health care and money...

January 5, 2011 -- ...And pound-foolish. Health insurance (mine is Blue Cross) will not pay for medicines if they are over-the-counter. They pay only for prescription medications, those that are ...licensed medicine that is regulated by legislation to require a prescription before it can be obtained. The term is used to distinguish it from over-the-counter drugs which can be obtained without a prescription. For example, my eye doctor prescribed Ocuvite, shown by controlled, randomized studies to delay onset of age-related macular degeneration. My Dad had that; if I live as long as he did, I will probably get it, too. There are some treatments (not cheap) but of course it would be better to delay or not to get the disease at all. But Blue Cross won't pay for Ocuvite because it's not a prescription drug.

Why is that foolish? Because health insurers save a nickel today and spend ten dollars later; their business model requires that they be stingy regarding prevention but generous regarding cure. I also saw this when I worked as a tobacco cessation counselor. My patients could not get reimbursed for the few hundreds of dollars cessation classes cost, but when they cost tens of thousands later for their lung and other cancers, heart disease, and COPD... no problem!

Why is it so? These short-sighted policies are demanded by how corporations work: they must show continually-rising short-term profits. This is done by minimizing expenditures in the present quarter. Higher costs in the future? They'll deal with that when the time comes. This is the behavior that's good for Wall Street, but it's bad for our health. The incentives are wrong. This is why -- by definition -- for-profit companies should not be in the business of making health care decisions. What would be a suitable alternative? Single-payer, of course!

Table of Contents