Don’t ever tell me online relationships can’t be strong. On Sunday, I had a premonition that drove me to “catch up” with a blogger whose site I hadn’t been to for a while. When I got there, the last post began this way:

– A conversation with my husband, shortly after arriving home this afternoon with fresh oxygen tanks, spots on my liver, fluid pushing around my lungs (likely filled with cancer, as are the tumors inside) and at least one broken vertebra that must be healed before we resume any kind of treatment. –

How did we get here? I asked my love, across the bed strewn with children’s toys, books, and an oxygen tank.

The post goes on to admit that Susan Neibur,  a woman we all knew as @whymommy, the author of the truly magnificent blog Toddler Planet, had asked for in-home hospice “at least for a while.”

The post is dated January 22. It encouraged me to keep checking back, and today I am grieving today for a woman I met in person only once, at a BlogHer conference, which she struggled to attend so she could give a keynote presentation.

Susan was a planetary scientist, and she was diagnosed with inflammatory breast cancer, a rare and aggressive form of breast cancer that doesn’t get talked about much ( the news covers things like whether women should have mammograms at 40 or 50.) But it kills young women, and now it has killed Susan. It is undignified to say that sucks.

I met Susan BlogHer and Twitter, where she actively shared all her experiences — sometimes with the clinical detachment of the scientists. I tried hard to engage with her in the only way I could, by writing encouraging comments on her blog and offering to introduce her to EmpowHer, a network of women interested in women’s health headed by a friend of mine who is a fierce patient advocate.

But, like all the women who read her posts and somehow believed she would defeat this terrible disease, there wasn’t anything I could do in her individual case. So now, I raise my voice: perhaps too late for her, but not for other women, and indeed not for other men as well, who suffer and died way too young.

And here is what her husband says about all of us here online, where some still doubt that relationships are “real”:

 I can’t begin to describe how her friends, those physically nearby and those she knew only on the internet, enabled her to carry on through five years of treatment and recurrence.  Many of you have commented on Susan’s strength and grace, but these were traits that she pulled from all of you.

Related articles

• Goodbye, WhyMommy (betterinbulk.net)
• Goodbye (toddlerplanet.wordpress.com)
• What. A. Wonderful. World. (theyearofwhatif.com)

Today the Susan G. Komen Foundation succumbed to the will of the women it purportedly exists to help and

Image via Wikipedia

agreed to continue funding Planned Parenthood. Everyone will see this issue somewhat differently, but I see it as another hopeful sign of the power of social media to affect large organizations of all kinds, from government to corporations, and of our need to get our act together about what we want from the health care system in the future.

Think about it: Bank of America tried to charge customers $5.00 to use a debit card for a purchase, and a huge consumer outburst on the social networks shut that idea down very quickly.

Then Amit Gupta, a leukemia patient who needed a match for a bone marrow transplant, posted his need to his Tumblr, and a match was found through “crowdsourcing.”

“San Francisco resident Amit Gupta was diagnosed with leukemia last fall, and he desperately needed a bone marrow transplant. Instead of just accepting his diagnosis, he decided to use his social media skills to raise his chances of finding a willing donor. Gupta, a Web entrepreneur who created the startups Photojojo and Jelly, looked for a donor with a post on Tumblr. Now, four months later, thanks to his own determination, the support of caring friends and strangers, and help from social media, he has found a match.”–Yahoo News

It goes without saying that the power of social media is already recognized in foreign affairs: the crowd-forced ouster of corrupt Philippine President Joseph Estrada,  and the Arab spring are the best examples of this phenomenon.

In our own country, we can only look to former  Senator Christopher Dodd‘s shock and surprise when the SOPA and PIPA bills got derailed in Congress. Dodd, now a spokesperson for the MPAA, thought he had it nailed.

No one has it nailed anymore.

This poses a huge responsibility for us, the crowd. What do we really want?  How do we want to transform our system, which I believe will be politically transformed somehow during this election cycle or the next — much faster than we expected.

In health care, this is even more important than in politics as a whole, because health care affects the entire population. Listening to Rick Santorum tell the mother of a sick child that drug companies have to make a profit made me realize we have to have a dialogue about this that includes more than just President Obama, his successor, if there is one, and members of the legislature with axes to grind on both sides.

In Greece, austerity measures have hit the health care system hard, and there has been a public response:

Striking doctors, health workers and pharmacists in Greece have marched on parliament in Athens, protesting an EU/IMF reform to cut spending and liberalise.

