Recently I received a letter in the mail from my prescription drug provider (an insurance company that is different from my health insurance provider, which is also different from my dental insurance provider). It goes something like this (paraphrased):
Dear Mr. Kane,
We are proud to announce that we have enrolled you in our brand new online, mail-order pharmacy. You may visit our website to order your prescription drugs from now on. We are so sure that you will enjoy this new feature that we have taken the additional step of tripling your co-payment when you purchase prescriptions, after three months, from any other pharmacy. We are doing this to ensure that you have access to the most affordable prescription drugs possible.
I was somewhat taken aback.
I live within about two miles of no less than five pharmacies. Most of them are 24-hour pharmacies, and are typically staffed by multiple pharmacists. I did the mail-order thing through two companies once, a couple of years ago, and decided that it was just too inconvenient. This was especially true when mistakes were made, or when delays were introduced. You see, when prescriptions don't arrive promptly, you need to go and get them filled elsewhere, and mail-order pharma doesn't like to take refunds.
But, what the heck I decided to give it a go. The first thing that I noticed was that there was not obvious method to transfer a prescription from another pharmacy. In addition to this, they have some sort of system for pricing prescriptions. So we priced one vitamin prescription. I was kind of surprised to find that the average retail price that they quoted me, as well as their "discount" price were both more expensive than the last time I just went and bought it from my local pharmacy. In this case, the prescription is cheaper than my co-payment, so I'll just buy it from my local pharmacy without using my prescription drug plan. However, it doesn't help support their claim that their mail-order pharmacy is "controlling costs". It seems more likely to me that someone up there determined that there were X number of subscribers to the plan who were using their insurance to cover the profits at their local CVS or Walgreens store. It was seen as a viable source of revenue for the insurer to take measures to drive that profit back their way. It's a profit-minded innovation, but in no way is it a customer service or treatment innovation. To compound the problem, they state on their website the ability to transfer prescriptions from another pharmacy, but when you call them up the operator tells you that they cannot do this. Additionally, the over-the-phone customer service is about as helpful as customer service at any private corporation, complete with the conflicting information if you do end up calling back to talk to another "health care representative". Their web-based ordering system looks to have been hastily constructed, complete with image-buttons directly sourced from akamai.net, which meant they were initially all blocked by my image-blocker (yes, I know some of you kossacks dislike such service, don't worry: I see all the ads on dailykos, and even visit them sometimes). On top of this it was slow and clunky, and I didn't want to use it. If I had this bad of an experience with a retail pharmacy, I would leave with my prescription and go to another one. Unfortunately, my insurer decided not to allow me to do this anymore. One single-member network, or I pay a tripled "out of network" co-payment, no matter what the real cost.
Frankly, if the insurance company wants to exclude overly-expensive pharmacies from my network, that's fine. If it takes a big enough dent out of that pharmacy's revenue, it will force their hand to reduce their costs. That's how the whole private insurance system was supposed to work, from what I recall. However, if my prescription drug plan simply becomes a single-payer private prescription service what benefit am I, as a customer, actually getting from this? I can't just go out and get new prescription drug coverage. I can't use the Freedom of Information Act to demand documentation proving their assertions that my new-found hassle is really helping to keep my premiums low, or doing me any favors. Sorry if I don't trust private enterprise to be looking out for my own interests, but by definition they shouldn't be. I am not a health care customer, my employer is a health care customer, and they are less interested in my personal inconvenience with regard to mail order prescriptions than they are to making sure they keep costs low.
What is next? Will my health insurance company try to start buying up hospitals and clinics? How long before my only choice of general practitioner is the computer-selected doctor that my health insurer picked out for me? This is why health care needs to be reformed: To preserve our right as consumers to choose our providers. The "private market" has already begun down the track of removing the unpredictability of "free choice" from their budget.
Another omen: The Cincinnati Enquirer (and other Gannett-owned media across the state) ran this article entitled "In Greater Cincinnati, little competition among health insurers" explaining that over 70% of heath insurance in the Greater Cincinnati area falls under a single insurer: Wellpoint. The next-biggest is United Health Care (at a whopping 12% market share). Looking broader at both Ohio and Kentucky, the overwhelming majority of health care coverage in both states is only provided by two insurers. In both states, health care costs and insurance premiums both continue to rise at a rate that far exceeds the rate of inflation.
It is time that the right stops deluding itself and faces the reality that the private health insurance market has failed to provide healthy competitive relationships based upon the values we need in our health care system. The proposal in Congress may not be the perfect plan, but it will go a long way to stop these private insurers from competing on schemes to reap more profit from their insured, and force them (via legislation) to compete on the values and innovations that really improve the life and well-being of their insured. Isn't that supposed to be the point, anyway?