Monday, November 3, 2008

Where this country fails...

She approached the counter nervously and asked to speak to a pharmacist. Her hands were shaking and voice quivering as she explained that her hours had been cut at her job, and she was dropped from the company's insurance plan. However, since she still maintained part time status, she made just a little too much money to qualify for Medicaid. She had various panic and mood disorders, and without insurance, she would have to pay about $1,000 per month for her medication.

She started to cry as she pleaded for us to help her in any way we can. There was just no way she could afford $1,000 per month for medication. However, going without them meant putting her mental stability and ultimately her life in jeopardy.

Not knowing what else to do, my pharmacy manager (a great guy) called social services on her behalf. Nine times out of ten, this causes you to wait on hold for 30 minutes until you finally speak to someone who tells you there's nothing they can do. This time, he got lucky. He still waited for 30 minutes, but when someone finally picked up, they were actually able to help him. He was able to get her set up with an appointment with a Medicaid "triage specialist" first thing the next morning.

We explained what she needed to bring to the appointment and gave her 3 days worth of her medication at no charge. Our efforts to help calmed her down as she was no longer crying. She was still shaking a bit, but she was very grateful. As she walked away, all I could think about is that she'll most likely be denied coverage...

This highlights a major flaw in this country. Health care, in our current system, is a privilege instead of a right. If you are lucky enough to get insurance through your job, or if you make enough money that you can afford the $12,000 per year for the average insurance policy, you get access to health care. Everyone else is fucked.

What kind of society do we live in when we have to choose between being able to pay a mortgage or pay for health care? How can we live with ourselves when we have to look at patients struggling to get by and tell them, "Sorry, you can't have the medication that keeps you healthy unless you can afford to pay for it." Or, "I'm sorry it's too expensive for you to see a doctor."

Just about every other industrialized nation in the world has some form of national health care. We stubbornly resist. Just like we stubbornly resist to join into agreements to cut carbon emissions. Just like we stubbornly resist to adopt the metric system. Just like we stubbornly resist accepting the scientific consensus that climate change and evolution are real. As much as we love to make fun of France in this country, France's system of national health care far exceeds our own. France is ranked #1 in the world in health care by the World Health Organization. The United States is ranked 37. Perhaps it just might be a good idea for us to stop insulting France just long enough to look at what they're doing with health care and try to incorporate that into our own system.

The only 2 arguments I hear against it are wait times and that it will increase our taxes. As for wait times, do you think that person who currently has no coverage at all right now cares about the wait times? Canada, with all its supposed wait times is also ranked higher than the United States in overall health care. The cost of Canada's health care plan is also less per citizen than the average cost of $12,000 per year for the average health care policy in the U.S. In fact, the United States pays the second most in the world for health care as a percentage of GDP. We're ranked first in per capita health care spending. For spending all that money, you'd think we'd be better than 37th in the world.

And don't give me the socialism argument. Socialistic institutions seem to be just fine when it comes to the police, fire departments, education, public works, etc. In the name of the free market, why don't we privatize all of those? Yeah, stupid idea, right? About as stupid an idea as privatizing health care insurance.

There's no good reason for people to be denied health care simply because they can't afford to pay for it. I dream of a day when the United States stops dragging its feet and finally adopts a superior model that is more in line with the rest of the industrialized world. Maybe then we can actually have something to back up our persistent claims of being the greatest country in the world.


PharminItUpinTahoe said...

Sounds fine to me, I do not want to have to pay for my diabetes or cancer treatment in the future, that is going to be expensive.
Between the pack of cigs/day, constant fast food and my sedentary lifestyle there is no way I am not going to develop a few chronic disease states along with cancer.

Tax dollars can pay for my health care and I can pay for my cigs, burgers and satellite. Good times, good times. Hell, with the money I will be saving, I will be able to buy Marlboro instead of Pall Mall.

America needs to wake up and start preparing to take care of those too lazy and stupid to take care of themselves!

I'm with you Mike, I will even do my part by switching to diet sodas with my Value Meals, I don't want to cost the tax payers too much.

Pharmacy Mike said...

Other countries don't seem to have this problem. French citizens smoke, eat cheese and other fatty foods all day, yet they still live longer, and pay less per capita for superior health care.

The tax issue is irrelevent when we pay more per person for health care than any other country in the world. Nationalize health care and suddenly you take a huge burden off businesses by not making them pay for their employees health plans. This frees them to hire more workers and pay higher wages.

Your tax dollars pay for education for those who drop out of school. Your tax dollars pay to fight fires started by stupid people who don't know not to play with matches.

Your tax dollars also pay for Medicare, which is one of the most successful public programs ever enacted (Part D aside). That's a health care program. You don't see too many elderly people looking to give up their Medicare, do you?

Bitch and complain about taxes all you want, but I'd rather pay slightly higher (and that's all it woudl be at most) taxes and have health care for EVERY SINGLE CITIZEN in the United States.

