How do pharmaceutical reps make their money and what exactly do physicians/quasi-physician-psychiatrists get out of it? The answer is both exactly what you think and something entirely different, something bordering on perversion.

First, I’ll show you the money. Here’s how pharmaceutical reps earn their livings: “Every company determines their own method of how to assess growth and this can change every 6 months -– so don’t get too comfortable! For example, some pharmaceutical sales companies track the # of new scripts coming in and your goal will be set in reference to that measure. Other companies may determine bonus by measuring the total # of scripts.” That’s from a pharmaceutical rep “education” company inventively called Pharmaceutical-Rep.com.

But how to do reps make the sell? Logos…lots and lots of logos. According to the Markkula Center for Applied Ethics (apparently no one informed Santa Clara University that applied ethics long ago died in the business world, if they ever existed), “Many prescribers receive pens, notepads, and coffee mugs, all items kept close at hand, ensuring that a targeted drug’s name stays uppermost in a physician’s subconscious mind. High prescribers receive higher-end presents, for example, silk ties or golf bags… This kind of advertising is crucial to sales. A doctor is not going to prescribe something he or she has never heard of, and it’s the drug representative’s job to get the products’ names in front of the physicians… It’s a way to get in the door so that your information rather than somebody else’s reaches the doctor’s brain.”

If that’s not insidious enough, here’s more from PLoS Medicine’s Following the Script: How Drug Reps Make Friends and Influence Doctors, which begins with a quote from one of its authors, Shahram Ahari, an ex-drug rep: “It’s my job to figure out what a physician’s price is. For some it’s dinner at the finest restaurants, for others it’s enough convincing data to let them prescribe confidently and for others it’s my attention and friendship…but at the most basic level, everything is for sale and everything is an exchange.”

Ahari and co-author Adriane Fugh-Berman expand upon this process: “Reps may be genuinely friendly, but they are not genuine friends. Drug reps are selected for their presentability and outgoing natures, and are trained to be observant, personable, and helpful. They are also trained to assess physicians’ personalities, practice styles, and preferences, and to relay this information back to the company. Personal information may be more important than prescribing preferences. Reps ask for and remember details about a physician’s family life, professional interests, and recreational pursuits. A photo on a desk presents an opportunity to inquire about family members and memorize whatever tidbits are offered (including names, birthdays, and interests); these are usually typed into a database after the encounter. Reps scour a doctor’s office for objects — a tennis racquet, Russian novels, seventies rock music, fashion magazines, travel mementos, or cultural or religious symbols — that can be used to establish a personal connection with the doctor” [my italics].

From all of this, I can only conclude that physicians/quasi-physician-psychiatrists are amongst the loneliest people on earth. I’ve often entered a quasi-physician-psychiatrist’s office just as a drug rep leaves. Couldn’t the “doctor” have spent that time calling his wife? Alternatively, couldn’t she have read a monthly journal describing immediately-available new psychotropic drugs and their uses and side effects? Wouldn’t that take less time and at least approach professionalism? As it stands, the wise patient will reference prescribing information online, since it’s almost never provided prior to The Writing of the Scripts. Why a psychiatrist is paid at all remains a mystery. A better job title and one deserving minimum wage: “Treadmill Technician.”

I suppose if I asked physicians/quasi-physician-psychiatrists why they spend so much time with pharmaceutical reps, they might respond, “Thanks to insurance costs, I can’t afford pens, Post-It notes and coffee cups; I need those things, goddamn it.” Next, they’d stalk out of the office and weep upon the steering wheels of their BMWs, then call the kinds of prostitutes who don’t visit offices with suitcases full of samples and logoized potpourri.

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PAUL A. TOTH's Airplane Novel, already a Midwest Book Review Reviewer's Choice and the 9/11 novel, is available now. His other novels include Finale, Fishnet and Fizz. Click here to visit his sites.

