A problem with medicine that ObamaCare won’t solve

25 Jun, 2011 by Bookworm

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I spent four hours at my Mom’s yesterday trying to organize her medicines. I am more gray now than I was before. My son, who was with me, kept saying “This is insane. This is insane.”

The insanity operated at a lot of levels. Some of the insanity comes about because my mother likes her medicines (my son calculated that she takes approximately 800 pills per month, or 9,600 pills per year), and because she takes them on a schedule of her own devising, entirely separate from what’s on the pill bottles. This meant that, after I’d organized her 800 pills for the month according to the actual prescription, she announced that half the drugs in the boxes shouldn’t there because she doesn’t follow the prescription. At this point, my son physically restrained me from leaping across the table and strangling her. (I exaggerate. He actually gave me a kiss and a hug when he realized I was getting very frustrated.)

Another aspect of the insanity is the uncoordinated medical care my mom gets. I’m used to Kaiser, which operates on a centralized model. The doctors all plug into the same computer system, so whether I go to an Ear, Nose & Throat specialist, a Generalist, or Dermatologist, each has access to my medical records, and can readily see what drugs, if any, I’m taking, and what treatments, if any, I’m getting. This means that I don’t get overlapping, duplicative, or conflicting drugs or treatments. Also, because it’s not fee for service, Kaiser has an interest in efficient medicine, which includes cutting down on unnecessary pills. Market competition, however, ensures that Kaiser doesn’t take this philosophy so far that it deprives its customers of necessary treatment.

My mother, however, refuses to make the market choice to go to Kaiser. In the days before medicine went insane, Kaiser did not pay very well compared to private practice, and private practice doctors weren’t yet driven broke and mad by malpractice, managed care, and government regulation. Medicine’s best and brightest, therefore, did not usually end up at Kaiser. As medicine changed, though, with private practice doctors overwhelmed by the costs of malpractice insurance, and buried under managed care, government, and insurance requirements, Kaiser suddenly started looking very good. As a result, in San Francisco and Marin, Kaiser provides some of the highest quality medical care available, all for one monthly cost, plus low medicine co-pays.

My mother’s traditional care is the exact opposite of the Kaiser model. Although she ostensibly has a geriatric doctor who oversees and coordinates everything, the reality is that she goes to several private practice offices, none of which are connected to her geriatric doctor or to each other. Heart Specialist A has no idea what medicine Endocrinologist B is giving my mom. Theoretically, each sends an email to Geriatric Specialist C, apprising him of the situation, but it’s like the old game of telephone, where the message breaks down. The situation is made worse by my mom’s personality, since she distrusts one of her geriatric doctors and, as I said, ends up taking the medicines to suit herself anyway.

The real problem, though, comes at the pill level. Because my mom orders from different pharmacies, and because these pharmacies order drugs from different manufacturers, all of her pills look different from each other. For a given prescription, Pharmacy X might send a purple 50 mg capsule, with instructions to take one at bedtime; Pharmacy Y might send a red/white 50 mg capsule, with instructions to take one at bedtime; and Pharmacy Z might send blue 25 mg capsules, with the instruction to take two at bedtime. Regardless of cause, the result is that, from month to month, my mother, a very visual person, has no idea what her medicine is supposed to look like and often has no idea how many pills to take.

Pharmacy labels are also a problem: They’re sooooo small. The only company I know that has taken this issue seriously is Target, which specifically markets clear, large print, straightforward labels. Unfortunately, my mother, a stubborn person, refuses the Target option.

The end result of this is that the labels my mom gets vary from pharmacy to pharmacy. All, though, offer small writing, with the relevant information appearing almost randomly on the labels. Between my mom’s macular degeneration and my middle aged eyes, both of us were struggling to compare the pills before us to the laundry list of medicines she takes. Fortunately, my son was there to read the multi-digit numbers printed in microscopic font on the drugs themselves.

I don’t see how ObamaCare can fix this problem. To begin with, it cannot change my mom’s psychology. She’s going to do things the hard way regardless. Second of all, you cannot replicate Kaiser on a nationwide scale. If Kaiser were suddenly a government owned and operated business, with no competition, it would simply be Britain’s National Health Service, which is running out of money. Read the British papers and you’re daily assaulted with stories of massive drug and treatment denials.

The lack of competition is the real killer (literally) for NHS patients. In response to stories about old or sick people are left in hallways to die, deprived of food or drink, or otherwise abused, or about treatments and medicine denied, the British government organizes commissions that, after several years, release studies and make recommendations, which recommendations then slowly wend their way through the political process and are occasionally passed, only to be ignored by the hospitals, which have no competition.

ObamaCare doesn’t improve the confusing pill situation either. There is no ObamaCare mandate requiring that all drugs look the same, regardless of manufacturer. Nor can one force all pharmacies in a region to buy from one manufacturer, or require a single pharmacy to stick with one manufacturer regardless of price needs. The best pill solution is a market-based solution, although Target is so far the only one that has seen the light.

As it is, I’m just going to keep adding the gray hairs, and dragging my son along to aid in my emotional stability.

Cross-posted at Bookworm Room

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