Formularies Somewhere along the line, we ceded control of healthcare to bean counters and bankers and American society is worse for it. Rather than Big Brother, watching to see that we aren’t working to undermine the state, we have a dozen different levels of medical bureaucracies, each with their army of bean counters, governing what medications we can take, what procedures we can get and what providers we can visit. This is not quite true. There is always the option to stick it to the proverbial man and refuse to play by bureaucratic insurance company games. This tends to work only if you either are a tech company billionaire, drug cartel boss or other insanely wealthy individual who can heat their home by burning bundles of $100 bills. The others who refuse to play the system are those who don’t go to the doctor for anything at all. While this may seem like a viable option when you are in your 20s it is not so viable when all the bad decisions in your life come home to roost in your 50s. For the most part, I am resigned to dealing with the healthcare, industrial complex. In my most open-minded and generous spirit, I recognize that healthcare providers are highly skilled and should be fairly compensated for their years of training and level of responsibility. I also recognize and accept that healthcare facilities are expensive to build, maintain and keep current. This is especially true in rural areas where there might not be as many patients using any particular piece of equipment or diagnostic tool so those of us who do, might have to pay more in order to have it available. This level of understanding and graciousness on my part goes out the window when I get a bill for things you need to be a coding expert to understand. Worse is when I get told that I need to switch from one generic maintenance prescription to a different brand of generic medication because the “formulary changed.” To me, this is just health-industry doublespeak for a pharmacy benefit manager getting a better kickback from company B than from company A and forcing everyone to jump through hoops for it. Like many people, I monitor my blood glucose levels. Every morning I prick my finger and bleed onto a little test strip for it to tell me that having that ice cream cone the night before was a really bad idea. I don’t mind the daily bloodletting so much, because it has actually helped me make better diet choices. What I object to is when the bean counters decided that we had to switch from a pretty basic monitoring device and test strips to a fancy new shiny black one with prettier interface. It came along with test strips bragging about having a wider area to bleed on, implying that it would be easier to test than the pinpoint of the previous model. This was, of course, nonsense. The wider test strips require more of a daily blood sacrifice to do their one required function. If you bleed too little, you get an error informing you of your inadequacy. This requires the use of a new test strip and to poke yourself again with the fancy finger pricker tool. It becomes truly annoying when you need to double-prick, due to poorly designed test strips. This uses them up at faster pace. When you go in to buy more you are told you aren’t due for more yet and you feel like the orphan boy in “Oliver” begging for an extra helping of watery gruel, “Please sir, may I have some more.” I am fully aware that my personal frustrations with the layers of bureaucracy and bean counters in the healthcare industrial complex are mild compared to what others face on a daily basis. Those who live with severe and chronic conditions routinely have their savings drained and financial future put in risk simply to survive another day. By comparison, my concerns are inconsequential — a mosquito bite to another person’s lacerated limb. The challenge for both, is finding a solution that allows people to get the care they need, when they need it, without bankrupting them in the process. The person who can figure that out will either be sainted or martyred, quite possibly both. Brian Wilson is News Editor at The Star News. Contact Brian at BrianWilson@centralwinews.com. Formularies Somewhere along the line, we ceded control of healthcare to bean counters and bankers and American society is worse for it. Rather than Big Brother, watching to see that we aren’t working to undermine the state, we have a dozen different levels of medical bureaucracies, each with their army of bean counters, governing what medications we can take, what procedures we can get and what providers we can visit. This is not quite true. There is always the option to stick it to the proverbial man and refuse to play by bureaucratic insurance company games. This tends to work only if you either are a tech company billionaire, drug cartel boss or other insanely wealthy individual who can heat their home by burning bundles of $100 bills. The others who refuse to play the system are those who don’t go to the doctor for anything at all. While this may seem like a viable option when you are in your 20s it is not so viable when all the bad decisions in your life come home to roost in your 50s. For the most part, I am resigned to dealing with the healthcare, industrial complex. In my most open-minded and generous spirit, I recognize that healthcare providers are highly skilled and should be fairly compensated for their years of training and level of responsibility. I also recognize and accept that healthcare facilities are expensive to build, maintain and keep current. This is especially true in rural areas where there might not be as many patients using any particular piece of equipment or diagnostic tool so those of us who do, might have to pay more in order to have it available. This level of understanding and graciousness on my part goes out the window when I get a bill for things you need to be a coding expert to understand. Worse is when I get told that I need to switch from one generic maintenance prescription to a different brand of generic medication because the “formulary changed.” To me, this is just health-industry doublespeak for a pharmacy benefit manager getting a better kickback from company B than from company A and forcing everyone to jump through hoops for it. Like many people, I monitor my blood glucose levels. Every morning I prick my finger and bleed onto a little test strip for it to tell me that having that ice cream cone the night before was a really bad idea. I don’t mind the daily bloodletting so much, because it has actually helped me make better diet choices. What I object to is when the bean counters decided that we had to switch from a pretty basic monitoring device and test strips to a fancy new shiny black one with prettier interface. It came along with test strips bragging about having a wider area to bleed on, implying that it would be easier to test than the pinpoint of the previous model. This was, of course, nonsense. The wider test strips require more of a daily blood sacrifice to do their one required function. If you bleed too little, you get an error informing you of your inadequacy. This requires the use of a new test strip and to poke yourself again with the fancy finger pricker tool. It becomes truly annoying when you need to double-prick, due to poorly designed test strips. This uses them up at faster pace. When you go in to buy more you are told you aren’t due for more yet and you feel like the orphan boy in “Oliver” begging for an extra helping of watery gruel, “Please sir, may I have some more.” I am fully aware that my personal frustrations with the layers of bureaucracy and bean counters in the healthcare industrial complex are mild compared to what others face on a daily basis. Those who live with severe and chronic conditions routinely have their savings drained and financial future put in risk simply to survive another day. By comparison, my concerns are inconsequential — a mosquito bite to another person’s lacerated limb. The challenge for both, is finding a solution that allows people to get the care they need, when they need it, without bankrupting them in the process. The person who can figure that out will either be sainted or martyred, quite possibly both. Brian Wilson is News Editor at The Star News. Contact Brian at BrianWilson@centralwinews.com.
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