20 responses to “Take This Logo and Call Me in the Morning”

  1. You have good insight into the phenomenon. Interesting and well written. I worked as a Department Manager at a hospital for almost 17 years. There were two types of professional people (other than hospital staff) who you could pinpoint from across a crowded room:

    1. Funeral Directors. They all looked the same with black suits and ties. They were always in a hurry and thought they and what they wanted to achieve were more important than anything else at the moment. They all had a demeanor of a grieving tzar.

    2. “Detail Men.” The most used term for pharmaceutical reps. They were usually male back in the day. Now I think the females may have overtaken them. They looked like funeral people in the way they dressed: all black suits. They feel important. They bring gifts to the Doctor’s staff to help get them in the office. Once in there, the Doctor gets the really good stuff. Although, a free lunch for staff is a real winner. They differ from the funeral guys in that they alway have a black carry-on type of suitcase on wheels – dragging it behind them with all the goodies inside. And, while their stance indicates they are important, they have smiles on their faces.

    Come to think of it, there is a number 3 that both 1 and 2 feel like (to me): slimy used car salesmen.

    Personally the less contact I have with either number 1 or 2 or 3 the better.

    The best logo goodie I ever received was a solid ceramic blue Thorazine tablet paperweight. I had it for a few years before it was finally stolen.

    The doctor got a free trip to a Medical Conference in Jamaica.

  2. Paul A. Toth says:

    Oh, you could have made a pretty dollar off me for that Thorazine paperweight! And Jamaica conferences: I knew some of the goodies had to be better than coffee cups with Prozac labels. What I find comical is that I can tell not only what I will be prescribed but how I will be diagnosed (I fall between a couple of categories, so it’s a guessing game) by taking a look around a psychiatrist’s office and noting the logos always in view. You’d think they’d take them home, but then, I suppose Prozac coffee cups just wouldn’t do for those of that social class.

    Many thanks for the comment. You’ve added a lot to the article with your inside info.

    Best,

    Paul

  3. t1 says:

    Last time I was in my doctor’s office a rep stopped by and the receptionist said: “I’m sorry, the Doctor does not see reps. If you’d like to leave some literature, he may review it.” The rep tried to drop off a coffee mug full of logo pens and some stuff and the receptionist returned that to her.

    I liked my Doctor even more after that.

  4. Judy Prince says:

    Thanks, Paul. As you say about what exactly physicians/quasi-physician-psychiatrists get out of their association with pharmaceutical reps: “The answer is both exactly what you think and something entirely different, something bordering on perversion.”

    Knowing it makes me sick. And it should.

  5. Paul A. Toth says:

    To T1: Yes, there are indeed cases of physicians and “physicians” who actually have something in mind besides where to build their third houses. These cases are known as miracles.

    To Judy: Going to the doctor, especially the “doctor,” as in psychiatrist, is guaranteed to make you sick sooner or later; it’s just a matter of how and when. The difference between the two is that doctors learn something in medical school, whereas psychiatrists apparently spend their time in medical school reading Playboy and dreaming about their future Porsches.

    • Judy Prince says:

      Paul and T1, it’s sad, isn’t it, that T1’s non-gift-accepting doc seemed an exception?

      In my hunts for a doctor who doesn’t whip out a prescription pad at the end of a whirlwind body tour, I’ve found one bragging that my x-ray corroborated his diagnosis….for which he had a drug as the only answer. Another doctor, his office filled with logo mug, logo rubber placemat, logo body diagrams and naturally a logo prescription pad, insisted that a particular drug was the only thing to cure me (of what I hadn’t known was a problem). I mentioned that recent scientific data showed that the drug caused necrosis of the jawbone and that the stats of my current condition were those which many patients strove for. He said that if I didn’t take the drug, in 5 years I’d be “bent over like a pretzel, hardly able to walk” and that the jawbone deaths were statistically miniscule. Needless to say, I never went back to that doctor (who had been highly recommended to me). His practice flourished. People like to take drugs, I found out.

