Drugs, Choice, and the “Free Market”

I went to see my allergist yesterday. One of the treatments she prescribed was Dymista. It is a nasal spray containing an antihistamine (Astelin) and a corticosteroid (Fluticasone). I have been using these separately with some success but the combination simplifies their use. She gave me a couple of samples that will last me 2 to 3 weeks. She mentioned that my insurance might not pay for it. However, since I generally buy my own medication I was not too concerned about insurance. That is until I looked up the price from the wholesaler that I use and found that Dymista is $175 for 30 doses. If used twice a day, like she prescribed, that is a little over two weeks of medication.

I am all for modern medicine and I think many of the drugs we take have improved health and prolonged life but I for one think Big Pharma has taken advantage of us. And the government has been impotent in curbing their rampant greed.

If you bought Dymista at Walmart, which is the cheapest price I found on GoodRx.com, it would cost $188. Its ingredients Astelin ($30) and Fluticasone($15) cost about $45 for the same amount.

Mylan Pharmaceuticals is charging four times as much to combine the two drugs into one formulation. It is much like charging $3 dollars for a cup of coffee and a dollar for cream and then charging $17 for coffee with cream.

This is an example of the “free market” that conservatives think solve all economic ills. If regulators would get out of the way and just let the market decide we would all be better off.

What never seems to come up is why regulations are necessary in the first place. The term “government overreach” is a favorite term of conservatives but what they fail to understand and acknowledge is that the overreach began with players in the market, pushing the legal and moral limits for power and profit. Regulations are a reaction to wrongdoing in the marketplace to try to serve the “common good.”

Until we as a society decide that pharmaceutical price gouging cannot be tolerated the Mylan Pharmaceutical’ s of the world will continue to manipulate and take advantage of consumers for their bottom line benefit.

In a review of William Cavanaugh’s book Being Consumed: Economics and Christian Desire, Alex Abecina says, “Cavanaugh contends that the so-called ‘free-market’, having been detached from objectively good ends, actually leaves consumers vulnerable to economic enslavement under an advertising saturated society, controlled and surveyed by a small handful of transnational corporations. This small but powerful sector possesses the research and marketing ‘know-how’ to produce artificially created consumer desires that are capable of dictating our choices for us.”

Freedom in a “free market” involves freedom to make informed choices, taking into account ethical concerns of fairness and the common good. Absent those parameters the “free market” is just about greed.

Healthcare: Public or Private?

Amid all the hullabaloo about repealing the Affordable Care Act a little noticed meeting took place in Dallas in June.

Dr. Tom Price, the Secretary of Health and Human Services and former Georgia Congressman, met with eight Dallas doctors. How they were chosen is uncertain but the mix was representative of one of the things wrong with healthcare in America. Six of the doctors were male and represented surgical subspecialties or anesthesia. Two members were female and were family practitioners. The minimalizing of primary care input into the debate is regrettable.

The HHS website reported on the meeting that it was very long on complaints but very short on suggested solutions. Sort of like the majority party in Congress.

I have contended for some time that if I gave anybody a magic wand and said “Fix healthcare in America.” That person would be unable to come up with a solution acceptable to all.

President Obama reportedly said,” If we were starting from scratch, a single payer system would make sense.” But we aren’t starting from scratch. Our health insurance system evolved as a way to give workers benefits without raising wages. Then unions fought for it and it became an expectation. Then President Nixon introduced the Health Maintenance Organization Act of 1973 and the “BUSINESS” of Medicine was off and running. And thus we have large hospital organizations that one doctor said are really only construction companies funded by sick patients. It is hard to pass a hospital these days without a crane in the sky signaling more building. And those buildings must be utilized and thus the other thing difficult to escape is advertising billboards on major thoroughfares. Did you know the United States is only one of two industrialized country that allows direct advertising of prescription pharmaceuticals to consumers? (New Zealand is the other)  “Ask your doctor…”   has become as ubiquitous as “This Bud’s for you.”

Say what you will Big Pharma, Big Insurance, and Big Hospitals are not going away. I have always believed that single payer with its lower administrative overhead and universal coverage was the best solution in a perfect world. And it still may be the solution America ultimately comes to. But what do we do about all those health insurance executives and employees?

