SayUncle to sue Wal-Mart for not having Pemmican Brand Beef Jerky
No, really:
Backed by abortion rights groups, three Massachusetts women sued Wal-Mart on Wednesday, accusing the retail giant of violating a state regulation by failing to stock emergency contraception pills in its pharmacies.
The plaintiffs argued that state policy requires pharmacies to provide all “commonly prescribed medicines.”
Wal-Mart carries the morning-after pill in Illinois only, where it is required under state law, said Dan Fogleman, a spokesman for Bentonville, Ark.-based Wal-Mart.
First, the morning after pill isn’t exactly contraception, which is defined as prevention of conception or impregnation. Second, are these people serious? And third, seriously, the state of Illinois demands that stores carry products?
The fact the state can mandate that an establishment has to carry something strikes me as an overreach on the part of the government. Next, they’ll mandate that all stores have to sell ink jet cartridges or Vaseline. I realize, of course, that things of a medical nature may warrant some sort of regulation to ensure that people have the best medical care but those people can also shop somewhere else.
February 2nd, 2006 at 12:27 am
Makes me wonder if NARAL is scratching Big Union’s back for some reason.
If you see union pickets turning up in some odd place, you’ll know why.
February 2nd, 2006 at 1:27 am
Emergency contraception is apparently just plain old birth control pills. If you are rushing to the doctor, and then the pharmacy to get some, I would suggest to get a prescription for both. Odds are, unless you are trying to fill it at the Vatican Pharmacy, that the pharmacy will stock one or the other. Better yet, stockpile some extra BC for yourself beforehand.
I wrote a blog post about this here:
http://standardmischief.com/2005/11/09/forcing-pharmacists-to-dispense-drugs-emergency-contraceptive/
Using birth control for emergency contraception is sorta like taking four 200mg ibuprofen OTC pills instead of one Rx only 800mg horse pill. You still get the same dose.
The linked article was pretty crappy. The reporter seemed to fail to confirm that the prescription was indeed commonly prescribed. If it really is commonly prescribed, Wal-mart is not carrying it for the same reason that they are bleeping out the cuss words in the music section.
I don’t buy music at Wal-mart
Boycott the store, write letters, or shop elsewhere, just don’t misuse the thuggery of the courts to get your whiny-ass way.
February 2nd, 2006 at 12:06 pm
Google Ads are funny. They are all about beef jerky because of the title of this post.
They had the spokeswoman for NARAL on the local talk station(WRKO) here in Boston this morning. The host said that the key point is whether this particular prescription(The morning after pill) is covered under the vague law they are using as their basis for a lawsuit. They could only find three people who say they were harmed by Wal-Mart’s practice and the drug seems to be readily available elsewhere. This seems to be more in the campaign to attack all things Wal-Mart. They are just throwing this against the wall and seeing if it will stick. It could, here in Mass. If they get the right judge.
February 2nd, 2006 at 12:23 pm
As close as you are to the Crockett Creek jerky outlet, why would you buy jerky anywhere else?
February 2nd, 2006 at 12:29 pm
Forget beef jerky. I’m going to sue Wal-Mart because they don’t sell handguns anymore.
February 2nd, 2006 at 1:45 pm
And Pemmican is teh suck. Eat Jack Link’s. It is like candy. I have it for desert sometimes.
February 2nd, 2006 at 2:40 pm
“I realize, of course, that things of a medical nature may warrant some sort of regulation to ensure that people have the best medical care…”
Government regulation = best medical care ?
Does that logic also apply to other products and services? Like say firearms? After all hasn’t government regulation of firearms improved our ability to procure and use them?
No thank you. I certainly have all the government I can use.
February 2nd, 2006 at 2:59 pm
Uncle:
Actually, by that definitoin of contraception, the morning pill is contraception, because while it doesn’t prevent contraception (fertilization of an egg), it does prevent impregnation (the implantation of said fertilized egg in the uterine lining). And it actually medically mimics an event that happens all the time by natural causes. By most estimates, something like 75-80% of fertilized eggs fail to implant. EC merely increases those odds into the 99% range.
And your beef jerkey example is woefully inadequate. Anybody who owns a grocery store, department store, gas stations, convenience store, whatever, can sell beef jerky. Only licensed pharmacies can sell prescription drugs like EC. And in many, many places, Wal-Mart is the only game in town. So you’re essentially arguing that Wal-Mart should have a right to tell small-town American women to go fuck themselves, and that you have no problem with this. Nice.