  6. Paul A. Toth says:

    Judy, good point. Many people understandably believe their $100-per-10 minute psychiatrists understand the ramifications of drugs they prescribe. As you describe, this is patently not the case. Except in a few states, continuing education is not even mandated [http://pn.psychiatryonline.org/content/45/2/local/complete-issue.pdf — see pp. 1 and 34]. Even worse, “continuing education” is often paid for by…pharmaceutical companies.

    If you’re going to prescribe dangerous and/or addictive drugs, you should be forced to take continuing education courses regarding the ever-growing number of drugs available. Teachers, paid next to nothing, must endure endless hours of continuing education. Meanwhile, highly-paid psychiatrists need not even have a clue as to the dangers they create when prescribing drugs without knowing anything more than what a drug rep told them, and you can be sure that didn’t include side effects. Witless about the drugs they prescribe, but happy to sell them, psychiatrists are nothing more than drug dealers with degrees.

    Of course, it’s no surprise that “continuing education” has been privatized and turned into yet another Easter egg hunt. Meanwhile, I’ve learned that psychiatrists receive eight hours of addiction training during medical school, which no doubt consists of, “Send them to AA or NA.”

    • Judy Prince says:

      “…psychiatrists are nothing more than drug dealers with degrees”—-I’d have to agree with you, in the main, Paul, even assuming the best aims and efforts on the part of the psychiatrists themselves.

      Excellent, pragmatic, spot-on legal point you make here: “In the case of psychiatrists, it’s malpractice, in my opinion, to prescribe drugs without knowing the side effects and announcing all of those side effects to them to the patient. That’s the only way to prove they’ll actually read them. Not doing so should subject them to malpractice suits. They can extend their appointments from ten minutes to fifteen minutes…”

      As I’ve said in other writers’ posts’ comments, I’ve steadfastly refused “happy” pills, having witnessed at close hand the horror that my friends and their children who were hooked on them had (and still have) endured. My own saviour from what is called depression was reading and writing out the exercise responses in David Burns’ immediately helpful and stoopidly titled workbook _Ten Days to Self-Esteem_, (cognitive therapy), plus my crafting a helpful prayer I say every morning and lots more during the day.

      Re cognitive therapy (often called cognitive behavioural therapy), it’s recognised statistically/experiments’ally as the most successful of therapies. It’s recognised as such and government-supported and encouraged in the UK—- but in the USA it’s all but invisible. Psychologists and psychiatrists, many of them, do recommend Burns’ books as “bibliotherapy”, but vast government and other organisations seem to shun it. The reason, I suppose, is: To whom would we sell happy pills? Aye, there’s the rub. Pharma rama rama.

      A last bit now. Helen Fischer, in discoursing on the chemistry of love, takes a serious sidetrip admonishing folks to forego their happy pills because they abort the body’s love-producing chemicals. I’ve not researched the topic, but if she’s telling the factual truth, then we have a tragically ironic situation: happy pills actually kill a body’s mechanism for love and intimacy. Let that be explained to patients by their prescribing physicians/psychologists/psychiatrists. Do they even KNOW of it?

  7. Irene Zion says:

    Paul,
    You always make me laugh.
    This was a good piece.
    No one can ever have a more dark perspective on anything than you.
    You are so easy to count on!

  8. Paul A. Toth says:

    Ah, Irene, I’m not predictable; the world’s predictable! The idea for this article started with my wondering how the whole drug rep thing works. It’s not my fault the truth is dark. I’m a much sunnier place than the world…even Florida!

    pt

  9. angela says:

    having worked in the pharmaceutical industry for 10 years (not as a sales rep, thankfully), it was interesting to see the changes from about 2000 through 2005.

    although it’s not against the law for sales reps to give healthcare providers high-end gifts, some companies have voluntarily stopped giving them – have even stopped giving out pens and other small tchotchkes (i can never spell that), let alone taking docs to resorts and expensive dinners and the like. the atmosphere changed drastically from big spending to complete paranoia. sales managers i knew were so scared about getting into “trouble,” they didn’t know what was okay to give docs, aside from some brochures and samples.

    and doctors weren’t so innocent themselves. they accepted the expensive gifts, after all.

    the bigger question is should Big Pharma even exist? should sales reps even be doing what they’re doing? why not go generic with everything? but generic had to start somewhere, and nowadays it takes big bucks to fund the research into innovative medicines.

