Sia: Very interesting piece about how health insurance works (rather badly) in this country and WHY.
Congress and My Prostate - Some good news
by Robert Reich- Feb 5
Friends,
Today I want to talk about prostates. (Wait! Don’t delete this post! Give me a minute to explain why you might be interested.)
All of us are getting older, and some of us are becoming quite old.
Many old men, like Joe Biden and me and several million others in the United States, have prostates that contain cancerous cells.
But because prostate cancer grows very slowly, most of us old geezers will die with it rather than because of it.
Yet some prostate cancers will threaten our lives if we do nothing about them. (A tip-off is if a man’s prostate-specific antigen — PSA — starts rising.)
Biden’s is reported to be aggressive, prompting a wave of sympathy from normal, empathetic people. (Not surprisingly, the moment the news came out, Mr. Compassion in the Oval Office made the baseless claim that Biden had covered up his cancer while he was in the White House.)
What to do? The standard treatment is a combination of radiation and drugs to lower testosterone levels (prostate cancer needs testosterone to grow). My understanding is Biden is getting both.
Unfortunately, testosterone-lowering drugs have some unpleasant side effects — fatigue, weight gain, declining bone and muscle mass, reduced sex drive, impotence and erectile dysfunction, hot flashes, mood changes, liver damage, and greater risk of heart attack.
Think menopause for men.
Long story short, I was about to take a testosterone-reducing drug when a doctor offered a second opinion, urging me to use estrogen (estradiol) patches instead. She told me about recent research in the U.K. showing the patches to be just as effective as testosterone-reducing drugs in lowering testosterone and fighting prostate cancer — but without most of the awful side effects.
Oh, and the patches are far cheaper than the drugs.
So, you may ask: Why are testosterone-reducing drugs still being prescribed when they have all sorts of lousy side effects, and when estrogen patches are just as effective without most of those side effects, and they’re cheaper?
Answer: because pharmacy benefit managers (PBMs) prefer the more expensive drug treatment.
Okay, now I need to give you a bit of background on PBMs.
PBMs rake in big profits by controlling the pharmaceutical market and siphoning off some of the profits to the biggest insurance companies, from which they extract rebates.
Ergo, they have every incentive to push for pricier drugs because that’s where the money is. (This also explains why research into cheaper remedies is so often done in the U.K. and elsewhere rather than in the United States, where the PBMs have a lot of influence over what’s researched.)
Under former Federal Trade Commission Chair Lina Khan (whom I spoke with recently), the FTC released a series of damning reports on PBMs — and filed a critical antitrust case against them for inflating the prices of insulin.
The FTC found that the big three PBMs — Caremark Rx, LLC (affiliated with CVS), Express Scripts, Inc. (with ESI), and OptumRx, Inc. (with OptumRx) — marked up generic drugs dispensed at their affiliated pharmacies by thousands of percent.
Lina Khan says these include many lifesaving drugs, such as those to treat cancer.
Which is why Pharmacy Benefit Managers have been pushing more expensive drugs to treat prostate cancer — drugs that also have worse side effects than estrogen patches.
But here’s the good news. Congress has just reined in PBMs.
Based on the work of Senators Ron Wyden and Mike Crapo, Congress issued rules that prohibit PBMs from discriminating against smaller pharmacies or keeping any part of the rebates they extract, limiting them to flat dollar amounts rather than percentages of a drug’s price, and requiring them to give their customers full pricing information.
The new rules were included in the DHS spending bill that Trump signed into law Tuesday. Most of these changes will go into effect in 2028.
(I don’t know how Joe Biden is doing but, should you be wondering, my patches and the radiation seem to have done exactly what they needed to do. Enough said.)
I had a very uncomfortable exam a while back that probably should be reported because of the way it happened. I won't share the details but it is a reason I am reluctant to see a doc about any discomfort, ever.
A Jack of all trades is master of none, but oftentimes better than a master of one.
... And many thanks for the masters in skill for setting our standard of work to instill.
Did you have inject yourself? I HATED having to do that with so many
I AM grateful I’m in remission, which is the main thing. RESIST!
Believe me, I know about abdomen injections having had to do it to myself for about 7 years before
Posted by Sia on February 5, 2026, 3:49 pm, in reply to "Thank goodness, no" ADMIN
switching to infusion meds, which still involved needles, but I didn't have to do it to myself.
I'm glad you're in remission. We're they able to establish the the cancer was gone because of the injections and chemo drugs?
I seem to dodge many bullets
Posted by Pikes Peak 14115 on February 5, 2026, 3:35 pm, in reply to "Thank goodness, no"
Health care for profit is immoral.
Europe abolished slavery decades before we did. Europe established socialized medicine and we have yet to do that. People who argue against it call it communism.
Hope you both fully recover soon.
