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David Hines [userpic]

my health care policy suggestion

July 22nd, 2009 (07:47 pm)

Health care stuff is all over my flist; I've cut-and-pasted the below from comments I left at [info] marag's LJ, because I think it's something that is worth mentioning.

My pet item that nobody is even considering: hey, why not a *massive* deregulation of prescription drugs? I can understand some stuff like antibiotics and narcotics, from a public-health standpoint, but you can buy amoxicillin OTC in Mexico and the world doesn't seem to have ended. The last I checked, I am a frickin' grown-up, so why do I, a grown-up, need to pay another grown-up to give me a permission slip allowing me to give a third grown-up yet more money?

(Said with the extreme bitterness of an asthmatic who does huge amounts of business travel. IT IS ALBUTEROL. IT IS THE STANDARD MEDICATION. IT IS STANDARD DOSAGE. THERE ARE NO VARIANTS. And yet I have to get a permission slip to buy it, and pay a doctor in order to get said permission slip, before paying a specially-trained and licensed professional to get the item.)

It's not that the doctors won't give me the prescription. They unfailingly do. What I object to is that I and my insurance company often have to pay them for an office visit, just so they can agree with me that yes, I have the chronic condition that is plastered all over my medical records and has been since childhood.

Most doctors will renew a prescription based on a phone call, of course, once you're an established patient, but that still involves a waste of time for me and for them, because I have to make the call and their staff have to take it and relay the message to the doctor who approves it and has it called in to the pharmacy. Annoying as hell for me, a substantial waste of time and money for them, because with a practice's worth of patients it adds up quick. Deregulate, or deschedule, or whatever the term is, most of that stuff, and I'll go to the local Wal-Mart or order it online and have it shipped to my door, fewer headaches all around.

Also, it would make it a *hell* of a lot easier to comparison shop on prices.


Posted by: Elspeth (elspethdixon)
Posted at: July 23rd, 2009 12:09 am (UTC)

IT IS ALBUTEROL. IT IS THE STANDARD MEDICATION. IT IS STANDARD DOSAGE. THERE ARE NO VARIANTS. And yet I have to get a permission slip to buy it, and pay a doctor in order to get said permission slip, before paying a specially-trained and licensed professional to get the item

Word, word, word. I have a bad tendancy to go for long periods of time without asthma medication just because it's such a pain to take time off from work for a doctor's appointment to get a presecription (and then it's summer, and suddenly I can;t breathe). Can't they just give you, like, a longterm prescription for medication for chronic conditions tht just requires you to check in with a doctor once a year for them to look at you and go "Yep, you still have asthma?"

Posted by: tried to eat the safe banana (thefourthvine)
Posted at: July 23rd, 2009 06:51 am (UTC)

That is in fact precisely what my doctor does. She gives me a scrip with three refills, and when the refills are out, I have the pharmacy fax her. I get three more refills without ever actually speaking to anyone at her office. Eventually, I go in to see her for something else, and she confirms that - shock! - I still have asthma. I get my Xopenex. Whee.

Posted by: Sara LaKali (sara_lakali)
Posted at: July 23rd, 2009 12:53 am (UTC)

Most doctors will renew a prescription based on a phone call...

Really? Wow. No doctor in this town will do that. You absolutely have to come into the office. As far as I can tell, most doctors around here charge in the neighborhood of $150 to $200 for an office visit, so they have a vested financial interest in not renewing prescriptions by phone.

Posted by: HIH Thomas,Son of Richard, KA, DMH, LMMO, CES, etc (forvrin)
Posted at: July 23rd, 2009 03:05 am (UTC)

Why is it illegal to mail order wine in some states, or why MUST you buy your coffin from an undertaker in others?

Because the wine distributors and the undertakers have paid money to politicians in return for laws passed which protect their economic niches.

Ultimately, the only meaningful reform, in this or any other economic activity, to ensure laws to keep the consumer the customer. In healthcare, the primary customer for your medical treatment is not you, but your insurer. In health insurance, the primary customer is not you but your employer / the government.