Consider this before you answer. According to CMS (the agency that administers Medicare/Medicaid) there is roughly one Medicare/Medicaid employee for every 21,800 insured lives. For Health Insurance Companies there is one employee for every 340 insured lives. In other words a CMC employee handles 64 times as many lives as does an employee of private insurance. Score one for single payer.

But are we going to put over 500,000 people out of work? I think not. So is there another way to consider? Many students of healthcare policy advocate for a system like Switzerland’s which utilizes private insurance. Although it is the second or third costliest of the industrialized nations it is still 6% lower as a percentage of GDP than the U.S. (17.3 % for U.S. and 11.5% for Switzerland). So a Swiss system might save 6% of our GDP, a significant amount. So what are the tradeoffs to an annual saving of upward of a trillion dollars? The tradeoffs are: 1) Coverage is mandatory. 2) The Government defines the basic minimum policy that must be offered. 3) The Government controls prices for hospitals and doctors.  And 4) although now only a Swiss healthcare proposal, Government negotiation of drug prices will produce further savings.

For conservatives the “G” word is anathema. But they must face the facts that no profit driven system for healthcare has ever worked without some control on usage and pricing. Somebody has to decide how we use these resources. The doctors who met with Price want unfettered ability to treat and charge what they like. I did too when I was in practice. But we are only a small part of one of our nation’s obligations to its citizens: to promote the general welfare. To solve the problem of healthcare we are all going to have to give up something. If we can agree on that then maybe a compromised solution will be possible.

Should we obey governments that are bad? Robert Jeffress says Yes

 Jeffress: God gives Trump authority to take out Kim
Robert Jeffress

Dallas pastor Robert Jeffress, one of President Donald Trump’s evangelical advisers, released a statement Tuesday saying the president has the moral authority to “take out” North Korean leader Kim Jong Un. “When it comes to how we should deal with evildoers, the Bible, in the book of Romans, is very clear: God has endowed rulers full power to use whatever means necessary — including war — to stop evil,” Jeffress said. “In the case of North Korea, God has given Trump authority to take out Kim Jong Un.” Jeffress said in a phone interview that he was prompted to make the statement after Trump said that if North Korea’s threats to the United States continue, Pyongyang will be “met with fire and fury like the world has never seen.” The biblical passage Romans 13 gives the government authority to deal with evildoers, Jeffress said. “That gives the government the authority to do whatever, whether it’s assassination, capital punishment or evil punishment to quell the actions of evildoers like Kim Jong Un,” he said. Jeffress knows his comments on North Korea could be considered controversial, even among fellow evangelicals. “Some Christians, perhaps younger Christians, have to think this through,” he said. “It’s antithetical to some of the mushy rhetoric you hear from some circles today. Frankly, it’s because they are not well taught in the scriptures.”                                        From Dallas Morning News 8/9/17  by SARAH PULLIAM BAILEY, THE WASHINGTON POST

Is Jeffress right? Are we obligated to follow Hitler or Stalin or Putin?

Should we obey governments that are bad?
Matt Slick

Romans 13:1 says, “Let every person be in subjection to the governing authorities. For there is no authority except from God, and those which exist are established by God.” If this is so, what about the bad governments like the Nazis or the Communist regimes where they killed millions?  If God is the one who sets up governments, are we supposed to obey those bad governments? The answer is no. We are to obey governments unless they violate Scripture.  Acts 5:29 says, “We must obey God rather than men.” Whenever a government violates biblical teaching, Christians are obligated to disobey that government.  For example, if a government were to declare that we should kill all Asians, or immigrants, or people with Down’s syndrome, we should disobey.  Governments are run by people and often become corrupt.  Furthermore, the Bible never tells us to obey governments in contradiction to the revealed word of God. In the Old Testament, God sent the Israelites to destroy different nations.  Technically speaking, we could say that God set up those various governmental systems that he told the Israelites to destroy.  But when systems become ungodly and anti-Christian, they are no longer properly representing God and should not be obeyed. Are we seeing a conflict or a contradiction?  Not at all.   Let’s take, for example, Exodus 20, where we see two commandments: obey your parents and do not murder.  We can see that our parents are the authorities above us, even as governments are, and we should obey them.  But, what should we do it our parents tell us to murder someone? Should we obey?  Of course not.  Obedience to our parents is only proper when it’s consistent with the rest of the Scriptures.  Likewise, submission to the governmental systems is only proper when it is consistent with Scripture. Finally, let’s look at Rom. 13:6-7, “For because of this you also pay taxes, for rulers are servants of God, devoting themselves to this very thing. 7 Render to all what is due them: tax to whom tax is due; custom to whom custom; fear to whom fear; honor to whom honor.”Notice that Paul says that the rulers are servants of God.  This is the context of the submission that is mentioned at the beginning of the chapter.  If these rulers are no longer servants of God, and if they contradict Scripture, they are not to be obeyed.

