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Notes -
A Window Into How Health Insurance Companies Harm Consumers by Threatening to Deny Coverage
From the New York Times, we learn about how health insurance companies hire PBMs (Pharmacy Benefit Managers) to help them restrict access to doctor-prescribed drugs. For all the talk of insurance companies directly denying coverage, when it comes to pharmaceutical drugs, specifically, they're able to offload a significant amount of Delay, Deny, Defend onto third parties, in this case PBMs. By restricting coverage, insurance companies are able to reduce costs and increase profits. A bonus is that they don't even have to be The Bad Guy; they can pawn that off on a third party, who is ostensibly making the choices for them. They don't have to personally defend the decisions to deny; they can just obfuscate, wave in the direction of the third party, and let the complexity of The American Healthcare System stymie consumers.
The Times does a deep dive into a Good Guy Pharmaceutical Company and the lengths they have to go through to navigate this minefield to get their high-quality, purity-assured drugs into the hands of the market. Primarily, they've gotta give the PBMs a cut of the money, who in turn share it with the insurance companies and employers they represent. For a while, they were rebating 23% on average, allowing patients to access the drugs their doctors prescribed at prices that were reasonable to them, their employer, and their insurance company. One PBM reportedly wanted (and got) more - 60% rebate to keep prices low and avoid inflaming popular anger with denials. Of course, that still doesn't quite reach how good some Medicare plans were at 'negotiating'; they got about 70%!
The Good Guy Pharmaceutical Company knew how much people wanted its product; they knew that doctors were prescribing it; they knew how dangerous the alternatives could be for many in the market. They were offering a well-known, well-tested product, clean from any adulteration, and outrage would surely rule the populous if folks had to turn to alternative products or sketchier outlets, possibly with less-stringent quality control. So, they selflessly paid the toll to do the right thing, to get their product into the market, to save lives. NYT rightly applauds their admirable efforts to do what they could, at cost to their own bottom line, to protect consumers from the restrictive, denial-focused tactics of health insurance companies and their lackeys.
Oh wait. NVM. It's Purdue. It's Oxy. Flip everything 180 degrees. Apparently, nobody (other than Purdue and their supporters) thinks it's good to flood the market with high-quality, pharmaceutical grade opioids with well-known potency properties. They somehow don't think that this is preferable to folks getting funneled toward lower-quality, potentially dangerous alternatives. They're back to liking the gatekeeping of insurance companies and their lackeys, ya know, so long as they're doing so in keeping with their own political proclivities. Gatekeeping is Good and Right, so long as the folks who buy digital ink by the barrel can browbeat the gatekeepers into doing things the way they want it to be done. ...and they sure ain't even thinking about including libertarian politics on drugs in the list of their demands. Woke politics, tho? Sure, why not?
I think the bottom line, is this is just what a low trust society looks like. Everyone smashes the defect button as often and as quickly as possible, in every situation. There is literally no solving this problem, only clearing the way for a different species of defector who will ruin things, do material damage, and end lives with their greedy, corruption and indifference.
I was sitting in the car one day, pondering how low trust our society has become. I was at a gas station while my wife was using the bathroom. And I couldn't help but notice that the emergency gas shutoff switch is just out there, in the open, totally exposed. It got me thinking about the damage that will be caused when our low trust society devours that. I mean, it's there, unguarded, for a reason. Gasoline is dangerous, you can't just have it spilling all over the place. In case of emergency, you might not have time to grab the manager, have them get their keys, etc, etc. So it's just out there, for anybody to hit, whether there is an emergency or not. Which makes me wonder how long until some asshole tiktok prank becomes smashing that button as many times a day as possible until gas stations across the country have to start locking them up. Which then leads to more avoidable accidents at gas stations.
It's just going to be this way with everything. Nothing is going to be too trivial, or too important for some asshole to pillage, either metaphorically or literally.
By law, they can't lock them up. In a blue state we'll just get op-eds and politicos opining about how this is why we need to ban gasoline cars and go to all electric. There IS a solution to this particular class of problems, but it's banned. Basically the "railroad bull" solution -- swift and painful punishment for the assholes that do it.
I have lately wondered if what we're missing is a bunch of, I suppose, nuns with rulers or the equivalent to punish modest anti-social behavior (defecting, in this conversation) promptly with a transient painful stimulus that neither leaves lasting marks nor a permanent legal record.
But I don't think it would work in all cases, or maybe even at all. And it's almost certainly disallowed by the Constitution. And suffers from a lot of ambiguity as to where to draw the lines.
A good chunk of our current society has made every effort to metaphorically disarm and discourage the previous set of 'nuns with rulers'. I don't see how trying to artificially implement them from the top down is going to do anything but make things worse.
Put bluntly, if you want a high-trust society, get more Daniel Perry's and stop punishing them when they actually step up and do things.
I have heard tourists (here n Japan) remark on how surprised they are that the iPhones in the shops are just sitting there for you to look at and aren't locked up. The reason is that if you steal one you'll be summarily caught and sent to jail. This seems like a blindingly obvious policy.
Having written that I admit sometimes the catching takes time. Last Saturday in Kyushu some asshole stabbed two teenagers in a McDonald's, killing the girl, and is still at large.
While there may be rule of law here, when it does go south there are very few Daniel Pennys.
Edit: Found him
Comparing two different nations with very different setups, society, and ethnic spread is always a bad comparison.
What works for one doesn't always work for another. I envy Japan on a level you cannot imagine for their train network, that doesn't mean I expect the same to be implemented in the US.
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