    THEN AGAIN, how innovative is innovative? is it just expensive research for the sake of research? how useful is what this innovative research is finding?

    as a patient, i’m extremely reluctant to take many meds, aside from allergy medicine. i had some vertigo a while back and my doc wanted to prescribe my motion sickness medicine, which only masks the symptoms and doesn’t solve the problem. and i just found out my cholesterol is borderline high – the same doctor threatened me with Lipitor if it doesn’t improve by my next appt in October, although my good to bad ratio is still good. three words: no fucking way.

    needless to say, i’m eating salmon at practically every meal.

  10. Paul A. Toth says:

    Thanks for the inside dope, Angela. Perhaps drup rep sales involve state rather than federal regulation, as I’ve seen no changes here. Of course, this is Florida, and as I always say, being a “well-respected” doctor/physician here is like winning the Special Olympics. Most of those quotes I posted were fairly recent. However, some states may have enacted watchdog laws. They will probably be thrown into the sea with the tea for doing so: God forbid we limit profits in the interests of society at large.

    On the other hand, yes, it’s certainly true research costs big money. I would at least like to see all drugs made generic in “Third World” nations; the law could simply state, “Generic or no international sales at all.” In the same way, if the United States government was interested in its own workers and workers overseas, it could simply apply an international minimum wage adjusted nation by nation. Once again, “Want to do business? Then pay the minimum wage. Don’t want to pay it? You’re gone.” Yet again, though, I suppose Armageddon will commence if corporations aren’t allowed to cut costs by cutting workers’ throats and disemboweling the environment. Thus, the whole ruse of the anti-immigration campaign, organized by the very politicians who let campaign-financing corporations hire “illegal immigrants” for cheap labor…the Republican wet dream. I recently Twittered the following: “Technically, aren’t whites America’s illegal immigrants?” I’m surprised the same movement hasn’t begun against blacks, claiming their inherited citizenship cannot be traced to an “original” American ancestor with actual citizenship. How low can we go? I don’t want to know. Arizona is pointing the way down.

    My motto is this: If you can’t afford to go into business and pay a living wage, then don’t go into business. As to the reps, I really have less against them; they’re like any other salespeople, trapped in the game of Monopoly and forced to sell at any ethical cost to pay the rent. But the physicians and, I suspect much more so, the pseudo-physician-psychiatrists who accept these gifts have no excuse. For Christ’s sakes, don’t they take enough vacations? I do understand that behavior in the case of low-budget clinics, which need the free samples. In that case, I, as a doctor/psychiatrist, would turn the scam around and milk the reps for more and more samples, claiming the “other guy” offered more. Otherwise, it’s an outrage. In the case of psychiatrists, it’s malpractice, in my opinion, to prescribe drugs without knowing the side effects and announcing all of those side effects to them to the patient. That’s the only way to prove they’ll actually read them. Not doing so should subject them to malpractice suits. They can extend their appointments from ten minutes to fifteen minutes; they’ll “make it,” as they tell me so often whenever I try to describe my sky-high anxiety (which has reacted much better to REBT than any prescription; unfortunately, too late…I’m hooked on Valium.)