Matt Slick is the President and Founder of the Christian Apologetics and Research Ministry.



Westminster Confession of the Presbyterian Church Chapter 20




“Stuck in the sandbox, you must play with the toys you have.”


Jon Michael Hill plays Moses and Ryan Hallahan plays Mister in Antoinette Nwandu’s “Pass Over” at Steppenwolf Theatre. (Photo Michael Brosilow)

My friend Lance Sterling sent me this recent musing on the Sun-Times review of the play Pass Over. The Chicago Sun-Times critic has caught a lot of grief for it. Click the link below to read the review.

Pass Over review by Hedy Weiss

Lance’s response

Recently, Hedy Weiss,the famous theater critic for the Chicago – Sun – Times, wrote that we need to avoid white cop stereotyping and pay more attention to black on black violence. The reaction to her veiled racism was swift and brutal. I am one who reacted.

While it is true that there is far more black on black crime than white cop on black citizen crime, the second is more insidious than the first. Blacks kill one another for social reasons not racial ones. Stuffed in the ghettos that whites have created for them, blacks fight with one another over limited resources, like dispossessed people everywhere do. They indulge in life – and – death disputes over drugs, over turf, over illegal business deals, over supremacy (elsewhere called “market share”), over power. There aren’t many other options, but one black has never killed another black because he was a nigger.

White cops do that. And white juries generally acquit them, despite videos and eyewitness accounts. Not surprisingly, white juries convict blacks of all crimes in disproportionate numbers. Surely there is a commentary in the fact that almost half of this country’s 2.3 million prisoners are black. Something is amiss, and blacks know from an early age exactly what it is. Like our president pointed out, “The system is rigged,” just not in ways he supposed.

When blacks kill blacks for the reasons suggested above, they are behaving like any nation state, like America. Largely segregated among themselves into enclaves, blacks quarrel over the usual issues, all related to power. Like America, they want more power. As the Mafia says, “It’s business.” But it’s not discrimination. It’s trade and economic superiority and jobs, all the causes America fights for. When Trump says he is going “to make America great again,” whites applaud the very objective they dislike in blacks. If blacks had oil, they would be fighting over it. They have drugs and other cultural flotsam, so that is their casus belli. Stuck in the sandbox, you must play with the toys you have.

This problem will be cured when blacks are, if ever, fully integrated into white society. Blacks will compete like whites, equally ruthless but in a more socially approved manner, cutting throats figuratively, not literally. But make no mistake: Their cause is a racial matter. When the white community gets rid of its sense of racial superiority, social equality will follow. Enfranchised, blacks will no longer have a reason to quarrel among themselves. They will compete in the larger society and embrace the methods and tools of that society, as conniving as whites but in a way that whites recognize and approve of. And white cops won’t shoot blacks any more than others. I don’t want to paint too rosy a Pollyanna picture. Cops will always be cops. Like all people with power, they will always be bullies, always except (sic) graft and kickbacks, always shake people down and extort, always use excessive force, and always gorge on doughnuts. But when society stops discriminating against blacks, cops will too.

Statistics will reflect this equality like they now reflect inequality. Blacks constitute about 12% of the population so they should represent roughly 12% of most statistics. We will know progress is being made when our prison population is 12% black instead of 48%; when black drug convictions are 12% of the total drug convictions instead of 80%; when 12% of CEO’s are black; when 12% of those in the top economic 1% are black; when 12% of doctors, lawyers, university professors, and PhD’s are black; and when only 12% of ghetto dwellers are black. At present, none of these statistics applies, which is why black lives don’t matter. Statistics will tell us when they do matter to whites. And at that point, blacks and cops will stop killing blacks.

