Perhaps you caught Rush Limbaugh, he of the $400 million radio contract, marveling at what wonderful care he received in a Honolulu hospital recently. He refused to take questions (notably about the opiates that were in his possession when he was stricken) or "talk about politics" but he did manage to give a typically logical sermon on the glories of free market health care:

"Based on what happened to me here, I don't think there is one thing wrong with the American health care system. It is working just fine, just dandy, and I got nothing special."

We'll assume that his "confidence inspiring" experience left him short a little blood in his brain, and therefore he should get some slack for failing to understand the difference between point-of-service health care and the financial underpinnings of the system. Most Americans believe that outstanding health care is available and the problem, if anything, is that a lot of people can't afford it. Find a way to insure everyone and we'll truly have the best system in the world, right?

I disagree. As long as Rush is playing the anecdotal evidence game, let me share some of my own.

Having insurance is very important to me – perhaps moreso than the average person who lives life without a financial safety net – because I have a couple of chronic health problems that require a Keith Richards-sized handful of expensive medications to keep in check. Lots of people are in similar situations – diabetics, for example, have continuous, substantially above average medical requirements that make them costly members of an insurance pool. The last time I was brave enough to calculate the total, my out-of-pocket cost would be about $1600 per month. So I'm thankful to have coverage.

Anyway, the point is that I already take a lot of pharmaceuticals. I'd prefer to take less, but people who have cancer would prefer not to have cancer. Our health really isn't about our preferences.
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Last week I saw a new doctor for the first time, given that I've been pretty healthy since moving to a new state. We had the standard new patient visit, just chatting about my overall health. I mentioned that I've had a lot of respiratory problems since moving here, perhaps because of a local allergen that I'm not used to. He said something offhand about this area being bad for allergy sufferers and rattled of a prescription for Symbicort and a second for an Albuterol inhaler. After a perfunctory respiratory exam (which he didn't bother with before giving me the inhalers) he told me I might have a touch of bronchitis, necessitating Zithromax and some cough suppressant I'd never heard of. He noted that my right shoulder sounds like a cement mixer when I raise my arm – an old boxing / drumming / etc. injury that probably requires surgery – and wrote me up for a nice anti-inflammatory.

It almost became a game at this point.

He asked about my sleep habits. I truthfully answered that I sleep terribly, usually a few hours per night. Before the sentence was punctuated he was halfway through the Lunesta prescription. He suggested that given my family history I might consider a beta blocker for high blood pressure – which I don't actually have, but I might get at some point in the future. I considered faking the symptoms of pregnancy to see if he'd give me an epidural, but I let it go. I walked out of the office holding – I shit you not – eleven prescriptions counting my long-term medications and the Appetizer Sampler of other medications he decided I should try based on our 10 minute consultation and a cursory physical exam. Excepting one of the inhalers – I have to admit that my asthma is horrible lately – I threw them all in the trash.

This, to me, is not good health care. This is a vending machine that dispenses pills. It is one step removed from a WebMD-style interface in which one inputs symptoms and presses a button to have pills clatter out of the computer like a slot machine. Like Mr. Limbaugh I'd make the argument that the care I received was in no way exceptional. In fact I consider this pretty standard based on my experience with a lot of doctors over the years. Our health care system, primarily due to the "get 'em in and out as fast as possible" business model of insurance companies and the exaggerated influence of the pharmaceutical industry, makes almost no effort to find out what's wrong with us. It doesn't treat conditions, it treats symptoms.
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Did my doctor suggest allergy tests to figure out what's causing my problem? A shoulder X-ray? A sleep specialist? Nah. Tests are expensive! Writing prescriptions is easy. Doesn't cost the provider a dime. And let's not hold the public blameless either; we are a nation of people who want quick, chemical solutions. We don't want to make lifestyle changes, we want pills that thin our blood and absorb more cholesterol and put us to sleep and wake us up and give us boners and make pain go away.

I'm certainly not going to go Tom Cruise on you and suggest that taking medicine is inherently bad. But before we crown the American Way the best of all possible worlds we need to examine more closely what those who can afford our health care are receiving. Rather than parroting the all-too-convenient line that our system is great except that some people can't afford it, I'm more interested in "reform" that addresses both cost and quality. Because the latter often falls woefully short of the "confidence inspiring" monument to patient care that makes Rush and his ilk so misty-eyed.

17 thoughts on “VENDING MACHINE”

  • There's always homeopathy…………..kidding. I do the same thing, I keep the prescriptions that pertain to what I went to the doctor for. The rest is trash.

  • baldheadeddork says:

    My wife has also dealt with chronic conditions for most of her adult life and had doctor experiences that were almost identical to yours, except when they hinted it might all just be in her head. Yeah, she was complaining of gastric pain and maybe you can't blame the primary care doctor for not noticing in her ten minute exam that she also gave off big warning bells for depression and anxiety, but the excuse didn't make it better. She lived with that pain, sometimes debilitating, for twenty years.

    When we moved to Bloomington it was incredibly hard for us to find a family doc because neither of us worked for IU or Cook and only a handful of doctors in town were in our plan. We wound up going to a walk-in clinic behind the Big Lots – and stumbled into the most attentive health care either of us have had since we were children. When the anxiety issues came to a head because of stress at her job, he listened and asked questions for a half-hour and then did blood tests to rule out a physical condition before starting an incremental drug treatment plan.

    I'd love to know how their business model allows this when regular practices have to get you in and out in eight minutes, but I'm afraid to ask.