Lenders have set this as a high priority, since roughly 10 percent of Greek GDP is spent on healthcare, around 25 billion euros per year.

We have a huge opportunity to insist on what kind of health care system we want and are willing to pay for if we continue to raise our voices. Maybe we should not wait until the austerity that faces America actually comes to pass. If society has to prioritize, shouldn’t it prioritize the health of its own citizens?

I’m really not saying much here except that health care does not seem to be much of an issue in this election, and it should be. We are facing either Obamacare or the repeal of Obamacare, and both mean changes to the status quo. Don’t be blindsided: be informed.

Image by mariachily via Flickr

I was fortunate enough to be able to attend the Rock HealthHealth Innovation Summit onJan.20th. It was the third day of a conference that highlighteddevelopment, design, and business issues around the potential for health care transformation through technology. The room was full, and the audience stayed until the end, even on a Friday afternoon.

Why? Because they knew something big was up. What’s up is the awareness of the Rock Health accelerator and the move to change a system only a young person from outside the industry could even hope to change. For three days, enthusiastic developers listened to cynics like me talk about business models, chasms, and challenges. I hope our doubts didn’t make a dent in their drive.

A year ago, there was no Rock Health, but more important, there was no community pulled together around the cause of health care innovation brought about by young people largely focused on digital and mobile technologies. A scant one year later, there is a vibrant health tech community in San Francisco, supported by large hospital systems, insurance providers, VCs, angels, entrepreneurs and mentors. The need is recognized, but until Rock Health, there hasn’t been a community. Health 2.0, another wonderful step in the direction of change, focused more on showcasing change than on financing or mentoring change.

The second class in the Rock Health program kicks off this week. Some of the grads from the first have already received additional funding or gotten to revenue.

They won’t all succeed. They have no concept of how complicated this industry is. But here’s the most important point: Rock Health has drawn together all the people inside and outside the system who want it to change, who are willing to take chances, and willing to support the effort to move the needle.

And thus I feel like 2011 was a tipping point for health care as an industry. After last year, for many reasons, it can’t remain the same. The larger providers and payers have already begun to circle the wagons around Obama’s health care reform law, because they are realists and know it’s not going to be repealed completely no matter who gets elected. So they’ve begun the journey toward bundled payments, Accountable Care Organizations, medical practice acquisitions, and better electronic health records. The battleships are slowly changing direction.

And the best part, Rock Health was founded and is run by women — the very people who make most of the health care decisions anyway.

Related articles

• A Dozen New Health Care Startups at Rock Health (ushealthcrisis.com)
• Rock Health Gathers Healthcare & Technology Stars: A Photo Gallery (xconomy.com)

The difficulties that health technology innovators will have breaking into the health care industry were no more clearly illustrated than by the talk given by Dr. Sam Ho, Chief Medical Officer of United Health Benefits Group, on the third day of San Francisco-based health incubator Rock Health’s  Health Innovation Summit. After two days of exciting stuff about design and development, CEO day presented the cruel reality of the market .

Dr. Ho began by admitting the system was broken. Payments, he admitted,  didn’t align with objectives, and outcomes were an afterthought.  But now things are in the process of change, partly because of the passage of Obamacare (although he didn’t mention it by name), partly because of the too-temporary tenure of  Dr. Donald Berwick at CMS, and partly because in a worldwide recession, we can’t afford our health care costs any longer.

So the big players, fearing innovation from without, have decided to try to innovate from within, and came up with a slogan called “The “Triple Aim:”  a slogan that embraces how to improve the individual experience, improve population health, and control inflation of per capita costs. Dr. Ho believes these three aims are separate now, but they must be aligned  to succeed.

For United Health, this means Care Management Programs, Transparency and Premium Designation Programs, Hi Performing Preferred Networks, Value-Based Benefits, and Value-Based Contracting. These can be read as forms of rationing and cost shifting by the more cynical among us. However, for him,  it mans developing more and more incentives for changing consumer behavior. For example, patent premiums will get lower and benefits richer if consumers enroll in a diabetes plan and stick to it. If they manage their blood pressure or lipid levels, they will also have richer benefits. But what if they try and fail? I’m all for outcomes-based medicine, but we have to be careful we are measuring things that are within the control of either patient or provider. And how do we judge?