Lance Sterling



A message to Pete Sessions about Planned Parenthood

In front of Pete Sessions’ Washington office in April 2017


From Congressman Pete Sessions TX32ima@mail.house.gov


Dear Dr. David Anderson Haymes,

Thank you for contacting me in support of women’s health services. I appreciate you taking the time to express your thoughts on this deeply personal issue.

Providing access to free and low-cost healthcare is an important part of our healthcare system, particularly in many areas of Texas. Through the Title X Family Planning Program, Congress provides federal funding to millions of low-income women for critically important healthcare services. This funding is a necessity for many of these providers and clinics to keep their doors open. I fully support the funding of more than 13,000 federally-qualified community health centers, which outnumber Planned Parenthood clinics 20 to 1 nationally. These clinics provide not only low-cost access to healthcare for women, but men and children as well.

As you know, policy related to federal funding of abortion is a fundamentally and historically controversial topic. Federal dollars have not been spent on abortions since the first passage of the Hyde Amendment in 1976. I believe that current law should remain intact to protect taxpayers from having their dollars spent on services that violate their moral values.

Again, thank you again for contacting me regarding access to women’s health services. Please continue to keep me updated on the issues that matter to you. If you have any questions or concerns, please contact me at Sessions.LegStaff@mail.house.gov. I look forward to hearing from you in the future.

Pete Sessions
Member of Congress

From: David Haymes [dahaymes@gmail.com]
Sent: Tuesday, July 18, 2017 8:44 AM
To: ‘Sessions.LegStaff@mail.house.gov’

Subject: A reply to your letter: Planned Parenthood is not the enemy and provides services community health centers do not

Dear Congressman Sessions,

Paul Ryan got 2 Pinocchios for making the same claim you make. The community health centers are not required to see the indigent or offer family planning. The need for Planned Parenthood exists and as you say no Federal funds are used for  abortion services, that account for less than 3% of Planned Parenthood Services. This is a diverse country. Planned Parenthood is not a threat to you or your constituents. Let it rest and get on to bigger issues – taxes, infrastructure, Russian meddling, gerrymandering, healthcare, and our bloated military budget.

David Haymes M.D.

click below to see Ryan’s statements

Ryan disingenuous on Planned Parenthood

From Congressman Pete Sessions TX32ima@mail.house.gov

Thank you for replying. Unfortunately, the mailbox (TX32ima@mail.house.gov) you are responding to does not accept incoming mail.

Too bad. You should open ALL avenues for your constituents to contact you. You should attend the mail box you send from…so you can “LISTEN” to your constituents.

Evangelina’s braids

Two braids made Cervando a Presbyterian. Back in Mexico in La Cardona near Mier y Noriega long before the revolution, as a teenager Constantino was smitten with Evangelina. He and a friend were riding through a dry riverbed one morning when he met the local priest and his companion riding in the opposite direction. As they approached, the priest said “Constantino, didn’t you have a fancy for Evangelina?” And with that he pulled two braids with blue ribbons out of his pocket and dangled them in front of Constantino. With a knowing smirk the priest replaced them in his pocket and pushed past Constantino and his friend.

Many years later when Cervando’s father, Cervando senior, asked for Maria’s hand in marriage Constantino said, “You may marry but NOT in a Catholic church!” And so they were married in Dallas at the El Divino Salvador Presbyterian Church at 1803 Payne Street between Akard and Harry Hines near what is now the American Airlines Center.

And that is how Cervando became a Presbyterian.

I will leave it to you to decide if the priest took more than Evangelina’s braids.


The Land of the Free and the Home of the Brave?

Constantino brought his family to the United States to escape violence and persecution. As we shall see, Cervando’s mother Maria had one year of education on the family’s journey to Dallas. She married Cervando’s father who worked as a waiter at El Fenix. From that union came two children – Cervando and his younger brother Rene. A psychiatrist and an educator and political activist for social justice. Great contributors to American society.

I have no idea if Constantino crossed the Rio Grande legally or if that was even an issue a hundred years ago.

