William M. Briggs

Statistician to the Stars!

The New Obama-care Arithmetic: Guest Post by Kip Hansen

Artist reconstruction of the Golden Dawn

Artist reconstruction of the Golden Dawn

I had quite the civil row [row, noun \’rau\ : a noisy disturbance or quarrel] with the pharmacist in my local American drugstore yesterday over simple arithmetic.

This surprised me on several levels and for more than one reason.

My wife and I have recently returned from the Northern Caribbean where we have spent the last ten years or so living on our sail boat, the venerable Southhampton-built SV Golden Dawn, a 42-foot ketch-rigged motor-sailing catamaran. We employed our time in various full-time, sometimes double-time, charitable and humanitarian efforts, mostly in the Dominican Republic. There, in tropical paradise, medical care is best received through self-diagnosis or by telephone with one’s American based physician. We were favored with a locally based highly qualified American physician who was in-country doing similar work and was also a personal friend, who would consult.

Medications were available at local pharmacies simply by paying for them, assuming only that you knew their names in Spanish (except for controlled substances—which are more easily obtained on the street corner from the shifty-looking guy with lots of gold chains). I got quite good at asking for the Spanish version of the Physicians’ Desk Reference and looking up the names and dosage information for the medications I or an acquaintance required. All that was necessary to treatment was understanding your doctor’s instructions and following them.

When my odometer clicked over to the magic 65k figure and I qualified for the magnificent gub’ment medical care plan, we moved back Stateside for deferred maintenance. My new physician prescribed a medication to be taken every four hours for 28 days. I dutifully went down to my American drug store, to the pharmacy counter, placed my feet on the little black footprints labeled “Please Wait Here”, and eventually received a bottle filled to the brim with 24 ÷ 4 = 6 x 28 = 168 tablets.

When the month was over, I went back to the pharmacy to get my prescription renewed. Even though I had correctly placed my feet on the little black footprints labeled “Please Wait Here”, and had not approached the counter until asked to do so, I was told that somehow this time, in the new year, there was “a problem” with my prescription. The pharmacist then began to grill me, there is no other way to describe it, on how I took this medicine.

She asked if I actually took this medicine “every” four hours.

“Yes, of course”, I told her.

“Every four hours”, she asked again, accusingly.

I began to feel a bit put out, I admit. “How else am I supposed to interpret the doctor’s instructions to take it every four hours?” I ask politely.

“Do you, for instance,” she asks slyly, with a got’cha in her voice, “set the alarm and wake up in the middle of the night and take your medicine then?”

“Well, of course I do! Darn it, how else could I take it every four hours?” I demand. “In hospital, the nice nurse wakes me up and gives it to me, doesn’t she?”

“Ha, well, that’s it then. Your health insurance company says every four hours means only 5 tablets a day. You’re not allowed to take a tablet in the middle of the night!” she exclaimed triumphantly.

Asking her to repeat this three times did not change the answer, despite my increasing frustration. She calmly explained that in the Obama-care Health Care Universe we use the New Arithmetic that demands 24 ÷ 4 = 5…because patients at home simply don’t get up to take medicine during the night…no matter what their doctors instructions might say to the contrary. I left the pharmacy without my medicine, my problem unresolved.

Welcome, dearly beloved, to the New Arithmetic!

16 Comments

  1. Just wait until they factor in the “no patient ever takes the medication as directed” for even simple instructions. I have been told by doctos that patients rarely take the medication when and as often as prescribed, so some physicians “over-prescribe” (which seems to be Kip’s experience).
    Suppose most people skip their blood pressure medication at least once or twice a week? Or they only take thier cholosterol medication when eating large quantities of food and fat? You can see where this goes. Loved the post, Kip.

  2. Sorry. confused. Why did the discovery that you took it during the night mean that you didn’t get the pills? Why didn’t your “if you have a problem ask your pharmacist” pharmacist just say, “You must stop doing that” and hand them over?

  3. The problem may be deeper than that, as I’ve noticed over the years that physicians also have their own brand of arithmetic, as I am often reminded by my own GP. The Doc may also think that every four hours means five times a day. The real question is why did they give you 168 pills and not 140 pills? I also see that you write equations the way that my students do, where the equal sign means “and then I do this”. 🙂

    There is also no guarantee that the prescription will last until the next scheduled appointment. They are just not good at math, bless their souls. You need to develop a good relationship with your pharmacist so that when the Doc writes down the wrong name for a medication he can say that the doddering old fool must mean this, and change it accordingly. You also must realize that when your GP or specialist says come back for more tests in two years that they mean plus or minus six months, you know to include experimental error.

    I like your three times bit. I also find that a question has to be asked at least three times before you get a meaningful answer. The first two times is just to get their attention. There is a joke to that effect somewhere. I think that it involves ponies. But in your case an infinite number of times may be necessary where the answer is a negative number.