Five years ago, I lost a dear friend to a situation that never should have
happened. Although, if I were to ask him, he would tell me otherwise.
He would say his life’s journey was over. I would say the ignorance
and arrogance of his adopted country’s medical system killed him.  I am writing about this five years later because I was reminded of him this week by the Dalai Lama’s presence in Bodh Gaya, India. Things in American medicine have not improved since Sri’s death;if anything, they are quickly devolving.

N.S. (Sri) Sidharan was a retired technologist from Intel who devoted
his life to peaceful causes. He travelled frequently to and from Bodh
Gaya, India (the place where Buddha received enlightenment) to visit
Dwarko Sundrani, one of the last active followers of Ghandi. Dwarko
runs the Samanway Ashram, a school for village childen in the Bihar
province of India, far from the Bangalores and Hyderabads. Bihar is
poor. Not only can’t people afford to educate their children; they
don’t even understand why education is necessary. Some of the children
Dwarko-ji cares for are tribal. They only come to school because he
feeds them, and he teaches them only farming. With oxen.

Dwarko-ji was 85, and had no succession plan for the Ashram. Sri spent
his retirement years trying to raise money for the school and figure
out a way for it to go on after Dwarko-ji passed. Between trips to
India, he helped a bunch of start-up companies in Arizona, including
one that has a new method for diagnosing heart disease, participated
in several meditation groups, and began a business called Technology
Initiatives for Peace. He was a big proponent of trust.

Sri was my friend, and I admired him. I went to India with Sri twice, the first time
when Dwarko-ji was travelling from Bodh Gaya to Dharamshala
for an audience with the Dalai Lama. We flew to Delhi, took an
overnight train to Pathamkot, stayed in an ashram that served as a
retreat center for the people who run other, more public ashrams, and
then went to Dharamsala, the seat of the Tibetan government in exile.
Not one touristy thing did I see.

Although I didn’t personally meet His Holiness, I did meet Dwarko-ji,
and see the Dalai Lama and the chanting monks from afar. It was a
life-changing experience. Sri took incredible care of me.

I went back to India, to meet Sri in Bodh Gaya for
Dwarko-ji’s “eye camp”, an annual event in which tens of thousands of
blind Indians are restored to vision by cataract surgery in a
week-long surgical marathon that takes place in tents on a dirt field.
In the years since the eye camp began, they have never had a fatality,
and rarely an infection, despite the sheer numbers of surgeries and
the dusty, hot, crowded conditions. Volunteer doctors come from all
over to participate.

Sri wanted to spread the good will of the eye camp from India to
Africa, and in July 2006 he went to Ghana to try to scope out the
situation and set things up. He was very excited.

And then I never heard from him again. One day I awoke in the
morning, opened my email, and saw this message: “NS Sidharan died last
evening in Good Samaritan Hospital. He had recently returned from
Ghana. Details to follow.”

I freaked. It doesn’t take a rocket scientist to figure out what
happened. Sri returned from Ghana with a fever. He went to the
hospital. They diagnosed flu. He told them he had come back from
Africa. They suspected malaria. But they didn’t begin treatment.
They kept sending him home while they did tests. Some of the tests
were “inconclusive” (meaning the pathologist probably didn’t know how
to read for malaria).

By the time they got the diagnosis and admitted him to Banner Good Samaritan Hospital

Image via Wikipedi

his body was overwhelmed by the bacteria. Then they had to use drugs
so powerful that he died.

The friends who were with him told me he got good medical care. I beg
to differ. I googled malaria. Here’s the CDC web site: “Malaria should
be considered a potential medical emergency and should be treated
accordingly. Delay in diagnosis and treatment is a leading cause of
death in malaria patients in the United States.”

More: “Where malaria is not endemic any more (such as the United
States), health care providers are not familiar with the disease.
Clinicians seeing a malaria patient may forget to consider malaria
among the potential diagnoses and not order the needed diagnostic
tests. Laboratorians may lack experience with malaria and fail to
detect parasites when examining blood smears under the microscope.”

And the last quote: “This sometimes fatal disease can be prevented and
cured. Bednets, insecticides, and antimalarial drugs are effective
tools to fight malaria in areas where it is transmitted.”

In other words, if Sri had stayed in Ghana, or any underdeveloped
country, he’d probably be alive today. Only in America, where we think
we know everything about how everyone “should” live, from what they
should eat to how they should vote, is he dead. This teaches me
humility. And I grieve

Related articles

• Ngondro interrupted – Bodh Gaya, India (travelpod.com)

Until you have gone off the deep end on nutritional therapy as I have, a Western medicine aficionado has every reason to doubt its effectiveness. Thr only people who know how useful it is to tightly control the toxins, vitamins, and foods that go into their bodies are the people who MUST know: very sick people, usually with cancer or diseases that can’t be diagnosed and are chronically debilitating, people who sell supplements, and wackos like me who want to live long and prosper.