Many immigrants coming to this country are escaping terrible violence and persecution. Are we blind to this? What happened to

Give me your tired, your poor, 
Your huddled masses, yearning to breathe free, 
The wretched refuse of your teeming shore, 
Send these, the homeless, tempest tost to me,
I lift my lamp beside the golden door.

The story of immigrant contribution to America has been repeated so often that it is remarkable that we as a society forget how common it is, choosing instead to give into our fear of “the other.” We play up the immigrant in trouble with the law, the drug smuggler, the coyote, the gang member and we demonize a whole group as undesirable because of a few.

From today’s Dallas Morning News

If we are truly the land of the free and the home of the brave, is it brave to separate children from their mother? Is it brave to deport members of our military who have run afoul of the law? Shouldn’t they pay their debt to society like the rest of us – in the US justice system?

The argument that this will “enhance public safety” is simply bogus. Studies show immigrants do not commit crimes at a greater rate than  citizens.

And how about the mother who is a legal resident but voted, I choose to believe out of ignorance rather than malice. She is sent to jail and  threatened with deportation. She is given a  longer sentence than another woman convicted of a violent crime. What is brave about that?

Are we so frightened and blind that we cannot see that compassion is an American value.

We can do better. Be fair not frightened. Compassionate not cowardly.

Fear sells but it is a hollow product that will never satisfy.











Mier y Noriega Festival of St Anthony of Padua

My Med School friend Cervando Martinez has a two building three bedroom house in Mier y Noriega with a beautiful view looking at the hills to the east. He built it several years ago for about $15,000, including the land. He had not been there since March and so on our arrival we spent an hour or two shooing off the spiders and lizards, uncovering the furniture, plugging in the refrigerator, and opening the windows. It is sparse but comfortable with running water, an indoor toilet, but a COLD SHOWER.

The 4 day festival in Mier y Noriega concludes on June 13, the feast day of St. Anthony of Padua-the patron St. of lost things and of Mier y Noriega. In addition to carnival rides, food, a rodeo, and folk dancing performances there is a daily parade to the church led on one day by women, on one day by men, and on the last day by families. The festival concludes with fireworks on the evening of June 13, which in typical Mexican fashion did not occur until 1:30 AM on June 14.

Mier y Noriega and the surrounding area is where Cervando’s family originates. He has so many cousins here that we lost count. Arturo Villasana (in cowboy hat in photo) is a second cousin, meaning that he and Cervando share the same great grandfather. Their grandfathers were brothers. Arturo is a local cattle rancher and one of 22 children by one father and two mothers. Learning that, we understood where all the cousins came from!

During the repeated violence of the Mexican Revolution (1910-1920) Cervando’s maternal grandfather, Constantino Villasana, brought his family (including Cervando’s mother born in 1906) from the La Cardono Hacienda into Mier y Noriega. In spite of this relative safety, Mexican soldiers continue to raid the town, stealing food and horses. Each time they came Cervando’s grandfather sent his two sons into the hills to avoid their conscription into the Mexican army. To keep the soldiers from getting his horse Cervando’s grandfather hid his horse behind a large stone oven in the kitchen. Amazingly the horse remained silent and perfectly still. Cervando said this occurred many times until his grandfather tired of it and in the 1920’s the family emigrated to San Antonio; Hunter, Texas; Waco; and ultimately Dallas.

In 1901 when the above photograph was taken, Constantino and Angelina Villasana were young parents of, from left to right Rodolfo, Refugio, and Constantino II, in Mier y Noriega, Mexico. Though trained as a tailor, Constantino was a foreman on the La Cardono Hacienda of Matias Baez, one of the largest landowners in northern Mexico. By the time the revolution came, the Villasana had three other children, and the entire family was threatened by the rampaging violence. The Villasanas emigrated to Central Texas and then Dallas in 1906.

A Trip to Mier y Noriega, Mexico with Cervando Martinez M.D.

We left Dallas on Cherry’s birthday, June 8, 2017. We drove five hours to Kerrville Texas and spent the night with our friend Jan Pickett, a widowed nurse of the artist Denny Pickett. Cypress trees on the riverWe agreed to buy another one of his paintings from a style that we do not have represented in our collection.

