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!