    Finally, as to doctors paying high insurance premiums, which you don’t mention but seems an issue relevant to this discussion, I’ve found that if anything, doctors and especially pseudo-physician-psychiatrists are too protected from being sued. The latter create addicts, then blame addicts who never knew they were getting into an anti-anxiety medication with a withdrawal period lasting up to a year. My doctor yanked me off them, unable to grasp that addiction is a process in which a person doesn’t realize they’re becoming addicted until it’s too late, not to mention what they face when they try to free themselves. In my case, I had a seizure from benzo withdrawal. My doctor went on vacation after yanking me, sent me to a detox that had no clue what it was doing, claiming I was “exaggerating” my anxiety. Yeah, right, I’m exaggerating so I can stay in detox longer. This entire topic is beyond belief…wait, I forgot…nothing is beyond belief, unless it’s positive. Time for my Valium.

    Thanks again!

    Paul

    Thanks again.

    Paul

  11. Paul A. Toth says:

    Judy:

    I will have to research that proposed love/intimacy killing mechanism. I am not aware of it and always like to ensure I’m not listening to organics’ salespeople, who often pitch products that are, if not dangerous, usually useless. For instance, I’ve tried every supposed natural tranquilizer on the market and not one had a noticeable effect. But I’m not sure she’s selling that idea. I will look into it. Certainly, anti-depressants and other drugs have a proven negative effect on sexual intimacy; that’s beyond debate, although I take Celexa and don’t have that problem. Prozac, on the other hand, was a nightmare in that department, as were certain antipsychotics prescribed when I was diagnosed as bipolar. I’m still not sure of how I would diagnose myself, except to say that I don’t seem to reach the point of a bipolar diagnosis, and it’s a tricky business. I’d be doing fine if I hadn’t have gotten hooked on Valium, predictable not only because of Valium’s and other benzo’s effects, but also because of my own addictive patterns.

    My depressions are quite severe. The “highs” are more of the creative type. If that’s mania, I’m not sure I care to exchange it for a robotic state of constant depression. And I also prefer to stay on the Celexa as a preventative measure. But that’s just me.

    As to cognitive therapy, my personal choice is REBT and its founder, Dr. Albert Ellis, in my mind a genius, a sort of Henry Miller of psychology: to the point and no bullshit. It’s worked wonders with my anxiety. Nonetheless, addiction seems immune to REBT because REBT requires rationality, and of course addiction creates irrational thinking. It’s a trap, to be sure, and one I’m not sure how to escape.

    I don’t blame anyone for my having become addicted to Valium. My only resentment is that I was never once told of the excruciating and unbelievably long withdrawal period involved in quitting it, which I’ve twice experienced. It’s often described as worse than quitting heroin. Not only do I have to fear that but the thought that whenever even the slowest taper drops me to a point of renewed heavy anxiety, I may well resort to alcohol…my death sentence.

    I’m not exactly anti-pharmacotherapy. I’ve had too many severe depressions relieved by anti-depressants. What I do oppose is prescribing any of these drugs without knowing their effects, positive and negative, and telling them to patients, most of whom are unlikely not to simply trust the psychiatrist and never perform any research. I also do think that REBT, and for many people other forms of cognitive therapy, do work. I am not sure how effective they are against depression, which seems to be much more biochemical than anxiety. As I see it, anxiety has physical symptoms, but it seems to be caused by thoughts that create physical symptoms. Depression feels to me more like bad weather: unpredictable and uncontrollable. REBT or other cognitive therapies might help; I wouldn’t know because once I dropped the bipolar medications, my depression almost immediately lifted. But I always recommend Albert Ellis’ work, especially How to Control Your Anxiety Before It Controls You. That’s a key text for me. It allowed me to figure out that I was thinking myself into anxiety attacks…and trained me to out-think that thinking.

    Best,

    Paul

  12. Paul A. Toth says:

    Addendum: Hmm, I’m not sure I trust someone who runs an online dating service based on her findings: http://www.chemistry.com/

    I will investigate further!

    • Judy Prince says:

      Paul, I appreciate your thorough responses. Re Helen Fischer, her creds are impressive, truly—-but an online dating service!!! YAK! Nevertheless, I think a good search would likely find corroboration for many of her facts.