February 2nd, 2006 at 3:03 pm
Well, gee whiz. Maybe they should sue every other business for not going to the trouble of getting a pharmacy license, then. It’s not as though there were some law saying only Wal-Mart is allowed to go into that business.
February 2nd, 2006 at 3:26 pm
Xrlq to women who have a valid prescription which their pharmacy refuses to fill: “Too fucking bad.” I’m in awe of your apathy. As for the “go somewhere else” idea, I thought it was we “lib’ruls” who were supposed to be the big city elitists.
Heaven forbid we actually ask the Mighty Wal-Mart to actually, you know, comply with the law.
(And given that EC is merely a larger dose of common brith control pills, don’t try and feed me any crap about EC not being “commonly prescribed.”)
February 2nd, 2006 at 3:29 pm
Jeeze, if there really is a demand for EC, at least as big as say, live lobsters, I’m sure the market would step in and service those poor women in small town America. Planned Parenthood could set up a pharmacy in tax free Delaware or something, accepted faxed in perscriptions from doctors and overnight out EC in unmarked Fed-Ex mailers. 100% legal and it would help protect the privacy of those small town America women. Let the free market work.
February 2nd, 2006 at 3:32 pm
Tom, just to stir things up…
If there were a morning after pill that selectively prevented the implantation of the fertilized egg according to gender or race, would you be in favor of requiring pharmacies to sell it?
I don’t know what my answer to that question would be.
February 2nd, 2006 at 3:39 pm
tgirsch Says:(And given that EC is merely a larger dose of common brith control pills, don’t try and feed me any crap about EC not being “commonly prescribed.”)
I just got off the phone with my local wal-mart. They stock birth control pills. I’m sure every wal-mart pharmacy in the nation does. what they don’t have is the exact same drugs packaged and sold specifically for EC. That’s what they are suing about.
February 2nd, 2006 at 3:43 pm
Actually, to clarify, I can’t think of any possible justification for the race-based pill. Let’s say a gender-selective pill.
February 2nd, 2006 at 4:00 pm
To abstract this a little bit;
– State government says that in order to be a licensed pharmacy, certain medicines must be stocked.
— Kinda like the StateGov specifies that in order to have a liquor license, bars must check ID and close by a certain time.
– A specific retailer / pharmacy is not complying with state law.
— It is unclear if the people suing attempted to have the Attorney General enforce the law, or just jumped to the lawsuit.
We can debate what the law for pharmacies should be, and we can debate if item of conflict should be available, and we can debate if they should have gone directly for the lawsuit.
But I don’t think we can debate that the current law – as written and passed – should be enforced.
That’s my opinion on it.
February 2nd, 2006 at 4:10 pm
Les:
In response to your question, since pharmacies are by their nature granted a certain competitive advantage (not just anyone can sell pharmaceuticals), and since patients can only get their prescription drugs from licensed pharmacies, I support requiring pharmacies to carry (or be able to quickly obtain) any pharmaceuticals that the FDA has approved and which are legal to sell.
I would almost certainly oppose FDA approval of your hypothetical gender- or race-selective EC pill, and if it were approved I would join you in fighting to get it unapproved; but if a doctor prescribes a medication, whatever its purpose, the patient starts with a limited number of options as to where they can get that medication; they shouldn’t have to worry about the additional hassle of trying to figure out whether or not pharmacist X is going to refuse to sell them the medication in question.
I do agree with Standard Mischief insofar as you should vote with your dollars and simply not shop at Wal-Mart (I don’t). But taking it a step further and beyond EC, and talking about pharmaceuticals in general, it’s not the many I’m concerned about here; it’s the few. “The market,” left to its own devices, would tell people who need uncommon medications “tough shit,” or at best price gouge the bejeesus out of them because they can. The market is there to serve us, not the other way around. Too many conservative and libertarian types seem to feel the opposite. I do like the idea of selling things like EC (and, hell, even RU-486 and the like) shipped overnight in unmarked mailers, but that opens up other cans of worms (e.g., What other restrictions exist on mailing pharmaceuticals? I don’t know).