I doubt we'll ever see it though because people and politicians in this country love to drag their feet on things like this.

Amanda said...

I couldn't agree with you more! As for pharmacists, I'm okay with taking a slight decrease in pay if that's what it takes. It also means that the adjudication process will be simplified and hopefully that will save us time in the long run. Like I tell people outside the healthcare field who just don't understand why it's necessary: it KILLS me to see people walk away from the potentially life-saving care they need simply because they can't afford their co-pay!

Shieldmaiden96 said...

I've transported patients in the throes of an MI to the helipad for transport to the cardiac center 65 miles away on several occasions, knowing that the trip would probably save their life and bankrupt them at the same time. One man even said to me, "Oh well...they can't get it from me when I'm dead!" Sad that someone in the midst of a medical crisis even has to think about that. Here's hoping things change.

Anonymous said...

Mike, this is the most cohesive response I've read about this issue. Please, take this (your written opinion) somewhere that will accelerate action. Are you involved with the Alliance?

Anonymous said...

Mike, for certain cases, the companies themselves have aid for patients who could not otherwise function if not for that company's particular medication. I've been known to nudge certain patients to the pharmacorp's website.

Un-PC RPh said...

You know, you can purchase health insurance on your own In some caes you can purchase plans with RX coverage or low deductibles for only a couple hundred a month for a single person.

Of course, if you live in New Jersey or somewhere like that, you might get screwed, since there are state laws in place that no insurance company can deny coverage to anyone. As a result, no one can afford health insurance, either. Sort of a catch 22 by well meaning legislators.

There are generics out there on the evil $4 list that could work nearly as well as those new brands that are expensive. Why not use Citalopram, instead of Lexapro or Cymbalta?

If you lve in the UK or Canada, don't think you're going to get the cutting edge treatments or latest drugs on the market, either. Or that you might get any treatment in a timely manner. In some cases it more cost effective to let you die than treat your cancer or get that transplant you so desperately need to keep living.
In the UK, while on vacation in 2000, I was reading a newspaper article about how jolly good it was the waiting list for heart bypasses had gotten shorter. Most people on the list must wait 6 months or more, but due to the deaths of some of those ahead in line the wait time was getting cut down. Brilliant!

I have a friend in Calgary, who had luekemia. She developed severe anemia and it was suspected she would need a colonoscopy to determine if there were any bleeds in here digestive tract. So in August they scheduled her for a colonoscopy in late October. In September she received a letter regretfully informing her that her colonoscopy would have to pushed back to mid November. I sure hope she lives long enough.

Honestly, healthcare is not a right. A right is something that causes no burden to your fellow countrymen.

Your expectations of healthcare provided by government mandate may be a bit unrealistic. I would rather prefer to purchase what I can instead of allowing someone to tell me what I can have.

Pharmacy Mike said...

And with all those things you've mentioned, both Canada and the UK are ranked higher than the United States in health care. The people in both Canada and the UK have longer life expectancies. Both countries also have a lower infant mortality rate.

If wait lists are your only example as to why those countries are worse than the United States, you better keep on reaching. The FACT of the matter is that those countries provide health care to everyone at a lower price than in the United States, and they get better results.

However, I'm not even talking about the UK when I talk about health care. That country spends comparably less as a percentage of GDP than other countries in terms of health care, which is why you get those wait times. I'm talking about countries like France and Germany. France and Germany cover everyone, and they have not waiting lists.

Let me repeat that, France, the number 1 ranked health care system in the world, covers everyone in the country for what the United States spends on Medicaid and Medicare alone (per capita), and it doesn't have waiting lists.

Everyone in the United States seems to hate the French, but they're currently doing a lot of things better than we are. In the case of health care, much better. We should be trying to copy their system.

I will never ever be convinced that in a country as supposedly rich and powerful as the United States, health care should not be a right. The very notion that a company is trying to make money by providing you health insurance is unethical. In a business, the idea is to make as much money as possible by spending as little as possible. It's no difference with insurance companies... except their expenditures that they try to cut as much as possible are for treatments and medications that keep people alive and healthy.

If you are a citizen of this rich and powerful country, it should be your right to have access to medications and treatments that keep you healthy. It shouldn't be a privilege. No one will convince me otherwise.

Ninja Medic said...

I'm British. I lived there for half my life and was a patient in the system that entire time, so I feel I am more qualified to speak about the realities of the NHS than someone who has just read about it.
It's not just the wait times that are a problem, Mike. It's chronically understaffed, the staff that DO work for the NHS are horrendously underpaid and overworked, there are too many patients and not enough beds (people are dying on stretchers in hallways because there arent any beds to put them in), and people are actually being denied drugs to treat various cancers because the system can't afford to spend that much on one patient. My own father, before he died, had to stage a 'sit in' protest to get a cardiac bypass surgery performed after it had been cancelled four times (one of those times he was actually on the table in the OR, getting his chest swabbed with betadine when the surgery was cancelled).
Prescriptions are not free in the UK, either. Everyone has to pay in some form or another, even those on welfare or old age pensioners. My mother, when she came over for a vacation this year, was amazed that I could not only get in to see a specialist so quickly (less than 3 weeks after the inital referral from my PCM)but left his office with a surgery date instead of being told 'we'll put you on the list and let you know'.
I invite anyone who thinks that the NHS is an adequate system to go and live in the UK for a few years (on an income that prohibits the purchase of private health insurance), and whilst there, come down with some chronic condition that requires specialist treatment and surgery. Maybe having that direct experience would show people that no, it does NOT work.

