-old memories and the reasons are varied. We found that “living” in San Miguel was hard work, that shopping for groceries was long cab drive each way, that all of life’s necessities took effort and that I had picked a physically cold house that was too far from downtown and that the walk back up the hill from El Centro was a sweaty thirty-minute heart pounder. Take the inconvenience and add a house that you didn’t want to be in and you might as well have stayed in a hotel in the center of everything.

Our street. The gray facade is our casa.

It may be, too, that a month-long vacation is two weeks too long. I’ll take that on advisement. Having to plan payments a month ahead and find someone to mind the house is a stress giver that makes the trip too much of a job. There were highlights aplenty, but the living wasn’t easy, and we never felt we could just be. I arrived in San Miguel thinking it’s a place I could live. I left San Miguel knowing it is not.

The cliff leading to El Centro. It's steeper than it looks.

As is he case in the rest of Latin America, even Taos for that matter, the cultures are separate. In San Miguel the Anglo community is abundant and insular. And old. There were more bad facelifts than taxis and there were a lot of taxis. Restaurants and musical events in SMA reminded me of movie night at the Taos Community Auditorium, a sea of blue hairs with advanced degrees. I can tell you this, if I move anywhere it’ll be younger. I want to be the oddity not the norm.

Which brings up the subject of aging or being old. It’s cliché to say, “age is just a number” or “you’re as old as you feel.” It’s also more or less true. I’ve been asking the musical question, “When are you old?” for a couple of months.  I set up the subject with a disjointed preface that says something like, “I feel pretty much like I did when I was in my mid-forties. I still do the same physical exercise and hold myself to the same standard of effort as I did thirty years ago. But I know that one day something will set me back and I will be old and infirm. Presto chango. I also know that at 77 a very optimistic outlook is another ten years of being able to do the things I do now. I am not happy with the prognosis, Doctor. I don’t know any 90-year-old man-children. Strike that. Bob Cooley in his early nineties say he skies better than ever with his new knees and dances like a mad man. I want to be Bob Cooley when I grow up.

So, the question is this. Do you begin accepting the decline before it happens or hold out till it smacks you in the face? I see a lot of the former, the folks who acquit themselves as old people before their time. It even happens in middle age. Back in Lincoln, Massachusetts where we lived for 23 years, the housewives of the Radcliffe and Wellesley persuasion became matrons in their mid-forties replete with care free hairdos, scant makeup, formless attire and sensible shoes. I want to be my mother.

“Are to you still running?” is something I get asked a lot. I have the urge to answer, “Why wouldn’t I be?” I will till I can’t. And there you have it. Do it till you can’t. That goes for absolutely everything. And corollary to that is this bit of advice. Don’t stop (fill in the blank) because starting over again is a bitch. Every day you don’t do what you do makes it all the harder to start the old engine again. I’m testing that premise this very day.