Diary of a Neighborhood Pharmacist, Entry #10

Fortunately, I was a liberal to start with, so that what I'm learning doesn't come as an unpleasant surprise: There's a lot of poverty in the United States, and drug prices are unreasonably high.

Also, a simple single-payer health system would save as much as half the cost of providing care, since so many of our resources are tied up in simply deciding who pays for what and in duplication of inventories.

I'm working in one of the richest counties in the United States, 30th based on per capita income, so I'm constantly amazed at how many people qualify for Medicaid, the health insurance system for the poor. People on Medicaid at least have some degree of coverage. I don't know what their lives are like in other respects, but at least I can hand them their drugs without charge, or for a very low co-pay.

It's harder dealing with those people who don't qualify for assistance, but don't have insurance either. I hate the feeling I get when I say that a bottle of pills is $400, or some other price that must really hurt. There's a look of shock, followed by resignation.

It's worst for parents, I think. The pediatric antibiotic suspensions are expensive, and it's so rarely clear that the physicians even bothered to ask two basic questions: Is an antibiotic really called for? What will the family have to give up to buy this stuff?

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A lady walked in during the slow period, when there was time to talk. She introduced herself as a nursing supervisor in charge of the Alzheimer's unit at the local hospital. We talked for a while. I felt sympathetic. Other patients can occasionally say thank you, make you feel appreciated. Alzheimer's patients can't do that – they can only curse and condemn – it's part of the condition, so that you have to find the rewards inside yourself.

She told the story of a nurse who had held a very responsible supervisory position at a major hospital before succumbing to Alzheimer's disease. Every morning she gets up, goes to a table in the community room, takes out a pencil, and barks, "OK, give me a report on who called in sick today!"

Hospital staff can be strange patients. I recall starting at the hospital, before the first computer system, when the pharmacy staff had to price all the drug orders. One of the senior staff was admitted – I forget what for – but all the orders from the unit where he was admitted arrived at the pharmacy already priced.

See the previous installment, Diary of a Neighborhood Pharmacist, Entry #9, or the next installment, Diary of a Neighborhood Pharmacist, Entry #11.

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