• Calmer in the morning

    It’s a new day, and while I still don’t have my meds, I’m not ranting and raving anymore.  So let me take a few minutes and explain why this is important above and beyond just me, and to clarify some things:

    1)  I don’t think that the executives or the CEO of the insurance company are out to get me.  I don’t think they are malicious or evil.  I do think that they don’t understand the ramifications of their actions.  You see, I think they decided it made fiscal sense to consolidate the pharmacy use of their specialty meds into one location, and to own it.  But the problem with the plan is that it needs to be perfect.  They can’t run out of meds.  They can’t miss a shipment.  They can’t make a mistake.  And – look – they inevitably will.  But my experience shows that the system has absolutely no back up plan.  They just assume that everything will go fine.  It won’t.  Someone in the warehouse screwed up.  That’s all.  But it hurts me – the patient.

    2)  The reason that I’m not naming the company is that I don’t want this to be about me.  I’m not looking for a crusade in my name.  The point is that this can happen to anyone, in almost any state.  The system is screwed up, and that’s where the focus should be.  As I told Austin last night – I’m fine.  I’ll be OK.  But there are many, many people in similar situations who will not be.  This is happening to them, too.

    3) This highlights what I think is a major fault of the system.  We can err on one side or the other.  This system makes it difficult for people to get their meds, and that means when it slips up, we hurt people.  I think that is a bad idea.  It’s the same reason I keep pushing back against the moral hazard.  It works fine when you’re healthy, but it’s terrible when you are sick.

    4) I’m shocked at how many comments and emails recommended legal action.  Some of them came from people who have argued with me before that we need malpractice reform.  I can taste the irony.  Can’t we all agree that a lawsuit should NOT be the way to get the care you need?  Especially when many of you think there are too many lawsuits already?

    5) Many of you have recommended ways to solve the problem.  I appreciate that, but it’s misplaced.  Again – I’m fine.  Our goal should not be ways to find individual ways to work around the craptacular system we have in place that will take too much time, too much energy, and too much money.  It should be to fix the system itself.  That’s why I do what I do, and not primary care pediatrics.  It’s my way of contributing.  I’d rather it be yours, as well.

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    • “Can’t we all agree that a lawsuit should NOT be the way to get the care you need? ”

      Well, of course its not the way to get the care you need, but that said you did all the right things to get this care/meds and yet the provider failed you miserably. You had no other remedies-so what’s left?

      In your situation, perhaps a few days may not harm you, but in someone else’s situation, it could have real life impact. What should they do when they’ve done all the right things and are left twisting in the wind?

      If one person hurts another or puts them at risk, that’s often a crime. one some level, its at least a breach of contract.

    • Naming names wouldn’t make it about you it would set an example. When an insurance company does right – tell people, when they threaten your health and well being for profit – tell people.

    • “4) I’m shocked at how many comments and emails recommended legal action. Some of them came from people who have argued with me before that we need malpractice reform. I can taste the irony. Can’t we all agree that a lawsuit should NOT be the way to get the care you need? Especially when many of you think there are too many lawsuits already?”

      While I’m not a big fan of lawsuits (and I’m not suggesting one here) so long as there is no consequence and at least some perceived benefit to the insurance company, they will continue to maintain this mythical “just-in-time” “nothing-ever-goes-wrong” system. Until there *is* some consequence to them, there is ZERO chance that they will change.

      Isn’t that the whole point of health care reform? To force insurers to operate in the best interest of their policy holders instead of solely in the best interests of their shareholders? If you think your insurer is going to fix this problem without any very effective persuasion, then you’d probably think there’s no need to health care reform — insurers would just fix the system because it’s the right thing to do.

      To prevent an epidemic of expectation-based asphyxiation, I’d suggest not holding your breath.

    • “You see, I think they decided it made fiscal sense to consolidate the pharmacy use of their specialty meds into one location”

      This is a fairly common practice. Most insurance companies have a preferred specialty pharmacy.

    • Since when has malpractice reform been about removing legal action when someone *does* make a mistake that literally hurts you (as you claim it’s doing)?

      Should a lawsuit be the way to handle this? Course not, but we don’t live in happy land where there is any other way.