American medicine is the best in the world, but the best medical advice is this: Don't get sick.
We've got Medicare and Medicaid, pay-for-visit and managed care, and a prescription-drug benefit on the way to seniors, but actually getting delivery of the pills and potions can be more difficult than getting the legislation through Congress.
The delivery system of American medicine is overwhelmed. Getting through to the doctor is not easy, and after you finally get his attention there's the minefield of insurance claims, office bureaucrats, the pharmacists and sometimes the calico cat.
This is not exactly stop-press news, but I got an insight into how to ride the medical merry-go-'round the other day at a drug store in a Washington neighborhood of the affluent, the well-off and the powerful - and an illustration of why angry arguments over health care will be a permanent angry debate.
My prescription called for a drug that is powerful and often abused, and therefore hard to find. I called several pharmacies before I found a druggist who could fill it. He gave me a time to call for it; if the prescription is not picked up within a three-day window, the doctor must prescribe it again. "Come in Wednesday at 3 p.m.," he said.
When I arrived at the appointed time on Wednesday the prescription wasn't ready. "Come back on Saturday," the pharmacist said. "We had to order it." I had run out of my supply of the pills by Saturday, and when it wasn't ready I threw a little fit. A lady-like fit, but a fit. Diane, the harried pharmacist on duty, went back to a mysterious place in the stacks to see what she could do. Fifteen minutes later, she came back without my pills but with a sheepish expression on her face.
"Your prescription never got ordered," she said, "Somehow it got lost. We found it by the sink."
"Well, can't you fill it now?"
"No, no, we have to order it. It will take several days."
Another customer who pushed his way to the counter, taking advantage of my momentarily silent exasperation, found his angry voice. He had been waiting as long as I had and the clerk couldn't find his prescription, either. We played a temper-tantrum duet.
"Either fill my prescription or call an undertaker," my partner in frustration said. "Can't you see I'm desperate?"
Medical professionals do not usually appreciate death-bed humor (it reminds them that every patient dies). I confess: I raised my voice, and my fit became increasingly less lady-like. "I'm not leaving here until I get my medicine," I said. "You'll have to drag me out of the store."
Diane frowned. "Oh, we won't drag you out of the store," she said, in the manner of someone who had been through this before - many times. "Let me see what I can do."
She disappeared for another half-hour, and in that half hour I got an earful from others in the long and impatient line at the pharmacy counter. One woman, back for the third time, was reduced to begging for a few pills to last until the promised prescription would be ready the following day. A man, returning from the day before, was told that he had to fill out still more forms, and the forms were not available.
I finally got my prescription from a store in an adjoining neighborhood after Diane, the accommodating but overwhelmed pharmacist, spent nearly an hour on the phone trying to find a pharmacist who (a) had the medicine in stock and (b) was willing to fill the order. If I had this difficulty in a pharmacy in one of the most affluent neighborhoods in the nation's capital, I shudder to think how others in poor neighborhoods manage. Rush Limbaugh could be forgiven for turning to the street, if in fact that's what he did, to get the medicine to relieve excruciating pain.
Nothing in the new drug prescription legislation will make an impact on the inefficiencies of the delivery of medicine. Physicians have organized their consulting rooms into assembly lines that would impress Henry Ford. The neighborhood pharmacist/owner has all but disappeared. Those who remain try to compete by stocking cosmetics, perfumes, screwdrivers and sunglasses. Some line their shelves with wine and their refrigerators with beer to survive against the volume and prices of the chain stores sprouting, with Starbucks, on every corner.
When the new Medicare "reform" prescription legislation goes into effect in 2006, we must be prepared to stand and wait, satisfaction not guaranteed. It might help to prepare with a course in anger management. You'll have to pay for that yourself. Or arrange to have someone call the undertaker.