      I’ll get Albert Ellis’s book. I’d thought he was one of the forerunners of CBT.

      An irony in our approaches to ridding ourselves of depression (I’m loathe to nail anybody’s condition as “bipolar”) is that I apparently craved a *logical* cause for it, whereas you apparently think your anxiety had such a basis, but that depression’s not logic (or, rather, illogic) based.

      Burns and other cognitive therapists maintain the opposite, and Burns convinced me through logic that thoughts create feelings—-and most important for ending depression, fallacious reasoning produces depressive feelings. Quick examples: “I just can’t write truly fine poems” or “I’ll never get out of this negative-thinking cycle.” One logical fallacy in both: All-or-Nothing thinking. Rebuts: “So, have you ever written a line that you’d regard as a fine poetic line?” “Has anybody every told you that you’ve written a fine poem or a fine poetic line?” “Is it possible that you may learn to write a fine poem through practice or reading others’ poems?” Rebuts for the second example: “Have you ever gotten out of a negative cycle?” “Is it possible that you could learn how to climb out of a negative cycle by noting someone else’s way of doing it or from reading about how to do it?” “Is there something you did in the past that was free from a negative cycle?”

      Writing down the answers—-actually writing them down, rather than thinking them out—-made the crucial difference for me. Ironic that, as a writer, I disdained the power of WRITING out (i.e., thoroughly thinking out) my answers!!! Egad. Talk about ignoring logic!!

      MJ Fievre, a marvelously talented TNB writer, wrote a mesmerising post called “Cycle” which describes the feel of depression. Here’re a couple excerpts from my comment on MJ’s post:

      “As I recall my own cycles of up and down, they were fed by fear and the fear of fear. That is, when I was down, I usually felt guilty of some major infraction with someone and I loathed my all-imperfect self. When I was up, I *had* to hurry and do all the joyful things that I could bcuz I *knew* that those times would not last. Fear drove me, both to happy expressive and full living as well as to a shut-down, ever-grey, sequestered life.”

      “I don’t now *expect* grey cycles and uber-active cycles. I’m mostly enthusiastic for what I do and what others do, and when I feel a slump, I get quiet and actively call to mind the qualities I most want to have as well as the actions I most want to do—-knowing that I can and will do them.”

      “With the lovely encouragement that Mary gave recently, I’ll quote myself: ‘The Universe doesn’t zap you like a jealous hen. We just become more of ourselves’.”

      I look forward to your further research and writings, Paul.

  13. Paul A. Toth says:

    I stand corrected. Burns was actually a “follower” of Ellis’. And Ellis was the father of cognitive therapy. REBT wasn’t an offshoot of cognitive therapy, as I often inaccurately call it; rather, other forms of cognitive therapy are offshoots of REBT.

    I think anxiety and depression affect people in different ways. I find depression a more difficult emotion to attack rationally than I do anxiety; attacking anxiety-provoking thoughts now comes fairly easily to me. But I had forgotten that I learned REBT works for depression, too. For me, I have to get my motivation rolling, inch by inch, until it gathers momentum, and then I’m out. Another problem with benzos: They drill holes in your memory.

    As to Fischer, her credentials seem solid. Personally, I find a dating service a bit much, but that’s the anti-capitalist in me. (On that note, someone may notice Ellis wrote a suspicious number of books; however, my own concern about that issue was relieved when I learned he paid himself a modest salary and donated the rest of his profits to his REBT institute). Anyway, if the dating service works, great! I’m mated — checkmated — and don’t have a need to try it. Also, my fairly-low level of anti-depressants doesn’t have a negative effect on my romantic and intimate sides, but if that begins to happen, I’ll investigate her work.