When I undertook my journey to better health, it was for many reasons. First, the US health care system is broken; it is costly and access is limited by a critical doctor shortage. Second, I have two young grandsons, for one of whom I will soon be the only surviving grandparent. Third, two former husbands, a former lover, and my daughter’s inlaws all suffered from cancer. Fourth, I was on anti-depressants since the death of my last husband almost fifteen years ago.

I wasn’t a bad eater to start with: no fast food, little processed food, organic fruits and vegetables, limited amounts of meat.

But then I went to the nutritionist/pharmacist in North Scottsdale, where wealthy people have access to treatments the ret of us lack. They pay out of pocket, as I did.

The nutritionist (http://www.time4health.com) administered an IGC panel for food sensitivities and then prescribed fish oil, immune support, digestive enzymes, probiotics, and a multi-vitamin high in B Complex.

He also told me to eat only grass fed beef if at all, only Wild fish, no gluten, and for me especially no dairy of any kind and no Lima,kidney, or navy beans. (the blood test showed I have intolerances to them).

He also told me to get off frappacinos and start the day with protein rather than a banana, get off the single Diet Coke I drank a day, and stick to a pretty much plant based diet.

I balked. So would you. After all, I am a healthy person. I didn’t feel bad to begin with, although I did have a little joint pain and some digestive bubbles, which I thought normal for my age.

But I am now six weeks into the program. I can stand at a cocktail party without feeling my back. I easily gave up Diet Coke and Frappacinos, without even missing them. I have ten times the energy I had before.

But the most important result so far: I am off Lexapro. Those SSRIs are supposedly very difficult to get off, with major withdrawal. I, However, cut my pills in half for a few weeks, then went to half a pill every day, and then to nothing. With no withdrawal that I noticed.

One of my best friends is an MD. He kept asking me for the “literature.” My family doctor called me “meshuga,” Yiddish for crazy. But he did agree to order another series of blood tests to find out even more about me. Trust me, there is literature being written about this every day at major medical centers as a result of new clinical trials– trials that were forced into existence by patients who demanded them, patients who offered their own experiences online, and patients simply desperate for remedies for chronic conditions. Oh, and by a health care system staggering under the costs of treating these conditions– conditions that could be halted or prevented by proper nutrition.

Don’t let the American food-industrial complex maim you. Do your own research.

I am listening to the story of a woman who had malignant mesothelioma eleven years ago, was given 8-14 month prognosis, and is alive because her best friend is a specialist in personalized medicine at the University of Arizona. He found through tumor tissue analysis that her markekers were the same as those of someone with chronic myelogenous leukemia, which is treatable.

So there she is, up on the stage, a living example of why Arizona has committed itself to the Biomedical Roadmap to develop personalized medicine and customized care as a special industry for Arizona.

But here is the problem.

Right now, personalized medicine is for the rich, and most of us won’t be able to afford it. The speaker I heard admitted that her health insurance has paid millions over the years to keep her alive.

We MUST figure out a way to make these advances available to people at less cost to both the health care system and the individual patient. Ironically.personalized medicine and especially molecular profiling may end up saving, rather than costing, the system money, because we will be able to stop offering chemotherapy to people it won’t help.

Right now, one of the reasons the last six months of life cost so much is that we spray these expensive medicines at people without knowing whether they can really help. I’m the process, we ruin the patient’s quality of life and literally waste billions.

I found it eye-opening to learn that the same expensive interventions, done only where they are truly going to be worthwhile, could actually help save our health care system.

Yesterday was Rock Health’s first Demo Day. Rock Health is the hip, cool, incubator for health care startups in San Francisco, and I was fortunate enough to mentor many of the young companies. Almost to a person, they don’t come from health care backgrounds, so they are able to look at things with fresh eyes.

But to a person, they don’t come from health care backgrounds, so when I first saw them,  they had differing degrees of market knowledge.

And that is why Rock Health is even more valuable than a plain vanilla tech incubator. Health care is a very difficult industry to penetrate, but these founders have had access not only to capital, but to strategic partnerships and mentoring from some of the major players in the industry, like United Health Group, Aetna, Mayo Clinic, Harvard Medical School, and Genentech. (And me.)