The next day we headed to San Antonio and put our belongings in Cervando’s car and headed for Laredo. We arrived after dark and it took us four hours to cut through the red tape and get our car permit for the interior of Mexico. Cervando had neglected to get his last permit canceled and that was the hold up. It was hot but I was able to watch game four of the NBA finals on my phone, the only game Cleveland won.
We spent the night at a motel in Laredo and the next morning started our four-hour drive around Monterey and Saltillo to Matahuala and then through the town named Dr. Arroyo then to Mier y Noriega, a town of about 5000 people at about 5200 feet.

José Servando Teresa de Mier Noriega y Guerra was a Dominican priest born in Monterrey in 1765. At age 16 he entered the Dominican order in Mexico City. By the age of 27 he had a doctorate and was a noted preacher. On December 12, 1794 he was asked to give the sermon in front of the Archbishop and the Viceroy. In this sermon he alleged that the Virgin of Guadalupe (i. e. the Virgin Mary) had first appeared not in 1531 to Juan Diego but 1750 years before on the cloak of St. Thomas the apostle who had preached in the Americas after Christ’s crucifixion long before the Spanish conquest. Noriega asserted that the Aztecs had been preached to by St. Thomas and had made him their god, Quetzalcóatl.
This so incensed the Archbishop that Noriega was excommunicated and exiled to a convent in Spain, stripped of his doctoral degree, and prohibited from ever teaching, preaching, or hearing confessions . He was imprisoned several more times in Europe after escaping and in 1816 was part of the Mina expedition attempting to obtain Mexico’s independence. The Mina expedition landed in 1817 180 miles south of Brownsville, TX where they were again captured. Noriega is credited with bringing the first printing press to the New World on that expedition. He was finally elected a member of Congress in 1823 and died peacefully in Mexico City in 1827. The only memorial he got for his troubles was an obscure town in northern Mexico bearing his name. A copper statue at the town’s entry memorializes his image, his priesthood, imprisonments, and the printing press.  

A Memory: August 1999

The Woods Hole Ferry was right on time. Fortified by steamers and beer we wheeled our luggage up the ramp and found a place below to sit. It was dark and the night sky was coming alive. Haley and I ran up the stairs to explore the top deck leaving my wife and other daughter below. At thirteen Haley is at that not child/not woman stage of adolescence. She is becoming the center of her own universe. Parents want their children to stand on their shoulders to go further in the world but always long for a downward look of appreciation. As she disappears around the corner I sit near the front facing east. The ocean is dark. The night is much clearer than ten days ago. It was probably about there that the plane went down. (John Kennedy Jr., flying a private plane, and his wife had fatally crashed in the ocean just the week before). Boom. Gone. Life. No life-only memory, only regret. I think of another John, my cousin in South Carolina. His college roommate of long ago was murdered in Los Angeles by a jealous lover. A new experience with no manual. My cell phone works even in Massachusetts. He is not home. I leave a message of concern and love.
The ride to Martha’s Vineyard is only an hour. Vineyard Haven is deserted when we arrive. The agent told me that we could walk to the Captain Dexter House. Man, am I glad that I brought our industrial strength carrier with wheels. Buying it is the best one hundred dollars I ever spent. Following Haley, who has directions, we wheel down the Main Street. A sign in front of a three story clapboard house says , “Captain Dexter House – 1843.” On the front porch a couple sits on either side of the etched glass door drinking wine, white as I remember. “You can’t get in here,” she says. “You have to go to the side.” Our roller is useless so I carry as much as I can around him to the side door.
I am drenched in sweat after my second trip. He sips his wine and doesn’t say a word. I don’t exist. This is not Texas.
The Captain Dexter Suite is at the top of the stairs. We can imagine the sea captain living here but it is a stretch for the four of us. We look out on the garden through a trapezoid shaped window, a rectangle bullied by gravity over the years.
Stacy, my older daughter who always lands on her feet, calls her husband in Boston. Though married only eighteen months, he has loaned us his wife for 48 hours.
Tomorrow we will bike to Edgartown where the sailboats will remind three of us of Belize where Cherry and I honeymooned when Stacy was twelve. That evening we will dine at a French restaurant across the garden. Stacy will fly back to Boston the day after tomorrow and the three of us remaining will rent a jeep and drive to Gay Head looking east to the site if the crash.
But tonight we sit on the floor playing cards, enjoying the night and each other.