And concerning “packaged” EC, in many cases, generic versions (of drugs in general, not sure about birth control in particular) aren’t pre-packaged, but rather are packaged in the store by the pharmacy techs. And even failing that, it’s not uncommon for women to lose a birth control pill and request a replacement pill; if they have to break up packets for that, why can’t they break up packets for EC?
February 2nd, 2006 at 5:03 pm
TGirsch, one man’s “go f— yourself” is another’s freedom of association. It’s all well and good to complain that Wal-Mart should be required to follow The Law – as everyone should be – but that’s a non-argument when debating the merits of the law itself.
February 2nd, 2006 at 5:33 pm
I can get 24 bottles of water for about $5. However, if I want to get a cold bottle of water at the office, the vending machine wants $1.25. Am I being gouged? How about letting me decide if I want to buy water out of a machine or bring it from home?
In regards to the price. I just called my local CVS. They do stock Plan B. The price quoted was $48.19. Then, talking to the pharmacist, I asked about off label use. He said standard birth control tablets run about $40-60 a box, Depending on the brand. I’m gonna go out on a limb (I am not a pharmacist) and say the average off-label dose is 8 pills, divided, and you get 28 pills in a box (plus some extra placebo pills for the end of the cycle). I don’t normally buy the pill, but it may come in a 90 day supply for that $40-60 price. No matter, the off-label use is cheaper either way.
Perhaps this is why some places don’t wish to stock EC? Why spend money to store drugs that are going to just sit on the shelf and expire? Why again do we need government meddling here? Keep your laws off my pharmacist.
With me, when it’s coming out of my own pocket, I buy the cheapest generic and I subdivide pills with my $1.99 drugstore pill splitter when I can. I take several OTC pain pills rather than fill an exact same RX only prescription when it saves me money. I’m sure many other people do the same.
February 2nd, 2006 at 5:55 pm
Xrlq:
Maybe so, but even freedom of association has its limits, in particular in a commerce scenario. I don’t get to decide not to sell to black people and hide behind my freedom of assocation. I can choose not to socialize with black people, and that is my right. But once I’m a business doing public transactions, I don’t get to do that any more.
As to the merits of the law itself, you’re essentially arguing for allowing a pharmacist — or, worse, an entire company — to override what a doctor recommends to his or her patient. Call that “freedom of association” if you want, but to me, it sure smells like “go f— yourself.”
Mischief:
Your bottled water example misses the point for the same reasons that Uncle’s beef jerkey one does, but it manages to be even worse, given that you could just turn on the tap practically for free and get water. With prescription drugs, your options are far more limited. And we’re not talking about denying people luxury goods here; we’re talking about denying them needs. That’s a whole different ball game.
Now I suppose you could argue that we could deregulate pharmacies completely, at which point the types of market forces you keep appealing to would actually have a chance to work. That, at least, would make your position more consistent. Insane, but consistent. 🙂
February 2nd, 2006 at 6:14 pm
Nope, Every major drugstore chain in the nation carries standard birth control pills (at least I’m betting, because otherwise NOW would be just howling!)
The one case I actually called and checked on, you would end up saving money, $40 vs. $48.19, a saving of eight bux and some change. Plus you would get at least one spare dose with the standard birth control pills, so it ends up being at least half the cost.
Even if you insist on buying the brand name, CVS, a damn near nation wide chain carries the stuff. Looks like the free market is working just fine.
Because it’s so much cheaper, perhaps Plan B does not sell. In that case it very well may be that it’s not a commonly prescribed drug, and thus immune from the law.
Bottom line, it’s available, nationwide, it’s cheap, and the unnamed “abortion rights groups” are blowing smoke. I don’t see why they are not putting their effort towards passing legislation allowing women to buy Plan-B or the equivalent generic drugs OTC in an emergency. That’s something I can support.
February 2nd, 2006 at 6:43 pm
TGirsch, analogizing to racial discrimination in this context is hella-lame. Do you seriously think moral opposition to abortion, even at the earliest stages, is comparable to Jim Crow?! Even if I were to buy into that nutty analogy, the argument still wouldn’t hold, as Wal-Mart isn’t refusing to do business with any class of people, merely refusing to provide a service that certain individuals want. Imagine doing business with all races on equal terms, but getting sued for discrimination anyway because some of the items you carry are very popular among white customers, but you don’t carry certain other items that are more popular among blacks.