In both these cases, much of the instances of the "crisis" can be traced to the fact that you are not actually the one being serviced by the healthcare industry.

Posted by: Mari (marici)
Posted at: July 23rd, 2009 04:32 am (UTC)

This ^2 for birth control. Yes, there are drawbacks and health risks. No, none of them begin to approach the level of risk associated with alcohol, cigarettes, or fried chicken. No, the health benefits of regular gynecological testing/mammograms do not justify holding my prescriptions for OTHER ISSUES hostage to your tinpot OB/GYN dictatorship.

Posted by: Aiglet (aiglet)
Posted at: July 23rd, 2009 05:14 am (UTC)

Hey, at least they're probably never going to take Albuterol off the market. I would sign pretty much any kind of "no, really, I won't sue you if anything you've got listed in your side effects happens" paperwork if I could get my Celebrex back without having to jump through an eternity of flaming hoops.

What *is* it with this country and appropriate medication for chronic conditions and pain?

Posted by: David Hines (hradzka)
Posted at: July 23rd, 2009 07:07 pm (UTC)

Hey, at least they're probably never going to take Albuterol off the market.

Not quite; they were content to enact federal regulations requiring it to use a CFC-free, less powerful propellant, which counts as a reformulation, thus causing the standard asthmatic medication to become less effective while tripling in price, and eradicating competition from generics.

I wish I were kidding.

Posted by: Aiglet (aiglet)
Posted at: July 24th, 2009 12:43 am (UTC)

WTF? Do they just have people who sit there thinking "huh, this works too well, let's break it"?

I know, I know, they're trying to keep us from eating things that might hurt us, but FFS, can't they just slap a "hey, ozone destroying goop here" label on it and get on with their lives?

Or even come out with the new version as the organic-touchy-feely version and make their money off other crazy people instead?

Posted by: Mattia (mattia)
Posted at: July 24th, 2009 07:34 pm (UTC)

OTC vs prescription meds is a tricky thing; the situation in the US seems to be a little more excessive than it is over here. For full disclosure purposes: I'm a doctor (cardio resident). Most GPs here have an automated phone system you can call, and they send the scrip straight to the pharmacy. This is accompanied by a nominal fee, but nothing huge. Takes about 30 minutes at the end of the day to sort through all the repeat scrips, which can be picked up the next working day.

Honestly, there are relatively few potential problems with salbutamol as an OTC; yes, not great for heart patients, yes, it can cause cardiac death if overdosed (and since people DO NOT READ the instructions, if it's never been prescribed before, and inhalation technique never been described before), but it is, overall, very safe. Ibuprofen and Paracetamol are more dangerous (Advil and Tylenol, I believe). Quite a lot of medication that used to be prescription only, such as PPIs like Pantozole and Omeprazole, now have OTC equivalents.

Antibiotics, and almost all other prescription drugs I can think of, should be limited to prescription only for safety purposes; I can't think of any blood pressure meds, rhythm drugs, cholesterol drugs, or most antiplatelet therapies that aren't currently OTC that could safely be OTC.

Also, strict limitation of antibiotic use over here means we have some of the lowest incidences of multiresistant bacteria in the world; places where patients demand (and thus get) antibiotics for the sniffles have far greater problems.

Posted by: David Hines (hradzka)
Posted at: July 26th, 2009 10:59 pm (UTC)

Thanks for your take; it's appreciated.

Antibiotics definitely need to be clamped down on. We're doing better than we were, but we could do better yet. Apparently the UK is having problems with resistant bacteria, which is odd because you'd think the NHS would be able to put a top-down edict into effect.

Posted by: mendori (mendori)
Posted at: July 25th, 2009 06:13 am (UTC)

... dont even talk to me until you've spent a year plus on an opioid. I have to go to a doctor, and see A DOCTOR, not a nurse, not an assistant, not anyone else BUT A DOCTOR, to have the same med rewritten for me that I've been getting for over a year. EVERY. TIME. Oh yes, and they can't write refills on your perscription.


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