Wednesday, September 7, 2016

Came for the Scotch, Stayed for the Socialized Healthcare

Several months ago, I developed my first inner ear infection as an adult--no idea how, no idea why, except maybe as a demented birthday present from the world for turning thirty. I went to my primary care provider in Longview, got prescribed a course of antibiotic drops, and headed off to Walgreen's to pick them up. I was stunned to find out that a week's worth of ear drops would set me back close to $90--about $12 per dose.

Fast forward to the past week in which C and I were on vacation in Scotland. I somehow managed to develop another ear infection--albeit an outer one this time, but still (are my ears simply allergic to all the Trumpian bigotry of 2016? Before this year, they were happy as clams). And aside from the doctor I was married to--who cannot prescribe me medication, since that's a pretty big ethical no-no in the American Medical Association's book--I had no doctor in Scotland whom I knew I could turn to for help.

As it turns out, I didn't need one. The United Kingdom, sometime closely before their Brexit-induced spiral from sanity, passed a law that allows licensed pharmacists to prescribe certain--not all, but certain--medications if they complete a required course of training, much in the way that nurse practitioners can here in the States. And when you think about it, it makes a lot of sense. The pharmacists know the medications as well as the doctors themselves do, and for basic ailments that don't require an advanced or complicated exam to diagnose--like, say, an outer ear infection--a pharmacist should know exactly what to prescribe as confidently as an M.D. ought to.

This sort of law can make a big difference in a small town where a doctor might not be immediately present or available--a town like, say, Aberlour, where C and I were staying during our sojourn in the Scottish countryside, population 972 (at least, as of the 2011 census). This beautiful small town was just big enough to have a pharmacy, which we stopped at to see if we could at least get something over the counter to help treat my ears. And the pharmacist there was able to do us one better--after a short look at my ears, and a quick discussion of my medical history to avoid any allergic reactions to the medication, was able to prescribe me a course of neomycin and dexamethasone in a small spray that worked perfectly within just a couple of days.

Total out-of-pocket cost to us for this medication? Six pounds and change--the equivalent of a little over eight bucks, or one Good Burger. Less than one-tenth of what I paid for a similar course of antibiotics for a similar malady at the start of this year back here in the States.

Say what you will about the mean-spirited short-sightedness of the Brexit vote, but (a) Scotland voted to remain anyways, and by quite a large margin, and (b) we Yanks don't have much of a pedestal from which to criticize the Brits over the Brexit vote, considering we're just several polling points away from electing a vulgar, loudmouthed, womanizing, race-baiting, wealth-glorifying bigot to be the leader of the free world.

Which is indicative of the problem we find ourselves in to begin with: much more so than in Scotland, we Yanks live in a system that elevates money over people, and perhaps nowhere is that phenomenon more blatantly on display than the differences in our respective nations' healthcare. Brits can complain all they want about their NHS (and some of those complaints are justified), but here in America, I'm stuck paying ten times as much for ear drops. Ear drops.

And that's only the trivial tip of a far less trivial iceberg. The EpiPen, which is now costing some $600 per two-pack, probably only costs a tenth of that to make--about $30 each, or $60 per pair. There's that ugly 10x markup again. Whether it's ear drops or life-saving epinephrine, profit comes first in American medicine. And it's not just limited to relatively routine, everyday medications like those.

I have colleagues who have lost congregants to strokes and heart attacks that could have potentially been prevented but for insurance companies declining to pay for expensive, but life-saving, medications prescribed by doctors. Procedures that cost tens of thousands of dollars here may cost a fraction of that in other industrialized countries. And medical expenses continue to be leading cause of Chapter Seven personal bankruptcies in the United States.

According to the WHO, we spend more per capita on healthcare than any other country except Norway and Switzerland, both of whom beat us badly in life expectancy and other quality of life metrics, to the point that it isn't even close.

Believe me--that difference in cost isn't simply going to the doctors. I'm married to one, and this trip to Scotland aside, we live modestly out of necessity because becoming a doctor in the US--compared to in Europe, where university education costs a fraction of what it does here--is obscenely expensive.

This is why I'm not really convinced of a Medicare-for-all model here in the States--Medicare pays such a pittance that some doctors have simply given up and refused Medicare patients altogether, because the costs associated with becoming (and remaining) a doctor who relies on Medicare for revenue here in America simply make a Medicare-for-all scheme a losing proposition for attracting and keeping doctors.

(One poignant excerpt from the conclusion of the letter in that link:

I wonder if I will be able to afford to care for Medicare patients as a solo physician, not knowing if or when I will be paid, while my expenses remain fixed or increase with inflation. On the other hand, I do not want to return to a large group, losing the freedom to run my own practice in the way that I feel is best for me, my patients, and my staff.

I understand that whoever pays the bills makes the rules. The only recourse a player has is to choose whether or not to play the game, especially when the deck is stacked against them.)

But I am absolutely convinced of the need to see a change in healthcare. My experience in Scotland reinforced it for me. The work stories of both my colleagues and my wife's colleagues reinforces it for me. And the fact that I follow and worship a Messiah who healed a multitude of people, free of charge, no questions asked, reinforces it for me.

Which means that the cost of healthcare absolutely is a Christian issue. It has to be. The provision of miraculous healthcare is how our namesake made His divinity known the world. But the provision of healthcare now is how we have come to make our greed and love of profit known to the world.

How far we have fallen, and how far we have yet to come, in our pursuit not of profit, not of money, not of wealth, but of the Christ who healed those who asked it of Him, and gave new life to those long since written off as dead.

Longview, Washington
September 7, 2016


  1. Much, much food for thought, Eric. Thanks for the post!!

  2. Much, much food for thought, Eric. Thanks for the post!!