  4. Rich, the computer wouldn’t allow it: insurance!

    I am lost in spam again, help me Rick (Briggs), help me!

  5. Briggs

    January 24, 2014 at 10:27 am

    My spam filter might be proof of Strong AI: it seems to have a sense of humor and is vindictive.

  6. Golden Dawn? are you a Greek fascist?

  7. quertontinto

    quertontinto

  8. Can anyone point to the article in the “Affordable Care Act” that would dictate such an example?

    Of course, there is no such disposition in the law. Which means the pharmacist was either asking on the behest of the insurance company which is the one that would bother with such a thing, or she was simply a douche bag.

  9. Rich:

    If you have a prescription for, say, a month’s worth of a drug, many insurance companies will not pay for a refill until that month is essentially over. This can lead to some really annoying requirements for timing on when you have to go to the pharmacy to get the refill. I don’t know specifically how Medicare and ACA treat this.

  10. This post is a bit disingenuous (You know, disingenuous — as in “not candid or sincere, typically by pretending that one knows less about something than one really does.”). I don’t think you should infer that the Affordable Health Care Act or President Obama is responsible for the arithmetic of the insurance company or the stupidity (or vindictiveness) of the pharmacy personnel in your particular case. I have been living and working in Mexico as a technician for fifteen years and yes, I can buy whatever I want at the pharmacy without a prescription in most cases for non-narcotic medications. We seem to get along fine that way without the intervention of the health care industry pharmaceutical gestapo. As for medical care I have had better and less costly medical care here than I ever received from my money grubbing HMO in the U.S. and by the way I am also 65.

  11. I congratulate anyone who takes any medication more than bd! (twice-daily).
    6x a day? Blimey, haven’t they invented a slow-release form yet?
    I can see why the Pharmacist thought you’d never take that 4am dose, my wife’s a Pharmacist & the number of times relatives of a deceased or institutionalised patient come into her shop, bearing carrier bags full of unused, often unopened tablets, inhalers & the like. One lot came back last week, some dating back to 1986.

  12. So! Not for the first time I compare life in the USA and here in the UK and think I’m better off.

  13. Replies to comments:

    Rich ==> The pharmacist couldn’t fill the prescription as the health insurance company wouldn’t pay for it as written. They would only pay for 5 tablets per day. This required that the doctor change the prescription which he wouldn’t do simplyu because it wasn’t medically right.

    Scotian ==> Yes, I had to change my appointment with the doctor to be three days earlier, so that it coincided with the expiry of my prescription. 🙂

    Doug M ==> No, card carrying Christians. Daughter named the boat Alba D’orado, she loves dawns, we translated to English.

    Sylvain ==> Of course, it was the health insurance company, assisted by an inane pharmacist, both colluding under the new health care laws.

    Bob M ==> The new health care law empowers health insurance companies to override doctors’ decisions including instructions on how medications should be taken by individual patients, which is not and should be in the hands of insurance companies. These decisions are made by fiat by bean counters.

    In the DR, the decisions of what medications I was taking were made in open and free consultation with my doctors without interference from those with no knowledge of my medical condition or history.

    The general public health care system in the DR ranges form bad to horrible due to lack of resources, my wife and I were there funneling NGO resources into hospitals and clinics in a continuing effort to help the most needy. I received two operations due to accidents in public hospitals while there, without too much regret, though this went against advice of my missionary superiors.

    ALL ==> In the end, I finally called my doctor, and asked him to please simply change the prescription to agree with the health insurers ruling so that I could receive the medication. My doctor apologized for his powerlessness in the face of overwhelming government interference and acknowledged that it even though would mean more discomfort for me there was nothing he could do in any meaningful time frame that would be effective.

  14. Reply to Adam Gallon ==> Time release version? Yes, they do. But then is is abused by crushing, causing another public health problem. Unintended consequences..heh?

  15. This will come across, I imagine, as concern trolling but:

    Such things NEVER happened before ACA, right? Health care has been hostage to health insurer shenanigans for decades. The complexity and opacity of ACA has only provided fertile new fields for them to till.

    I’m a business owner and detest ACA right up there with the best of them but blaming things on it that have no discernible connection to it doesn’t advance the argument.

  16. Reply to Rob ==> This is meant as am amusing numerically oriented anecdote, vaguely related to the current affairs issue of Universal Health Care USA. Do try not to take things too seriously. I have no idea, as you will know if you’ve read the essay, I’ve been away the last ten years, about what nonsense went on here before.

    It is absolutely true, both is word and deed, that the new rules, which went into effect 1 Jan ’14, meant that my health insurer could then simply override my doctor’s decision on the dosage of a medication that he had prescribed for me without any reference to or concern about my medical needs.

    You may have missed my earlier replies that I have no political stones to throw — having thrown them all when there were issues of real import and now find myself stoneless and with a bad arm (no cracks from the peanut gallery, please!).

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