A couple of months back, I was with a friend of mine when she suddenly collapsed and I found myself having to run her to the emergency room. After a fairly harrowing 14 hours, the hospital released her, the doctor writing her a prescription for the still-very-intense pain she was in. So we stopped at her local Kinney Drugs in Vermont.
Despite having been called in by the doc, the prescription wasn't ready. Come back in an hour. Heigh-ho. So we left it an hour and a half, and then, not wishing to make another pointless trip, called the pharmacy just to make sure. No, sorry, the druggist said. They ran the insurance number and it was denied. So they canceled the prescription. Without calling the patient to tell her they'd canceled it. I passed the phone to my friend, lying on the couch like a tubercular Victorian heroine, and she explained that her employer had recently switched plans from Blue Cross/Blue Shield to Cigna and, midst groans, gave them the new policy number. She waited another hour in pain and we then returned to Kinney Drugs, using the convenient drive-thru lane.
This time, they had the drugs. My pal handed over her new insurance card. After some 15 minutes, the clerk returned and said the insurer had declined it. There were two cars backed up behind us. My friend said that couldn't be right, the number was valid, could they please run the number again. They did. Same result. There were now four cars behind us. The clerk suggested we drive around the building, join the back of the drive-thru line, and maybe when she'd taken care of the four cars behind things would have quietened down sufficiently for her to call someone and try to find out what the problem was.
Never mind my friend's crippling pain, spare a thought for me: I'd had to spend untold hours being kindly and supportive and sympathetic, which is not a role to which I'm naturally suited, and the strain was beginning to tell. In that useful Americanism, I didn't need this in my life right now. So I enquired of Kinney Drugs whether it would be possible for us just to pay for the prescription — you know, with money — and then bugger off to resume our lives. She went off to see whether that was still possible. Upon her return, I grabbed my wallet and pulled out a credit card.
"That will be eighteen dollars and 79 cents," she said.
Oh. For whatever reason — perhaps the sheer dogged determination required to negotiate this time-consuming transaction to a successful conclusion — I had assumed this would be one of those expensive pills about which one hears so much and I'd be ponying up 500 bucks. Instead, I put away the credit card and fished out a $20 bill.
And then I thought of the opportunity cost not only to me but to the four cars behind. It seemed a very expensive way to buy 18 bucks' worth of pills.
It turned out my friend's prescription was denied because someone at the pharmacy had transposed two numbers. Oh, well. Could happen to anyone. And, in fact, it does. Speaking as an unassimilated foreigner, I notice when you're standing in line that the big difference between a trip to the pharmacy in the U.S. and one in the rest of the developed world is that in America the druggists spend virtually their entire time talking about not the medicine but the "customer"'s degree of access to it. For example, while guest-hosting for Fox News just after Christmas, I was taken ill while in New York. Saw a doc, got a prescription, this time went to a Duane Reade pharmacy on Sixth Avenue. The lady ahead of me was going away for New Year's. Too bad. Her health-care provider declined to provide her with a renewal of her prescriptions before the 31st. The stylishly accoutered lady ahead of her had a better strike rate. After some delay, the pharmacist returned. She informed her (and the rest of us) that the good news was that her insurer had approved her Ortho, but the bad news was that they'd denied her Valtrex. Ortho is a birth-control pill. Valtrex is a herpes medication. Had her dinner date been a couple of places behind me in line, the news might have cast a bit of a damper on his evening. As it was, it occasioned general amusement among the women present.
I don't quite know what you'd call these rituals, but the term "private health-care system" doesn't seem the most obvious fit. Indeed, as in so many other areas of American life — the Fannie-Freddied mortgage market, the six-figure college education — the main purpose of these dysfunctional labyrinths ever more disconnected from any genuinely free market seems to be to discredit the very concept of a "private" system and thus soften up the electorate for statist fixes. I've argued for years in these pages that governmentalized health care fundamentally transforms the relationship between citizen and state in ways that make it all but impossible to have genuinely conservative government ever again. But at least the Canadian and British systems have the saving grace of an equality of awfulness. Both Obamacare and, alas, Romneycare seem designed to combine the worst aspects of the Scottish NHS and America's present third-party pseudo-market — and thus a scale of bloated, bureaucratic, inflationary capriciousness unknown to human history.
In free, functioning societies, it ought to be easy to buy a bottle of pills. The fact that it isn't is one reason why America has a real bad headache.