February 2nd, 2006 at 11:15 pm
Tom, you’re picking nits on the definition of impregnation. Impregnation means to get pregnant. And pregnant means to carry offspring. Once the little sperm hits the little egg, your carrying offspring. It’s not contraception it’s ‘oops, i may have screwed up.’
No, but they can tell them that they won’t sell products that cater to folks who did not fuck themselves the night before. Wal-Mart should be allowed to sell or not sell any legal product it wants. Period. Get the state out of it. It’s a market, someone sells it somewhere.
February 2nd, 2006 at 11:37 pm
Mischief:
Hey, man, I’m all for OTC Plan B. So’s the FDA’s advisory board, for that matter, not that that little tidbit seems to make much difference.
Otherwise, I think you’re splitting hairs on the idea of “commonly prescribed drug.” Clearly, the drug itself is commonly prescribed; of this, there can be absolutely no doubt. That particular dosage and packaging of that drug is far less common, but that doesn’t make the drug itself uncommon to prescribe. (Although I’m sure lawyers are even now wrangling over whether the “drug” your prescribing is, say, Advil (the brand name), or ibuprofen (the actual drug).
X:
Call it hella-lame if you want to, but the point stands, in the limited sense that what you’re talking about has about as much to do with so-called “free association” as racial discrimination has to do with contraception. Free enterprise, maybe, but certainly not free association.
And I don’t know how many more ways I can explain it — certainly none that would make you care — but when we’re talking about things like prescription medication, wherein the meds in question are often needs rather than just wants, and when we’re regulating who is and isn’t even allowed to sell the stuff, it doesn’t seem all that unreasonable to require them to carry stuff as part of the price of admission for getting access to that lucrative-but-not-open-to-all market.
For your final analogy to work, you’d have to make it a business that in many places is the only place (or maybe one of only two or three places) that’s even legally allowed to sell the product. And you’d have to make it a product that can only be gotten by the specific written recommendation of some sort of trained professional.
Uncle:
Sorry, chum, but you’re the one splitting hairs on the defintion of “impregnation.” Pregnancy does not begin until implantation, and in fact it’s impossible to even detect until that time. All of the hormonal changes that begin to occur in a pregnant woman don’t even start until the fertilized egg implants, and if I’m not mistaken, that’s generally about a week after fertilization.
And if you do insist on defining contraception using your definitions of those terms, then the pill itself doesn’t qualify as contraception; it works in two ways, by helping to prevent fertilization, but also by preventing fertilized eggs from implanting. That’s why the whole hub-bub a while back about the “pharmacists’ freedom of conscience” allowing them to refuse to prescribe even traditional birth control pills.
As to your whole “someone sells it somewhere” reasoning, you completely ignore the fact that in the case of Plan B, there’s a very limited window for you to get and use it. It’s not as if you have the luxury of shopping around, looking for it on e-Bay, and then waiting for it to arrive several days later by mail.
Then again, I view health care in general as more than just another profit center. I actually give a shit whether or not people can reasonably get it. Perhaps that’s where you and I differ.
February 3rd, 2006 at 12:02 am
tgirsch Says: Otherwise, I think you’re splitting hairs on the idea of “commonly prescribed drug.” Clearly, the drug itself is commonly prescribed; of this, there can be absolutely no doubt. That particular dosage and packaging of that drug is far less common, but that doesn’t make the drug itself uncommon to prescribe…
Clearly if the notion of “commonly prescribed drug” includes standard birth control, then the fact that wal-mart does carry standard birth control means that it is complying with the law. (excuse me, I meant “that stupid law”)
February 3rd, 2006 at 12:14 am
Sorry, dude, but contraception inherently implies prevention prior to. Hence the pill.
This man, he’s made of straw.
February 3rd, 2006 at 12:36 am
tgirsch Says: Then again, I view health care in general as more than just another profit center. I actually give a shit whether or not people can reasonably get it. Perhaps that’s where you and I differ.
Jeeze. It seems to me that every single part of healthcare (drugs, treatment, office visits) is getting more and more expensive, out-pacing even inflation.
Oh, except for elective stuff. You know like laser eye surgery and cosmetic surgery, both of those are going down in cost. New technologies are being developed, tested and put in to use at a rapid pace.
So get this, the part of modern medicine where people have to actually evaluate, price, and pay for out of their own pocket is the most efficient. Imagine that!
