A Note on Prescriptions in the Age of Government Healthcare Policy
I've rarely taken prescriptions during my health history, a few over the past few years (correlated with age?) You would think that in part some of premiums I and my employers over the years would be in a reserve for later years for conditions that develop over a lifetime, not unlike how we invest in retirement over the tenure of our adult work history.
But we've had a weird situation where health insurance has become tied to employment. I've mentioned the well-known story behind this meddling. During WWII, the enormous deployment of young men in the war effort resulted in labor shortages and inevitable upward pressure on wages. FDR was under the megalomaniac delusion that he could keep a lid on inflation by imposing wage and price controls, in part worried about the precedent of post-WWI hyperinflation in Germany. Unions threatened strikes. FDR made a corrupt deal with business and unions: he would look the other way for paid benefits, which the government would make more affordable with tax-advantaged treatment for both business and workers.. (Of course, business labor costs reflect total compensation, not just wages.) When government later sought to revoke this implicit subsidy, it was opposed by all the interest groups benefiting from the status quo.
At the time this intervention started, health insurance was more of what we recognize as legitimate insurance today: expensive hospitalizations, other high-priced, infrequently occurring expenses. As might be expected, some vested interests (e.g., unions and big businesses) acted to exploit the tax-free loophole by extending the nature of covered health expenses, to the point that elective expenses like birth control and Viagra coverage became major talking points for the ObamaCare abomination.
Government intervention in healthcare has had a number of bad, unintended consequences, nicely summarized by free market Mercatus Center at George Mason, including, but not restricted to:
At the time this intervention started, health insurance was more of what we recognize as legitimate insurance today: expensive hospitalizations, other high-priced, infrequently occurring expenses. As might be expected, some vested interests (e.g., unions and big businesses) acted to exploit the tax-free loophole by extending the nature of covered health expenses, to the point that elective expenses like birth control and Viagra coverage became major talking points for the ObamaCare abomination.
Government intervention in healthcare has had a number of bad, unintended consequences, nicely summarized by free market Mercatus Center at George Mason, including, but not restricted to:
- The individual is nominally invested in healthcare decisions. The employer chooses the providers, including possible expensive items the employee doesn't want or needs. There are "use or lose" items, which artificially raises the demand for certain services and hence related costs and prices. Subsidized costs to the employee appear lower (say, capped at a nominal copay). All of this (and more) has exacerbated health sector inflation
- Big businesses enjoy a structural advantage over smaller business due to economy of scale in negotiating health services. There is some evidence that employees of Big Business (with "good insurance") experience "job lock", less likely to move to jobs where their skills can be more effectively deployed.
Now during the Great Recession I did elect to take COBRA coverage between jobs; I think it cost me maybe $300/month. A couple of years later I was laid off from a small government contractor which was in the process losing its re-compete. (I didn't even know until I was going up for a Q clearance for a contractor position at the Department of Energy; the investigator all but accused me of lying, saying he found the headquarters of my former employer deserted. I later found the CEO's resume on Linked-In where he mentioned shutting down the company after losing the contract. Of course, I found what the government investigator couldn't, via the Internet. It's not like former employers contact me over changes in operations.) The point is that my COBRA would have been something like $900/month. That's a lot of money vs., say, an out-of-pocket $100 or so visit to a clinic every few months. I found that my previous physician in MD (before 2014) could have my blood work (for a thyroid deficiency) drawn locally and analyzed for maybe $30. I remember getting invoiced nearly ten times that amount for a similar test in the late 90's (the insurance company thought I was no longer under coverage, but even when they corrected their mistake, I still had to pay over $100 for my responsibility).
So, of course, I know all about generic prescriptions, and WalMart made a splash a few years back, offering a month's supply per prescription for around $4. Now what I'm about to say isn't that big a deal with my current prescriptions (currently 3) (and I can imagine some readers saying this isn't that big a deal at all, but I'm trying to provide some anecdotal points). These really dealt with having my prescriptions filled at WalMart, which is convenient because I do much of my local grocery and other shopping at WalMart, maybe a 15 minute drive away.
