05 February, 2005

Doing my part to aggravate the cost of health care

My old asthma medicine had expired. I need to have albuterol sulfate on hand whenever I visit my parents or my brother, since without fail I suffer attacks of asthma whenever I stay overnight at their houses. It's ridiculous to be allergic to your own family, but that seems to be my lot in life, unless one day they lose their obsession with cats.

I called the Student Health Center to ask for a refill. They told me they couldn't refill it, because the prescription had been transferred to Eckerd drug stores. That made me quite happy, since the closest Eckerd pharmacy is a short walk across the street, and there are many others throughout the States, whereas the Student Health Center is at school.

The pharmacist added that my prescription was over a year old. The last time this happened, my prescription was still with Student Health, and they refused to do anything unless I saw my doctor again and received a new prescription. To add insult to injury, my prescription was not over a year old on that occasion; it was only nine months old. My doctor shook her head with disbelief when I told her why I was there.

I decided to call Eckerd just in case. The lady told me that, sure enough, I had a prescription for albuterol sulfate on file with them, and it was indeed over a year old.

We can renew that for you if you'd like, she added.

Startled, I asked, Uh... you can? I didn't know that.

We can try, the lady answered.

Well, I'll be! I asked her to do that, and promptly forgot about it. I remembered again two days later, and on my way home from work I parked my bike outside Eckerd so I could get a refill.

The lady at the desk looked at my information on the computer. Yes, sir, she said; it looks like it was filled a couple of days ago.

Now, that's service.

I walked to the cash register and waited a few minutes while the gentleman in front of me paid for his prescription. This took a lot longer than I thought it should have, perhaps because the cashier was also helping someone on the phone — someone who was calling for a refill perhaps, as I had done two days prior.

While I was waiting for the cashier, the pharmacist called up an old lady who had been sitting on some stools nearby and (unlike myself) had been waiting patiently. I overheard their conversation, which went something like this:

Ma'am, didn't you have this prescription filled two days ago?

Yes, ma'am, but I lost the medicine.

I'm sorry, but your insurance company won't pay for lost medicine, and they won't pay to refill the prescription only two days after we filled it.

Oh, my... Well, what can I do? I need to take that medicine.

If you want, you can buy some pills for the next few days, until your insurance will pay for a refill.

How long would that be?

There was a pause while the pharmacist looked up that information. It will be two days. (or something like that)

How much do the pills cost?

It'll be $22, ma'am.

Twenty-two dollars for each pill?

No, ma'am; it's $22 for both pills.

Good Lord, I thought to myself. Eleven dollars per pill is still nothing to sneeze at.

When my turn came at the register, I pulled out my insurance card. That's okay, the cashier said, waving my card away; we already have your insurance information on file.

That surprised me; I didn't remember actually buying medicine from them before.

It comes to $10.43, she said.

I pulled out my debit card and asked her, How much would it have cost without the insurance?

She had to walk over to ask the pharmacist this information, because she didn't know. When she came back, she answered, It costs $23 normally, so you saved $13.


Twenty-three dollars is not a burden, and I only buy albuterol sulfate once a year or so. Even if I bought it once a month, using only my graduate student salary supplemented by the
occasional tutoring, $23 would hardly put me out on the street. It's a little less than an hour's worth of tutoring.

Make a lot of assumptions, unfounded perhaps, and multiply this by one million people with asthma (say), and we can suppose that the insurance company pays thirteen million dollars.

Consider also that pretty much all insurance companies now help pay for regular contraceptive coverage; i.e., the birth-control pill. This, because the companies fell over themselves to help cover the costs of Viagra, and that angered a lot of women who saw that as favoring dirty old men while ignoring hot young women. (Somehow, the fact that Viagra treats an actual health dysfunction, whereas birth control is meant to create a health dysfunction, never entered into the equation. Of course, I don't see why insurance companies should necessarily cover Viagra, either.)

I don't need insurance to pay for my asthma medicine, but some people (like that old woman) do need insurance to pay for their medicine. I've heard of pills that cost a great deal more than $11 each.

I walked away from the counter looking at my bag, thinking how expenses like mine are one of the reasons the cost of health insurance has exploded. There are many other reasons, of course — the fantastic array of new medicines we have; longer life expectancy and the demand for higher standards of living; the salaries of doctors, specialists, pharmaceutical researchers, medical malpractice lawyers, etc.

To me, health insurance ought to cover catastrophic costs associated with unforeseen disasters: for example, when some years ago I went to the hospital for mysterious abdominal pain, and underwent a CAT scan. Health insurance shouldn't be cover for these millions of foreseeable, minor costs. To expect our health insurance companies to cover all these "little medical expenses" is to invite "a perfect storm," a "death by a thousand paper cuts."

It's hard to escape the conclusion that, on the next occasion that I have my asthma medicine refilled, or fill any other low-cost prescription, I should forego my health insurance coverage, and "take one (or many) for the team," so to speak.

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