So when I called CVS today and asked how much Plan B cost, the sales-droid actually said “you mean cash?”. Obviously almost no one prices out drugs. The same thing happens if you walk into an imaging center and try to price out an MRI test. (Hell yea i’ll sit and lie in a tube to save myself some money on a paid-for-machine instead of the latest wiz-bang “open MRI” wonder. Have you ever tried to get prices in advance and shop around for your dentist?
Is it really too crazy to imagine a world where people have to actually pay the full cost of their prescriptions, those people might actually shop around and compare prices instead of just paying the copay? Perhaps they might chose to pick a medicine that is less expensive because it has a generic or perhaps they would buy cheaper per milligram, higher dosage pills and split them to save money.
I think you can make an strong case to the fact that the free market works in healthcare, and works particularly well.
I’m a strong proponent of “Medical savings accounts” with a “High Deductible Health Plan” as a safety net.
February 3rd, 2006 at 11:28 am
Uncle,
Plan B is usually used when you have no clue whether sperm has hit egg. It’s “crap, the condom broke and I shouldn’t be fertile, but I’m not taking any chances”. Plan B’s effectiveness goes down, hour by hour, and by the time you’ve missed a period, it’s too late.
And besides, the vast majority of the medical community defines pregnancy as begining with implantation, not conception.
But, really, this is all metaphysical hooey. Whether it happens before conception, after implantation or whenever is irrelevant to whether it should be made available to people.
What difference does it make whether we call it contraception or implantation-prevention? My hunch is that when Uncle says it’s misleading to call it contraception, the argument is that “Women who need Plan B are irresponsible.” And that’s just not the case.
February 3rd, 2006 at 11:36 am
Not at all. I think it should be legal, personally. But I can’t see calling it contraception. I would also wager there’s a portion of people who use it who fall into the irresponsible category.
February 3rd, 2006 at 1:42 pm
Mischief:
That strikes me as even worse, because then we’re talking about then carrying the drug but situationally deciding whether or not they’ll deign to honor a prescription for it. (Although I don’t know how the law is specifically worded; could be, they’re only required to carry it and not, you know, actually sell it to anybody if they don’t feel like it.)
As to your gripe about the cost of some types of health care over others, there are a couple of problems with it. First, elective services are competitively priced precisely because they’re elective. When someone doesn’t strictly need something, you have to entice them to want it; and when competition is inherently limited, not just by government regulation but also by high cost of entry and other factors, now you can charge just about whatever you want for a “need” product.
Second, you ignore the fact that medical costs have been driven up primarily by private insurance firms, which is a market force, not a government one. Most of us get our health care not through government programs like medicare and medicaid, but through private insurers. It is they who set our expectations, copays, etc., not the government; and they who helped drive costs up by driving increased demand.
Third, you might not know this, but you know what group health insurance has among the highest patient satisfaction ratings while simultaneously keeping among the lowest per-patient costs? The VA, a(n evil) government agency. So clearly, government doesn’t inherently wreck everything it touches.
Uncle:
Sorry, dude, but contraception inherently implies prevention prior to.
See paragraph two. “The pill” prevents implantation of fertilized eggs, thus by your definition it terminates pregnancy, and does not constitute contraception.
As to when “pregnancy” begins, see here. The consensus in the scientific community (whose opinions matter not at all these days) is that pregnancy begins at implantation. Why? Because, as I mentioned above, lots and lots of fertilized eggs fail to implant. How many times has your wife been pregnant? I’m going to say “two,” or not many more than that. But by the definitions you’re using, the answer is “lots”; statistically speaking, it’s at least ten. I seriously doubt you actually think that way.
And as for my “man of straw,” that may not be how you feel, but it’s sure as hell how you come across. And not just you, either, but “free market über alles” types in general. Simply repeat the mantra of “the market will provide” without ever seeming to care about what, if anything, should be done when the market fails to provide.
And snark aside, that’s where you and I actually differ. With very limited exceptions, you’re a pure free-market capitalist. I’m certainly not a socialist, in the Marxist sense, but I think that wholly unfettered free markets would be disastrous, and that they need to be balanced out; and that yes, certain common needs like education (where you agree with me) and basic health care (where you don’t) ought to be socialized to some extent.
