It's Your Fault Old People Are In Pain

Why, fat people? Why are you hurting the old folks?

So I'm reading this interesting story in the New York Times about the fact that there is a fairly risk-free vaccine which reduces the chance of developing shingles by more than half and the risk of post-herpetic neuralgia by over two-thirds. Shingles is caused by a reactivation, years later, of the virus which causes chicken pox, which most often occurs in older people. Post-herpetic neuralgia is an extremely painful complication of shingles.

The good news is that the U.S. Food and Drug Administration approved a vaccination against shingles in 2006, which the U.S. Centers for Disease Control and Prevention in 2008 recommended all people aged 60 and older receive.

The bad news is that few do, because, according to the Times it costs ten times more than other adult vaccinations at $160 to $195 per dose (it need be administered only once), may not be fully covered by insurance or even Medicare, and the reimbursement process is stupid (my word, not the Times).

Private insurers generally require patients to pay for it themselves and then apply for reimbursement. Medicare classifies it as a presecription drug, unlike other vaccinations for older people, and it therefore invokes the rather complicated payment structure currently in place for prescription drugs under Medicare.

Well, this ain't right, I'm thinking, and wondering if there will be in this article an explanation of why the vaccine is so expensive to begin with (there isn't), when, deep in the explanation of how burdensome all this is to physicians (the article was written by an M.D.), I come across this pearl of sad wisdom:

“There’s just so much that primary care practices must take care of with chronic diseases like obesity and diabetes and heart disease,” Dr. Hurley noted. “If a treatment isn’t easy to administer, then sometimes it just falls to the bottom of the list of things for people to do.”

J'accuse, fattiez! (Ok, I'm fat, too, but I'm speaking for the righteously non-fat here. They have so little voice.) Simply by virtue of having a BMI over 30, regardless of whether you have any actual illnesses (besides the chronic disease of obesity, of course) you are keeping the physicians of the world so damn busy that administering a shot which can keep old people from suffering excruciating pain for long periods of time goes to the bottom of their list of things to do.

You, O carrier of the Deathfatz! You have perpetrated this cruelty upon our elders! Unless you happen to be both fat and older, in which case you deserve to be in pain, because if you weren't so fat your doctor would have had time to prevent it.

The article does discuss a real problem in the reimbursement structure for this vaccine. As another quoted physician, Dr. Allan Crimm, says:

“It’s indicative of how there are perverse incentives that make it difficult to accomplish what everybody agrees should happen.”

But thank goodness we didn't manage to get through even one article on a medical problem without someone having the courage to point out who is really to blame, although I must say the connection was not exactly spelled out. Still, most people are perfectly willing to take for granted that anything and everything, and certainly any problems with health care, are the fault of the fat people. They don't require any actual documentation; they just need a little reminder now and then to keep that in the forefront of their minds. Fortunately, Dr. Laura Hurley was happy to provide that.