Medicine Done Stupid!

Some years ago, the government decided the average person needed help with their medical bills because they were stupid. Thus, Medicare came into being. It was so well done that over years, insurance companies have followed the lead of the government. It is worth noting this is the same government that built Washington D.C. without parking lots. That is unless you are dead and that is where we found the only parking lot in our visit to the Capitol. I left my car at Arlington National Cemetery because there was no other place to park. I sort of thought that cemeteries by their very nature were where people went to be permanently parked.

However, this government did so well with Medicare that insurance companies couldn't wait to jump on a bad idea. As best I can tell the AMA said nothing. Now we live with the insurance company in the room when you go to see the doctor. In fact, in the small waiting rooms I have been pushed off into, by the time you get the patient, the patient's spouse, the lawyers who might sue, and the insurance company who would like to tell the doctor how to practice medicine, there is hardly room for the doctor. I guess that is what the K-Y Jelly and the tongue depressor are for.

One of most onerous additions to Big Brother medicine is the formulary which I prefer to call "medicine done stupid." The formulary is really an extension of the "take two aspirins and call me in the morning" approach to medicine. For the most part--actually for every part, it is a pack of myths only believed by government bureaucrats and insurance company bureaucrat groups, many of which have serious genetic inbreeding in their backgrounds.

What is a formulary? It is a hierarchy arbitrarily constructed--did I say arbitrarily? I meant, constructed at levels to give you the cheapest medicine the pharmaceutical company can coerce, bribe, or as a last resort buy. These medicines are arranged by tiers. Tier I is mostly generics or those drugs that have been arm twisted into kickbacks for the company. Some were found in toxic waste dumps, but still usable because they are not beyond their expiration date. Tier II is the second level. Perhaps the arms don't twist as much, or the kickback are not so great. Tier III is medicine that may be getting to the modern era but you aren't going to see much of it. Tier IV and V, just makes the pharmaceutical company laugh and bring tears of merriment to their eyes.

What is the myth of the formulary? I am so glad you ask. I can think of several.
1. Formularies assume we are all the same age, the same sex, and respond to all medicines the same.
2. Formularies assume we all have the same degree of health and the same illnesses at the same time.
3. Formularies assume our illnesses present with the same symptoms and respond to the same medications in exactly the same way.
4. Formularies assume we are all taking the same drugs and are tolerating them equally well.
5. Formularies assume we have the same allergies.
6. Formularies assume we are all complete fools, and won't reach a point where we rise up and tell everyone to get out of the room except for the doctor and the patient whereby the doctor is the doctor and the patient is the patient.

The rest can leave the room wearing those funny green paper suits that make their cheeks look oh so rosy!