As they begin to penetrate the market with their brave new ideas, they may not hit the same walls as their less well-connected predecessors. In their favor. they also have health care reform efforts, a generation that is accustomed to getting services online, and a new generation of docs as anxious to change the model as their patients. Hospitals and insurance companies will have to come to the table, or they will be…disrupted.

Since I had seen six of the companies before, I was delighted to see how far they had come since the summer, and how many of them had revenue, partnerships, or pilots in progress. I believe their moment is now, and that we are truly about to see health care shift.

At long last.

Just a peek at the first graduating class:

Cake health. The average family spends $10-20k a year on health care. Cake Health says it has  the best free way to manage those health care expenses. You enter your provider, and It pulls in all your  costs and tells you where they went. It also tracks the claims that were denied. Cake Health is already funded.p

OmadaHealth attacks the costly problem of chronic diseases, beginning with diabetes. It is a social support, shared experience and trust network to ”treat” a diagnosis of pre-diabetes. Since the net present value of avoiding  a single case of diabetes is known to be $55,000 insurance companies are interested in this. 

Big Evidence has found a better way to get medical evidence to clinicians and the point of care, so they can make better decisions on how to treat. For the physician finding specific answers Is challenging and inefficient, and they are often too busy for evidence-based medicine. They already have a grant from the Nationsl Stroke Association.

Skimble, a wellness application already available on Android and iTunes,  provides expert coaching  and with follow- along multimedia workout instructions. It already has had over a million downloads.

Genomera is a consumer health collaboration platform that grows the number of people who organize and participate in health studies, which amounts to crowdsourcing clinical trials. Users can organize their own trials, advised by experts. There are already 17 trials under way

WeSprout provides an ultra-simple user interface to connect  parents to each other to crowd source children’s health information

BitGym wants to turn  cardiovascular exercise into video games  so people who hate exercise can have fun while riding the exercise bike.Their research showed that households often have More than 1.15 exercise machines per household, but never use them. Their first app is already in the Apple queue and they expect to be a producer of MMOGs for cardiophobics.

Pipette Is a tracker to reduce complications and  improve recovery times for people who are discharged from hospitals. It fills the education gap between the hospital’scryptic discharge instructions and what is necessary to prevent costly hospital readmissions. Pipette is developing content with Harvard Medical School and piloting with Mayo Clinic

Heartbeat is an enterprise solution for the one-person business that empowers people to do what they love by combining all the business functions into a single social platform..

CellScope uses Smartphone imaging for diagnosis of ear and skin infections via an otoscope, dermatoscope  – allowing magnification, illumination, calibration, and computer vision for decision support.Its pilot will be  funded by the FDA at Emory University.

BrainBot. Stress weakens the immune system, and costs the economy $300 billion a year.Thus, stress  management programs are being taught in 250 hospitals, and 10% of Americans use meditation as a stress management tool. Brainbot uses technology tools to provide feedback for beginning meditators.

Chronology is the next generation of a concept started by PatientsLikeMe, It is a social app for people who have poorly understood autoimmune diseases with terrible treatment options, such as Crohn’s disease, colitis, and fibromyalgia.  Its simple interface encourages relationships and information sharing, connects patients to each other, and gathers information for future research and clinical trials.

Taken together, this group of startups, and the partners and funders who have bet on them, will start the process of health care transformation. Will they all succeed? Probably not, but they will have a much better chance than the generations of entrepreneurs who have broken their picks on this recalcitrant industry.

Related articles

• RockHealth Demo Day shows off some cool health apps (venturebeat.com)

This post came to us from Anthony Lopez at E-Health Insurance.

Educate employees about health insurance costs: According to recent numbers from the Kaiser Family Foundation , the cost of employer-sponsored health insurance increased 9% for family coverage and 8% for single coverage in 2011. But the fact is that most employees don’t have a good understanding of how much employers pay toward their coverage. If you’re facing increased costs and need to ask your employees to contribute more toward their premiums, it’s time to sit down and have a frank discussion. If employees better understand the challenges increased costs present to your business, they may be more willing to accept necessary adjustments to their coverage or contributions.

Consider that employees prefer cuts in benefits to rate hikes: A recent survey sponsored by eHealthInsurance and conducted by Kelton Research shows that employees are more likely to be upset by increases in their monthly premiums than by changes to their benefits. Keep that in mind when deciding how to adjust your health insurance offerings for next year.