  • The buck, the buck, the hunt for the buck
    Is why most US institutions suck
    It's why everyone's clamouring to get on TV
    Or rorting the system as hard as can be
    And Gush Pimpwhore, the right-wing welfare queen
    Is the rortiest scammer that you've ever seen
    He'll smear his mother his country or you
    He don't give a fuck because it's all about the dough
    He sucks GOP dick harder than any other man
    That's why he don't need no medical plan…

  • Poor Rush, he got to deal with Socialized medicine (Yes, in Hawaii they have it.) & survived – he even liked it…

  • You should have gone for the epidural. You need to find another doctor, one that will listen and do more than push pills.

    As for Rush, I saw where someone had said that if Rush had died in Hawaii, would anyone believe his death certificate??

  • This is tripe. You know, this liberal whining about health care reminds me of how liberals are now starting to whine about how the increase in airport security is going to impede commerce and travel in general. These elitist intellectuals are so outta touch. When I travel, via my private jet and private airport access, I see no signs that supposed increased security measures are impeding international commerce or the free flow of ideas. These elitists are so outta touch with the concerns of everyday Americans.

    -Rush "I'm still fat in the face even though I lost weight" Limbaugh

  • Ed, I highly recommend that you check out Arrosti therapy for your shoulder if it is available in your area. I had an elbow that was damn near unusable and a shoulder headed that way from past injuries and it took two visits to get my shoulder back to 95% percent of what it was and the elbow is greatly improved as well (though that took a couple of more visits). It is superior to traditional PT (better results and faster) but it does hurt like hell, especially the first visit or two.

  • Last nigtht Olberman and Maddow were getting quite a few yucks about Limpdick's experience with health care in Hawaii, which is far far to the left of anything that will ever pass nationally.

    Everything you've said today is right on the Money, Ed.

    Here's another thing to think about – drug interactions. Drugs, in one way or another, an mucking around with your fundamental body chemistry. New drugs undergo a regimin of tests, which include two-way interactions with common drugs. These are nowhere near complete

  • Oops. Premature posting disorder.

    They never look at three way interactions.

    You walked out of there with 11 prescriptions.

    Nobody on god's warming earth has any hint what the effects of the cocktail might be.


  • My problem with the pharmaceutical world is that it pushes new drugs out like a coke machine and doctors pump their patients full of whatever they feel might work without ever considering the potential adverse effects of combining different drugs. An overwhelming number of cellular processes rely on cascades of signals from other processes, so when you start interfering with one of them, there's an outstanding chance that you'll impact another. Pre-clinical research and the clinical trials themselves attempt to ensure that this doesn't happen for a single drug, however, this drug is rarely if ever tested with combinations of other drugs. And hell, the number and variety of other drugs that a person might swallow at the same time is mind boggling.

    I have a feeling that there exist some health issues today that stem from over-drugging in this way and based on the profits enjoyed by pharmaceutical companies, such situations will doubtless continue to get worse without much prospect of ever getting better.

  • My usual caveat: GPs prescribe, surgeons operate, acupuncturists slip you the needles. You know what you'll get when you make the appointment, just as you know you'll get a haircut when you see the barber. It's what they do. Are you surprised?

    If things had gone slightly differently, you would have also had a few thousand dollars worth of MRI, bloodwork, ortho devices, and PT — in addition to the scripts — with the same outcome. If you don't have a skilled diagnostician, you got nothin'; and when people go to the doctor, they don't feel they got their money's worth (even if it was a $20 copay) without a prescription lollipop to take home.

    I grew up with a doctor honest enough to tell me when medicine couldn't offer curatives, only palliatives. Try to get healthy, try to stay healthy, and understand your illnesses when you do get sick. Good health doesn't come from the doctor, just as meat doesn't come from the grocery store, and safety doesn't come from policemen. Doctors are as honest and human as the rest of us schmoes — and sometimes not so perspicacious, though dedicated to rote memorization.

  • Great post. I have to admit when I heard about Limbaugh's health crisis I kind of hoped he died. Oh well. I agree about our health care system–it is far too reliant upon pharmaceuticals–we need a more holistic approach. That said, I have asthma too, and may I recommend something? I used to use inhalers several times per day–then a keen physician put me on Advair. Truly, I feel as if I don't even have asthma. I use it once per day. Jusr a thought. I hope you get some sleep!

  • I've had an allergy medication for 19 years now (19 years!–same thing!!) and been on various birth controls for 8, and when I moved up to Indy all I wanted was a vending machine. When I saw a doctor and walked out with the two scrips after a 10 minute conversation, I had mixed feelings: YAY! I got what I want…. but DAMN, that guy just wrote me whatever I wanted… he had to ask me for details about what number of doses to write on the BC scrip…



    Totally agree with fear JzB about interactions. That shit is scary. 11 scrips at a time for someone you just met is terrifying. Report him to the AMA?

  • "I have a feeling that there exist some health issues today that stem from over-drugging"

    Many of the women on "I Didn't Know I Was Pregnant" got pregnant because they were prescribed antibiotics that interfered with their birth control and no one told them about it. The reason I know that antibiotics interfere with bc is from effing Family Guy. I was also prescribed an antibiotic in September, right after indicating that I was on birth control. There was no word as to how that would affect the effectiveness of the bc.

  • I don't watch much TV (I don't actually own one) but one thing which always amazes me is the number of prescription drugs being advertised to the general public. During the day it was every other ad. These are things which the general public cannot buy, and 90% of the general public don't need and would probably be harmed by. The message is always the same. "Go pester your doctor for … and don't worry your insurance will pay for most of it … isnotforeveryoneandmaycausepainfulsuddendeathinsomepatients". Also, some doctors don't write prescriptions – they call them into the pharmacy. This means that there is no opportunity for any kind of economic decision making.

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