I don’t know of anyone who would deny this. But you could substitute literally anything for “it,” from glue to guns to cars to cabbage, and the statement still applies, which makes it too broad to be particularly useful. If we were talking about mostly irresponsible, that would be different, although I’d still argue that going to Plan B is still FAR more responsible than having a medical abortion later, or (worse) carrying a baby you’re financially and emotionally unwilling or unable to properly care for.
February 3rd, 2006 at 2:26 pm
Damn, we came full circle, rehashing the same stiff. Look, let’s imagine for a moment, that the only store that is possible for you to buy your Plan-B is one of the 44 odd Wal-marts. You just can physically get to one of the over 300 CVS stores. Ok then, in that implausible senerieo, you are just going to have to ask your doc to write it out as a birth control prescription, and not a Plan-B prescription. The doctor can just give you different dosing instruction. You might even save a little scratch by this method.
Another medical analogy. Wal-mart carries the 12 oz hydrogen peroxide, but you want to pass a stupid law requiring them to also carry, at all times, the jumbo 2 liter bottle of hydrogen peroxide, even if that size does not sell. I find this a needless throttle on the free market and the right of a store to chose the stock it wants to stock. Sure you could make the argument that the store has a license, and laws requiring it to stock certain stuff is just and proper, but there is no shortage, the free market is working just fine, 300+ CVS stores all over the state stock the stuff. Let the free market work.
If Kwik-E-Mart decided to stop selling tofu-dogs that’s their decision. It’s my decision whether or not I still want to buy my stuff from there. I’m also free to try to encourage my friends not to shop there either. And hopefully I could let Kwik-E-Mart know that tofu-dogs were really really important to a large segment of their buying public and it would be in their best interest to start carrying them again. Otherwise we may all go over to Circle-J to buy our tofu-dogs
February 3rd, 2006 at 2:47 pm
Nope, it’s real simple. let’s say I need an MRI. I can go to about 5 different places within a stones throw. All of them are the new “open” style. The cost to me is exactly the same, so all they are competing on is comfort, hours, and service. There is no incentive to keep prices low. If I’m only paying my copay, I’ll just go down to the one next to work on my lunch.
Now let’s imagine that I’m paying cash out of my medical savings account. That’s my money that my employer puts in my account. If I don’t use it all it rolls over to my retirement fund, I can leave the cash in the account to my heirs. It’s to my best interest to make wise financial choices with my money. Perhaps because money is tight, I might want to drive a 1/2 hour to a older machine that has already been paid for to save my money. (perhaps not, maybe I’m a rich lawyer and my time is worth more. I’ll go to the one that has faster service.) Furthermore, since it’s my money, there’s an incentive for me to keep myself healthy. In case of any catastrophic emergency, there is the high limit insurance that kicks in.
Your VA example won’t scale unless you draft everyone, including the doctors. Hilliary-care won’t work like the VA, it just means the rich people will fly out of the country to get prompt medical care, sorta like all those Canadians sneak across the border now to avoid waiting months for a rationed MRI test in Canada.
February 3rd, 2006 at 3:42 pm
Mischief:
Perhaps, then, this is where we’re talking past each other. I’m not arguing that you can’t go elsewhere (at least not in Massachusetts) or that you can’t do a medical end-around like this; I’m arguing that you shouldn’t have to. If I’m restricted to going only to a licensed pharmacy to get my medical needs, then I should have some reasonable expectation that whatever pharmacy I go to will carry — and sell me — what I need.
I suppose I could see a more “market-friendly” alternative: Rather than requiring pharmacies to carry and sell the products, you could just require pharmacies who refuse to carry (or sell) certain FDA-approved drugs to advertise themselves and prominently label themselves as “limited service” pharmacies. That is, you know going in — or even before you go — that this pharmacy might not carry or might refuse to sell you what you need. When we’re talking about non-luxury items like prescriptions, I’m not okay with requiring people to drive all over town to get what they need.
As to your “let the market work” logic and all of your comparisons, you still seem to be missing the point that pharmaceuticals are fundamentally different from other products. You seem to be of the opinion that something like amoxicillin is no different than something like a Kenny Chesney CD. I strenuously disagree.