I am not hiking anywhere today. RICE to the knee. It is improving. I can put weight on it and walk. I dodged a bullet and an ACL tear. Betelgeuse, Antares, Rigel, Deneb, Sirius, Castor, Pollux, Aldebaran, Polaris, UY Scuti, Stephenson 2-18, Sia, Greenman, Skye... lucky stars I count.
Joan's dementia is sometimes funny. Yesterday she thought I was under her pillow, and Stuart was under the chair beside her bed.
C'mon thaws! Cold hearted orbs that rule the night. Removes the colors from our sight. We decide which is right, and which is an illusion. Brave Helios! Awaken your steed! Bring the warmth the countryside needs! - Days of Future Passed.
You can look away from a painting, but you can't listen away from a symphony
I fell in the church parking lot after the big snow three weeks ago. I parked out in the lot so less able seniors could park by the building. I had to crawl across the lot to the building to stand back up. About 50 feet or so.
Then last Sunday we had the league match and then a postbowl afterward. 7-1/2 hours of bowling. Re injured it there.
Joan is my mil. Easier to just say "Joan."
It was 63f today. 64f yesterday. Most of the "winter" has been like that.
You can look away from a painting, but you can't listen away from a symphony
OK, it’s not normally in the 60s here in January, but for at least three weeks we’ve had huge piles of snow and 10 degree (or less!) temps.
It’ll be in the 40s this coming week, and feel like summer..
Knee problems are annoying, I had surgery some years ago for a loose piece of cartilege in the left knee. Not a big problem but chronic annoying pain. RESIST!
Glaring lack of snow in the mountains. That will be critical for everyone downstream from us this summer. You can look away from a painting, but you can't listen away from a symphony
OMG, it’s 20 degrees here
Posted by greenman on February 7, 2026, 6:03 pm, in reply to "70f today!" Valued Poster
I know, global warming has many effects throughout the world.. RESIST!
We've been in the minus territory every night for over 2 weeks now.
Scary dry up in the central mountains. This was on Mt Shavano yesterday.
Maybe felon's denial of climate change will miraculously provide water for everyone downstream from us this coming summer. You can look away from a painting, but you can't listen away from a symphony
Har..that is so weird
Posted by greenman on February 8, 2026, 5:52 pm, in reply to "74f today" Valued Poster
It’s 27 here and might be 50 next week…which will feel like 80 RESIST!
Strong, icy winds making it feel colder! It's been so cold that we've used 5 weeks worth of oil in just under 2 weeks. Day after day slipping below zero at night and often single digits during the day uses a LOT of oil. We've closed off 2 entire sections of our house and put them down to 45° to keep any pipes from bursting and dropped the garage down to 25°.
We haven't had such extended cold for years now so didn't bother to get a bunch of oak logs to cut up for firewood Since we haven't needed it. We used the last of the wood we'd kept for extremely cold nights to take the curse off the cold last week.
Next, we'll probably have an early, very warm spring to continue the crazy.
After her first bad ACL tear. Outside the Aldi market. A funny sight! She was in a wheelchair, with the injured leg braced straight out in front of her. She was pushed by a caregiver, and she was walking her little dog on a leash.
I think her decision to compete is questionable. We shall see! You can look away from a painting, but you can't listen away from a symphony
of her crash. It was if she was fearful of crashing even before it happened, twisting in mid air and trying to land on her right ski in order to protect her left leg.
A Baker bakes. A Smith works with metals. A Johnson is a son of John. What then, is a Trump? You can look away from a painting, but you can't listen away from a symphony
That's awful! Did you see a doctor? I know you don't unless
forced to so just asking. It could be serious if you've now injured it twice, once just by bowling a lot. Must be something underlying if that happened.
Have you iced it and kept it wrapped or used a brace to stabilize it?
It was healing until the marathon bowl, 12 games in 7-1/2 hours. Since I bowl seriously and competatively, I put stresses on my legs beyond "normal bowling." And I bowl with 15 pound balls. I hyperextended it.
I haven't ace wrapped it yet. But dottir is going to get one for me today. Problem is my legs are so damned big from all the climbing, skiing, cycling etc. Thighs are 28". Been that way all my life. I could press and multiple rep the whole stack on a Universal weight machine; 750 pounds with either leg AND the coach standing on top of the weight rack. Something close to 900 pounds. Point is the sleeve type ace braces don't fit me. Not even close. Nor do the velcro wrap arounds.
Joan lives in Pueblo, 40mi to the south. She turned 100 last July. You can look away from a painting, but you can't listen away from a symphony
They make long wraparound that you use clips to hold. You can use 2
Posted by Sia on February 8, 2026, 8:05 am, in reply to "Trying to RICE it" ADMIN
Together if necessary. Just make sure it's wrapped right so your knee is able to bend but have the support you're looking for.
on February 5, 2026, 9:39 am
