Saturday, September 19, 2009

Another Health Care Horror Story: Big Pharma Edition

At the outset of putting fingers to keys this morning, I wasn't intending to write about this topic. I changed my mind, however, because if one more documented instance of Big Pharma's greedy, hypocritical, exasperating behavior means that we might all benefit from substantial and lasting health care reform, then I am certainly not above sharing my personal story. In particular, this highly frustrating anecdote refers to the unnecessary hassle it has been to obtain one of the three medications I must take on a daily basis to effectively treat my illness. This forthcoming narrative also underscores the perfidy of the industry itself and, in particular, its automatic assumption that anyone who uses its free or reduced cost services must be trying to cheat the system. It shouldn't surprise any of us by now that this underlying attitude somehow isn't portrayed in the self-serving television advertising advancing the program's merits.

You may have seen the commercial. It was pretty ubiquitous for a good long while. A soothing voiceover, couched in hushed tones meant to intimate gentle sympathy, states that American's pharmaceutical industry might be able to help those who are uninsured attain their prescription drugs at a deep discount. We are led to believe that an imaginary bus tour is underway, looking for all the world like the kind favored by political candidates on their way back and forth from event to event. A series of different looking people from all walks of life announce proudly their allegiance to their own particular state of residence. A man who once led a daytime TV show which frequently showcased the results of paternity tests and established the true identity of baby daddies smoothly performs his role as spokesperson. That this ad aired constantly in the immediate period before Health Care Reform became a political and ideological football was no accident. The implication was that Big Pharma could regulate itself just fine, thank you, and not only that, the industry was so altruistic as to offer medications for needy Americans without need of government arm twisting. I admit at the time I viewed these ads with much suspicion, but after I unexpectedly lost my Medicaid coverage at the end of July, it was an option I had no choice but to pursue, since paying $700 a month out of pocket for a thirty day supply isn't exactly an viable alternative.

The process wasn't easy, for sure. In a way, it was almost debasing. I had to fill out a lengthy form full of questions that, in my opinion, bordered at times on invasion of privacy. Their extensive nature reminded me of the kind of exhaustive detail of which one has to provide a health insurance company when filing for coverage---self-reporting every conceivable illness or ailment, so as to make easier work for their underwriters. The second half of the lengthy form, denoted under the heading of "Patient Advocate", had to be completed by my doctor and his office with sufficient information to validate that the doctor was, in fact, a certified professional, while not forgetting to enclose a current, up to date, and verifiable prescription. Once approved, the medication was to be mailed to my doctor's office, not my place of residence. I was promised nothing more than a vague four-to-six week turnaround for the first month's worth of medication, if approved, and was told by my doctor's office that I'd have the option of a few free samples to tide me over if my claim was denied.

Fortunately, it did not take long for my first month's supply to arrive and I eagerly drove downtown to pick it up. Within two weeks I received a call from my doctor's office stating that my medications had arrived. "Easy enough", I thought to myself, daring allow myself the ability to stop worrying about the matter for a brief moment. In hindsight, I really should know better by now than to ever assume such a thing regarding any facet of our for-profit health care system. Those were indeed famous last words.

The day after I picked up my medications I received a call, first thing in the morning, I might add, from the pharmaceutical company itself. I thought at first perhaps they must simply be confirming that I had received my medication. That was part of their agenda, but certainly, as it turned out, not all of it. A terse (and unsmiling, I imagine) pharmaceutical representative informed me that I would only receive one month's worth of medication on their end, since they had determined that I could easily qualify for Medicaid and thus had no need for subsequent shipments. If I had to pick an word choice to qualify this person's overall attitude, condescending might be the best word choice. Once again, I had to explain that I had lost my Medicaid some weeks back due to my state's efforts at cost-cutting and budget trimming and the odds were not particularly favorable that I could ever get it back. The person with whom I spoke then demanded particular documentation to prove it. While I do have a letter of cancellation stating the date my coverage was terminated, that was not sufficient for the drug company. Instead, I was flatly informed me that I would get no subsequent refills unless they were provided an authentic copy of a denial of Medicaid services. That they would be this ridiculously particular about the matter strikes me as beyond petty.

At that juncture, I explained to them, for what seemed like the eight millionth time in the past several weeks, that Medicaid in my state is almost never granted to single people without children. I informed the representative that the only way I could probably even obtain Medicaid, regardless of how deserving I might be, would be to get married or to contribute to a pregnancy. And, I added, it was only due to a very specific provision of the Medicaid law, a provision now denied to me, that I was even able to get Medicaid coverage in the first place. In this state, those who have the best shot at actually attaining coverage are children, since we feel sorry for children more so than we feel compassion for adults. I informed the representative that while I could certainly reapply for Medicaid, due to a substantial backlog caused by high unemployment and an ongoing economic recession, it would be as long as 90 to 120 days before any judgment was made on my case, at which point I would certainly need more medication well before then. And to reiterate what I had just said a few moments before, I told the representative in no uncertain terms that I probably wouldn't get Medicaid coverage at all and that even bothering to apply would probably be a waste of everyone's time, including theirs. Despite all of this, that crucial piece of paper stating the obvious is what the company claimed it must have before subsequent months of medication were sent out.

I hung up the phone, deeply frustrated, while recognizing again that our automatic settings, both within corporations and within individual humans beings, are that of deep suspicion and heavy scrutiny whenever anyone requests something for free or at a reduced rate. This anti-welfare mentality leads us to adopt regulations that force a person onto the defensive, needing to provide mandatory, exhaustive information and sufficient, completely verifiable justification before we'll ever give him or her anything resembling a break. Somehow this is an attitude not extended to corporations, big banks, CEOs, or certain government agencies. If I had to state an opinion, I'd say that we're purely overcompensating. We assume we're not powerful enough, nor able to directly impact larger entities, so instead we think we opt to control and micromanage individuals instead. That we all have control freak tendencies at times is certainly food for though. That we aim low because aiming high promises results that might not succeed in what we deem a timely fashion, might not be easily measurable, or might not give our egos the satisfaction of basking in immediate results, however destructive they might be in the long run, is an even deeper note for concern. If any reform, health care or otherwise, is to succeed we might well contemplate changing our attitudes towards how we define productivity, success, and results. After all, Health Care Reform won't just affect us in the here and now, it will impact future generations and our future health and well-being.

1 comment:

Gail said...

Hi Kevin-

I hung on every word and I feel deeply, and personally your frustration and the injustice of it all. I am jumping through hoops to to "prove" my illness is worthy of me being on long term disability. An exhaustive and quite insulting endeavor.

am so sorry for how you are being treated. Where and how is there any resolve for you.??

Love and understanding