The other problem I have with the “let the market work” idea is that markets absolutely require competition to work. As repeatedly mentioned, pharmacies by their very nature face less competition than other retail-style outlets. But even worse, in an unfettered market, sooner or later somebody “wins” the competition, at which point no competitor can seriously challenge them. An argument can be made that especially in small-town America, Wal-Mart has already reached that point. So Wal-Mart can do pretty much whatever they want, because where else are you going to go? Sure, some small competitor may show up for a small time, and Wal-Mart can either buy them out or simply lowball them until they go under, at which time they go back to doing whatever the hell they want. And the “market” has absolutely no problem with any of this.
Is that a recent law change? Used to be, medical spending accounts were use-it-or-lose-it. If that’s changed, that’s excellent (and I need to re-adjust my contributions to said account).
First, I don’t personally advocate for “Hillary-care,” to use your term. What I do advocate is guaranteeing that health care is affordbale and accessible to everyone. So far, the “market” has done a piss-poor job of doing that. Costs skyrocket while the health care and pharmaceutical industries turn in record profits. How we achieve this state, where no one has to go without health care because they can’t afford it, I honestly don’t care. I’m totally open to suggestions. But the idea that the current state of (ridiculously expensive) health care is somehow all the government’s fault seems to be without merit.
Second, I’d need more than just your say-so that a VA-style system couldn’t scale. Part of the problem with Medicare, for example, is that the system is prohibited by law from using its tremendous market power to negotiate for lower prices, which is why it’s so bloated. The VA, on the other hand, has no such restriction, and uses its power effectively. It seems to me that growing the system would give it more market power to do such negotiation, not less.
Third, I have no problem at all with elective, pay-out-of-pocket “express” health services for those who want it and can afford it. In fact, I think that’s probably what the Canadian government ought to do to help fix their health care problems. You can go through the system for “free” (your taxes — and everyone else’s — pay for it, so it’s not exactly free), or if you want to, you can go to a private doctor at your own expense and bypass the system; doing so does not exempt you from paying into the national system, but it does impart choice onto those who can afford it.
A system like this isn’t unlike how education is funded in our country right now. Everyone is absolutely free to put their children in any private school they want to and can afford to; but everyone, including childless people like me, help to pay for an educational system that is accessible to literally everyone.
Last, your MRI example is a perfect one of the way in which the market fails the consumer. MRIs are exceptionally expensive, and government meddling has virtually nothing to do with this. Because the privately-operated health insurance companies are profit-driven, there’s great incentive for them not to approve MRIs whenever they can get away with it. I speak from experience. A couple of years ago, my wife had back troubles, and her doctor wanted to get an MRI to find out what was wrong. But the insurance company wouldn’t approve it. So our choices were to pay nearly $2,000 out-of-pocket for an MRI, or to jump through lots of hoops to get the insurance company to sign off. The “lots of hoops” turned out to be four office visits, three different prescription anti-inflammatories, and two months of physical therapy, all of which had to prove ineffective before the insurance company finally signed off on the MRI.
Ironically, the fix for this involves government meddling: banning health insurance outright, so that all shopping must be done out of pocket, thus forcing competition; or imposing price controls.
February 3rd, 2006 at 3:54 pm
Uncle:
I think I see the nit you’re trying to pick now. If you look at the word “contraception” and break it down to its roots, it roughly means “against conception.” But that’s not how it’s colloquially used, and as noted above, by that definition, even the pill doesn’t qualify as contraception.
Mischief:
I think it’s pretty clear that we’re not going to agree on this topic. If we were to boil down our fundamental disagreement, I favor guaranteeing people access to prescription drugs that doctors have legally recommended to them, whereas you do not. You have faith that “the market will provide,” whereas I do not. You think prescription drugs are just another product like CDs or dental floss or soft drinks, whereas I do not. As long as we can’t resolve these fundamental disputes, we’re not really going to get anywhere.
February 3rd, 2006 at 4:55 pm
I like it. this is kinda like the “warning label” on coffin nails and beer bottles. Although if you carry it to excess, you end up getting “warning label fatigue” (The chemicals in this can of paint thinner are know to the state of California to cause cancer. The Commonwealth of Massachusetts suspects that Stoddard Solvent is bad for your health. State law requires a respirator. The State of Maryland … ad nauseum). We’ll call it “Rx lite” or “Rx express”!
OK, well can you please explain it to me? The major difference I see is that one of the products probably needs to be covered by a much higher liability insurance. (A defective CD slips out of the case jumps up and dismembers an arm! Not!)