To be sure, WalMart isn't all that convenient for prescriptions. I typically would have to wait 60-90 minutes to get refills. (I do think they have some automated processes to avoid long waiting times, and I've sometimes dropped off my request in advance of a next day return.
But it turns out my employer's plan has a pharmaceutical vendor which has been warning me that I was on a final local refill without going through their mail order operations.
Now I never got something like a pharmaceutical card with a member id on it. And just for the record I have long had a research interest in human factors/ergonomics in information technology. I often look at usability issues in my personal encounters with practical computer in my companion SoftDoc blog.
So I had gotten these ominous snail mail warning from the pharmaceutical partner saying "[My] response is required". They warn unless I register through their mail service, future claims will be denied. It provides presumably a toll-free number to call and an Internet URL. Do you think it provides an account number for registration purposes? Nope. PII for enrollment, say SSN, DOB, etc? Nope. It wants a member ID I supposedly can find on a card I don't have. My insurance card had a group id, etc., but not the necessary member id to register on the website,
I ended up having to call their 877 line and wade through the PII prompt to get to a customer agent. The agent confirms they haven't sent out a card and gives me the ID I need to register at the website. Like I wrote, I like to anecdotally check the usability of the interface. They have a collection of my approved prescriptions but somehow swapped my regular physician's (later) prescription with a hospital prescription (long story). They had a weird form interface where you had to drill items to enter data and would not enable the submit button if any item was missing (it didn't highlight the item in question and occasionally reset already completed items). When I did submit, they suggested that I might want to let my physician know my prescriptions need to be approved.
The prices they're charging? I think all 3 generics are in the WalMart $4/month-$10/3-months program. This vendor is tripling the price; granted, they are throwing in free delivery. I need to contact HR over this,
I think there are some government people with a phenomenal work ethic; I, as a government contractor was doing some FORTRAN programming/analysis work at NASA Clear Lake City (i.e., "Houston"). I met this guy who was the Radar O'Reilly of the place (if you recall the series M*A*S*H, Radar was the genius who really ran the place, bartering whatever to alleviate some resource shortage). And then there were others who didn't seem to do much of anything, spending much of his time around the water cooler shooting the breeze, taking workout breaks in the afternoon, etc.
Most of the civilians I currently work with are competent and have a decent work ethic. And then there's this other Oracle DBA who, truth be told, would never be hired by anyone in the private sector, grossly incompetent and highly political (office vs. electoral)--you know the kind. He's the kind of guy who will cover his ass up the hierarchy at your expense. And in government work, contractors are particularly vulnerable, while civil servants have virtually guaranteed job security, regardless of the economy. In essence, a contractor is to be seen, not heard, and if (perish the thought!) you are seen as "unprofessional", being disrespectful to or trying to tell a civil servant what to do, you can find yourself a phone call away from losing your job, even though the facts support your position. (You'll find people saying trite nonsense, like 'it's not what you say, but how you said it'.)
I don't suffer fools gladly. I'm not politically suicidal, but people will often object to a perceived tone. I can't go into specifics, but I'll discuss in general terms. For security reasons, I've had to tighten client/server connections. It turns out one of the systems which interacts with our system is running old software which does not support the more secure algorithm I had deployed consistent with information assurance policy. Keep in mind I don't know the specifics of client software in deployment. The last thing I expected was to run into an issue with software desupported by the vendor 4 years ago. My dotted-line function manager had not propagated my planned change to mandate the higher algorithm to all the systems. So in essence when I flipped on the switch enforcing the algorithm, the old system's connections started failing (and it was a particularly high-profile occasion for such failures).
I quickly reverted the change, but I was not favorably impressed with the civilian DBA who had never bothered to upgrade his client software over years of connecting to a higher-version production database. He quickly responded that he thought implementing an upgraded client would invalidate his legacy install. I responded with vendor documentation showing how the client software could be independently installed (and probably download, installed and configured in 15 minutes). He then responds effectively, "You can wait for me to upgrade all the software [on some unspecified future date]. In the meantime, you can downgrade your algorithm to the weak one our vendor software version supports." Not going to happen. All connections but his are running on the higher algorithm.