Conduct an employee poll to find out which benefits matter most: If you find that you must cut benefits from your health plan in order to make ends meet, ask your employees to complete an anonymous poll. Don’t ask about their health or their medical history – that’s illegal – but ask them which types of benefits matter most to them: robust preventive care, prescription drugs, chiropractic, maternity care, low copayments, vision or dental coverage, etc. This can give you some guidance when choosing which kinds of plans to offer.

Consider ALL options available from your carrier, and new carriers too: When open enrollment season comes around, many employers get notices from their insurance company suggesting a few coverage alternatives, but there’s usually more to choose from. Contact your agent or broker to explore other options that might be available through your current carrier. A licensed agent representing multiple carriers can also provide you with fresh quotes from other insurers in your area. It’s all part of doing your homework if you want to make sure and get the most for your health insurance dollars.

Offer employees more than one coverage option: Smaller businesses tend to offer fewer coverage alternatives, but there may be benefits to offering more. If you’re currently offering your workers only one health plan, consider adding a second or third to the mix. For example, you might offer a high-deductible Health Savings Account-eligible plan, and then another plan from the same carrier with a lower deductible. The dollar amount you contribute toward employee coverage need not change, but it gives employees who want it the chance to start a Health Savings Account or to pay a little more from their own pockets for a plan with a lower deductible or more robust benefits.

Get that new tax credit while it lasts: Not all small businesses can afford to offer health insurance. But until 2014 tax credits are available for small businesses with 25 or fewer employees with average annual wages of less than $50,000. You may qualify for a credit of up to 35 percent of the premiums you pay toward employee coverage. Talk to your accountant to learn more.

Discourage employees from going uninsured: Some businesses will find that they’re unable to provide employer-sponsored health insurance in the coming year, or that their employees can no longer afford rising rates and opt not to enroll. If that’s the case, encourage your employees to do what they can to make sure they have some form of coverage. It gets them better access to medical care when they need it and helps keep them financially sound, which can only be good for your business. If their spouse works, they may be able to enroll in his or her plan. If they’re under age 26, they may qualify to re-enroll in a parent’s health insurance plan. To explore government-sponsored options, they can also contact the non-profit Foundation for Health Coverage Education at coverageforall.org.

Image via Wikipedia

Are poor Medicare recipients drug addicts, or are they selling their drugs on the street?  The stereotype out of the Government Acocunting Office says they are addicts defrauding the government.  Looking at the same study with an open mind, I think it’s just as easy to say they are trying to make ends meet by buying and selling drugs, just like most of the other residents of ghettos and barrios where the 99% live:

In 600 cases revealed in the audit, Medicare beneficiaries received prescriptions from as many as 87 different doctors in the same year indicating, the report said, that the patients shopped around to find as many providers as possible to write prescriptions for drugs in those 14 categories — mostly controlled substances and primarily hydrocodone and oxycodone.

“In these situations, there is heightened concern that these Medicare beneficiaries may be seeking several medical practitioners to support and disguise an addiction,” Kutz told the Senate Homeland Security and Governmental Affairs Subcommittee on Federal Financial Managment, Government Information, Federal Services and International Security on Tuesday.

The people who received multiple prescriptions accounted for $148 million in loss to Medicare, according to the Government Accounting Office, which conducted the audit. GAO believes that most of the “doctor shoppers,” who are disabled or elderly, are addicted to the drugs they’re buying.

I would like to challenge GAO: I would bet otherwise. I bet they are selling their excess drugs on the street to get money to live on. In this nation of haves and have-nots, Medicare is one of the last remaining sources of safety.

I looked this up on the internet. Here’s what Yahoo Answers says is the prevailing rate for oxycontin on the street: “usually the cardinal rule for all recreational pills is a buck a milligram.” In Palm Beach County Florida, where many elderly people live, recreational pain killers go for $8-$10 a pill.

Before we assume the Medicare beneficiaries themselves are the addicts, let’s look at who they are:

One barrier to spotting fraud among Medicare beneficiaries with low incomes is that they are a special group that can switch Medicare plans monthly, making it difficult to spot excessive prescriptions or excessive visits to the doctor, Kutz noted. Traditional Medicare beneficiaries can only switch Medicare plans once a year.

Doesn’t it make more sense that these people, who probably lack other necessities in life, have put their disabilities to work for them in the only way they can — to use them to procure drugs and re-sell them on the street. Of course looking at it that way would mean taking a systemic view of poverty, disability, social problems, and drug addiction. Prescription drug addiction is just as prevalent among the rich as among the poor, only the rich can afford to pay the $10 a pill.