Sorry, I thought that was self evident. Here you have a bunch of vets being treated by eager young doctors (simplification, sure) that could not afford to pay for medical school by themselves. When they are done with their term, they will go out to the real world . How is this gonna scale to civilians?
You’ve made a number of other good points, including a great example of heathcare rationing that I just can’t pass up. However, I am seriously slacking right now. I’ll address them shortly.
February 3rd, 2006 at 8:10 pm
:sigh:
Sadly, I think this is a frustrating example of partaking in an un-moderated (pretty-much) conversation. Quite a bit of off-topic examples and (from my perspective) people not staying tightly on-topic.
(This comment is mostly an off-topic tangent into the meta-topic of blogs and comment threads that discuss posts. I have a lot of respect and enjoy reading the comments of the visitors here – and the host!)
But this thread is frustrating.
From what I could tell, the initial topic boils down to whether a pharmacy should be required by law to carry a controversial prescription medicine.
The discussion has gone into some pretty sensitive areas without flaming and that’s very encouraging. But I don’t think any position has been clearly articulated as the topic has so much emotion related to it that the arguments and positions haven’t been clearly made.
But I do have to congratulate y’all on the civility. 🙂
February 3rd, 2006 at 8:31 pm
That’s a beet-red herring. Wal-Mart has no obligation to run a licensed pharmacy in any of its stores. By choosing to do so, it doesn’t interfere with anyone else’s ability to become licensed to compete with them. If Wal-Mart is the only licensed pharmacy in town, that’s not their fault; it’s the “fault” of everyone else in town who could have gotten licensed as a pharmacist to compete with them, but chose not to. What if there’s only one licensed gun dealer in town? Should I be able to sue him for not carrying my favorite brand/caliber/etc.?
February 3rd, 2006 at 10:11 pm
Uncle, how on Earth does one use emergency contraception irresponsibly? You can’t get high on the stuff, (in fact, it makes you feel seriously shitty), most people know enough to put it in the right orifice, and on top of that, it’s prescription. I just don’t see how anybody could use this stuff irresponsibly.
February 3rd, 2006 at 11:13 pm
Huh? I was talking about the lack of responsibility involved in the sex not abuse of a drug.
February 6th, 2006 at 1:58 pm
Mischief:
Because there’s no chance that the Chesney CD might keep me from dying, or from developing some long-term, expensive medical condition (like, for example, pregnancy). And because, while just about anyone else can sell the Chesney CD if store X chooses not to, those alternative options are substantially more limited in the case of amoxicillin.
I’ve toyed with other regulatory options on this subject, including requiring pharmacies that don’t carry the product to refer the patient to one within five miles that does. And if they can’t, then they have to fill it.
But again, this is where our philosophies differ. I think that all that should matter is that a product has been proven safe (FDA approval), that the patient wants or needs it, and that a physician has recommended it (via a prescription). You, however, would add profitability to this equation. In other words, if a patient needs something, and a doctor agrees that the patient needs it, you would allow the market to decide (based on profitability) whether or not the patient actually gets it. That’s why I make my complaint that the market ought to serve us, rather than the other way around.
_Jon:
Emotion is certainly a part of it, but as I noted above, I think the larger part is simply the fundamental disagreement.
February 6th, 2006 at 1:59 pm
Uncle:
At $50 a crack, Plan B would be an excellent libertarian-style “use tax” on irresponsible sex! 🙂
February 6th, 2006 at 5:09 pm
Xrlq:
You’re right, they don’t. But once they decide to, there are certain obligations that come with that (or, at least, ought to). Basically, run a pharmacy, or don’t. Don’t half-ass it, at the expense of your patients.
February 7th, 2006 at 1:21 pm
Mischief:
And because while the amoxicillin is likely to make you better, the Chesney CD is likely to make you sick. 🙂
February 16th, 2006 at 11:53 pm
[…] I hashed this out with tgirsch over at SayUncle’s place, but I have little to add to this specific argument. (There are other issues that I’ve promised to address.) tgirsch Says: But again, this is where our philosophies differ. I think that all that should matter is that a product has been proven safe (FDA approval), that the patient wants or needs it, and that a physician has recommended it (via a prescription). You, however, would add profitability to this equation. In other words, if a patient needs something, and a doctor agrees that the patient needs it, you would allow the market to decide (based on profitability) whether or not the patient actually gets it. That’s why I make my complaint that the market ought to serve us, rather than the other way around. […]