The incompetent DBA was playing CYA in battling me, trying to make me the issue, even though everyone pays lip service to my efforts in support of security policy. I don't have the standing to tell a civilian DBA what to do. Maybe the information assurance people can force his hand. (I've had other unpleasant encounters with this guy in the past.)
There are times I miss working for Oracle Consulting. I would often come into an engagement, and the manager would hand me the keys and tell me, "If one of my people gets in the way of your mission, just let me know about it." The government is much harder to work with.
The prices they're charging? I think all 3 generics are in the WalMart $4/month-$10/3-months program. This vendor is tripling the price; granted, they are throwing in free delivery. I need to contact HR over this,
My Assessment of Federal Employees is Nuanced
I have two siblings and an in-law who started in the military (and two of who retired from the military like my Dad) and later joined the Civil Service. My little sister, an Air Force RN, married an enlisted man (a no-no in the military: fraternization policies) and eventually resigned her commission, I think around the time of her first pregnancy. My sister and little brother have never discussed their civil service careers with me. But my sister recently retired on her birthday, calling it her best birthday gift ever, which to me suggested mixed emotions. I just remember one incident years back where my goddaughter, her second child, wrote an email; I did a reply all, not noticing my niece had referenced her mother's government email address. My sister went batshit crazy; I don't know if somehow they were monitoring her emails and she got read the riot act. I didn't have or use my siblings' work email accounts (well, very occasionally my middle brother's).I think there are some government people with a phenomenal work ethic; I, as a government contractor was doing some FORTRAN programming/analysis work at NASA Clear Lake City (i.e., "Houston"). I met this guy who was the Radar O'Reilly of the place (if you recall the series M*A*S*H, Radar was the genius who really ran the place, bartering whatever to alleviate some resource shortage). And then there were others who didn't seem to do much of anything, spending much of his time around the water cooler shooting the breeze, taking workout breaks in the afternoon, etc.
Most of the civilians I currently work with are competent and have a decent work ethic. And then there's this other Oracle DBA who, truth be told, would never be hired by anyone in the private sector, grossly incompetent and highly political (office vs. electoral)--you know the kind. He's the kind of guy who will cover his ass up the hierarchy at your expense. And in government work, contractors are particularly vulnerable, while civil servants have virtually guaranteed job security, regardless of the economy. In essence, a contractor is to be seen, not heard, and if (perish the thought!) you are seen as "unprofessional", being disrespectful to or trying to tell a civil servant what to do, you can find yourself a phone call away from losing your job, even though the facts support your position. (You'll find people saying trite nonsense, like 'it's not what you say, but how you said it'.)
I don't suffer fools gladly. I'm not politically suicidal, but people will often object to a perceived tone. I can't go into specifics, but I'll discuss in general terms. For security reasons, I've had to tighten client/server connections. It turns out one of the systems which interacts with our system is running old software which does not support the more secure algorithm I had deployed consistent with information assurance policy. Keep in mind I don't know the specifics of client software in deployment. The last thing I expected was to run into an issue with software desupported by the vendor 4 years ago. My dotted-line function manager had not propagated my planned change to mandate the higher algorithm to all the systems. So in essence when I flipped on the switch enforcing the algorithm, the old system's connections started failing (and it was a particularly high-profile occasion for such failures).
I quickly reverted the change, but I was not favorably impressed with the civilian DBA who had never bothered to upgrade his client software over years of connecting to a higher-version production database. He quickly responded that he thought implementing an upgraded client would invalidate his legacy install. I responded with vendor documentation showing how the client software could be independently installed (and probably download, installed and configured in 15 minutes). He then responds effectively, "You can wait for me to upgrade all the software [on some unspecified future date]. In the meantime, you can downgrade your algorithm to the weak one our vendor software version supports." Not going to happen. All connections but his are running on the higher algorithm.
The incompetent DBA was playing CYA in battling me, trying to make me the issue, even though everyone pays lip service to my efforts in support of security policy. I don't have the standing to tell a civilian DBA what to do. Maybe the information assurance people can force his hand. (I've had other unpleasant encounters with this guy in the past.)
There are times I miss working for Oracle Consulting. I would often come into an engagement, and the manager would hand me the keys and tell me, "If one of my people gets in the way of your mission, just let me know about it." The government is much harder to work with.