    Here are some links of interest — you’ll have to add the “http://www.” for technical reasons:

    This is a transcript of one of Ellis’ therapy sessions, which shows why his no-BS approach appeals to me, if not everyone: rebtnetwork.org/ask/transcript_01.html

    And another: rebtnetwork.org/ask/transcript_02.html

    Finally, a great REBT page for writers, addressing procrastination as well as reactions to rejections: archetypewriting.com/resources/downloads/rebt.pdf

    Thanks again for your input!

    Paul

  14. Simon Smithson says:

    So, knowing very little about the medical scene in the US, how is the Obamacare phenomenon that was all the world could talk about a little while back affecting things?

  15. Paul A. Toth says:

    I oppose Obama’s plan for the exact reason most of its detractors oppose it: If forcing people to buy health insurance is “socialism,” then Medicare must be communism. We should drop the quotation marks and go with socialized medicine, but it will never happen. We’re anything but lucky this much happened.

    Here’s why. The health reform plan, even with the two benefits mentioned in the next paragraph, is a huge gift to insurers. Otherwise, it never would have passed Congress in the first place. The Republican “socialism” mantra is a ruse to please their feeble-minded supporters and generate overall political opposition to Obama, not the health care plan itself. That of course does not mean the health care system has been reformed, much less socialized. It’s actually been deformed into dictated “free-market” capitalism.

    I do admit two big positives about the plan. Number one, no more “preexisting condition” bullshit. Everything’s a preexisting condition. It’s called “birth.” Number two, an additional law requires health insurance companies to treat mental health and addiction issues with parity; therefore, if HMOs didn’t or couldn’t limit you to fifteen visits for treatment of a physical condition, it can’t limit you to fifteen visits for treatment of mental health issues and/or addiction. Of course, the insurance companies balked at this provision. How dare we expect them to cover the cost of a sociopathic “economic system” (read: quasi-religion) that drives us crazy? The New York Times states, “Insurers and many employers supported the 2008 law, but they say the rules go far beyond the intent of Congress and would cripple their cost-control techniques while raising out-of-pocket costs for some patients” [my italics]. Yes, it’s just like HMOs to worry about our out-of-pocket expenses.

    Why the italics? Of course the health insurance industry supported the law; it creates a whole new market niche for them. Some “46 million Americans remain uninsured and millions more underinsured” [public-healthcare-issues.suite101.com/article.cfm/health_care_for_the_us_congress]. They will soon be forced to use what little if any discretionary spending they have after paying rent and utilities to cover health insurance. That’s not “socialism”; that’s “free market” capitalism by decree. Anything short of universal health coverage, i.e., socialized medicine, is not health care reform but a slight adjustment to the preexisting health care system.

    Finally, try as I might, I’ve been unable to locate a single estimate of what the “average” uninsured person will actually pay for health coverage. Even with tax subsidies, and even if more tax subsidies and various business penalties supported by Democrats pass (which they won’t), I’m expecting something along the lines of COBRA, priced in most states at more than the leanest employer health care plan. I find it interesting that our 24/7 “news” coverage, which specializes in roundtable fortunetelling, can’t find it within themselves to offer a single wild guess.

    You may want to know the penalty for not obtaining health care coverage when this plan takes effect. “An adult who does not have health insurance by 2014 would be penalized $95 or 1 percent of income, whichever is greater, so long as the amount does not exceed the price tag of a basic health plan. But by 2016, the penalty increases to $695 for an uninsured adult, and up to $2,085 per household, or 2.5 percent of income, whichever is greater.” [news.blogs.cnn.com/2010/03/24/some-may-face-penalty-for-shunning-health-insurance/] Also, in Arizona, they might check your papers.

    Trust me, take the penalty. Use hospitals, and don’t pay the bills (I call this “self-socialization” of the health care system). You’re better off dying young and using what you would have paid to pay cover, you know, leaving the house and doing something once a month. You’re better off having an at least minimal life than not-living until you’re 95 years old. You will just have to continue paying for the generic anti-depressants it takes to endure the level of this culture’s almost unbearable, artless irrealism.

    There’s nothing rotten in Denmark, but there sure the hell is here.

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