Pharmacy Mike said...

I appreciate the perspective. However, the UK isn't the country we want to emulate. The UK tries to do health care on the cheap, and that's why it has the problems it does.

France is the country we want to be looking at. France covers every citizen and doesn't have the wait list problem of the UK or Canada.

However, for every reason you can name that the UK system doesn't work, I can name 5 why the U.S. system of privatized insurance doesn't work. For one, there are 46 million uninsured Americans (about 1/6th of the population). That's 46 million that don't even have a chance of getting a procedure done if they develop a chronic disease. Health care costs are cited in 50% of the cases where people file for bankruptcy in the U.S.

Then, there's the problem with the people who are denied coverage due to "preexisting conditions." Private insurance companies only want to cover healthy people. They do whatever they can to make sure they don't pay out money. No matter how you cut it, that's unethical.

I am fortunate enough to have pretty great health care benefits through my job. For the time being, I don't have to worry about any of these things. For the time being, I have access to some of the best health care in the world. However, I will never be comfortable with the fact that there are 46 million people in this country that don't have what I have. In fact, in the name of fairness, I'd rather they take away some of my health beneifts if it meant they could give everyone in this country at least basic coverage.

I know... That's a crazy line of thinking in The United States, the land of greed and selfishness.

Ninja Medic said...

Oh, I'm not saying that the US medical system works because it doesn't. When hardworking, honest people don't go to the doctor for VALID reasons because they feel they can't afford to and Americans are just one major illness away from bankruptcy, we have a HUGE problem.
I agree that healthcare should be a right rather than a privilege, but I don't know the best way to make that happen. I DO know that the UK's model of socialised medicine is NOT the one to follow (as as aside, more and more Brits are becoming 'surgical tourists' and going to places like Thailand and India for their surgeries so they don't have to deal with NHS wait times).

I'm glad to see you blogging again, Mike. Did you find your muse? :)

Corrinne said...

Sorry for the almost year late response. You probably hate all these late comments but I had to speak up, and hang on, because I might rant and ramble...

I work very hard. I put in more than 45 hours a week not including the time I spend driving (1-2 hours a day). I am not a pharmacist but I am in sales/retail. My company offers insurance and it is about $260 a month for just me (No medical conditions, young, healthy female). Some months, I could afford it. Some months, I can't. I work on commission and those good months enable me to get by on the bad months.

I am in college full time for my Bachelor's in Psychology and I have been on the President's list the whole time (3.95 or higher). And I have to be knocking on deaths door to go to the doctor.

Now this is where I have a problem. I don't quite believe health care is a right... I feel like there are too many lazy, stupid, ignorant assholes abusing the system. I know people (who had kids when they couldn't afford kids or handle them responsibly) who get EVERYTHING handed to them. Apartments, food, college, health care... the list goes on. And this isn't just one person. I know at least 5 people that do this. Most don't even care for the kids, they live elsewhere and they lie on the paperwork.

It. Pisses. Me. Off. To no end. When I get my Master's and I can afford healthcare maybe it won't make me so angry but it still isn't fair. A lot of our system is so skewed. They get rewarded for being useless pot heads and I get punished for being an upstanding citizen.

Phew. Okay I'm going to stop now. I will end it by saying that many people NEED it and DESERVE it. We just need to weed out the abusers. I say mandatory drug testing, dammit. I take drug tests for my job, they should have to in order to sit at home.

Also, my mom had a stroke and was disabled. For almost 3 years she struggled to get by (Her job before was as a tech in a pharmacy, oddly enough)and it made me sick to see these jerks getting everything they wanted and my mom, a hardworker for over 40 years, not even be able to get by. She passed on in August but it still wasn't fair.

Healthcare needs reform. Period. If we could get people to take care of themselves (eat better, exercise) we would be so much better off. And if we could weed out the abusers. A study from a few years ago (2003 maybe? I wrote a paper on it) had these statistics- 300,000 deaths from obesity, 100,000 from alcohol, and 20,000 from drugs. We could save billions by preventing obesity... or helping people get healthy. There's so much more but I have wrote way too much.

I'm sorry if I am annoying. *rant officially off*

Pharmacy Mike said...

I don't think you're annoying at all.

I write these things for people to comment on them. Just because I wrote it a year ago doesn't mean it's any less relevant to today.

Please, comment all you want. I'm reading every one of them. Trust me.