American Healthcare in a Nutshell

Author, and Canadian, Douglas Coupland describes his experience with the American healthcare system.

The short version is that he had a cold that became bronchitis, and he went to a clinic, and got a prescription for an antibiotics and oxycodone(!) as a cough suppressant.

I do understand that opiods are effective cough suppressants, codeine used to be in half the cough syrups out there, but it does seem to me like hunting for an elephant with a microscope.

But here is the kicker, and it shows just how corrupting the profit motive is:

………

My doctor vanished for a few minutes and I looked around. The clinic was pleasant enough, as were both the staff and my doctor, who returned a few minutes later with some filled-out prescription forms. “I’m going to give you a course of antibiotics. Take one a day in the morning with food. Just one.” [emphasis mine]

“OK.”

“And here’s a prescription for oxycodone. Take two a day.”

“Oxycodone?” It felt weirdly glamorous to be getting some oxy for the first time.

“Yes. It’s a terrific cough suppressant.”

“OK.” In my head I was thinking, “Oxy — woohoo!” . . . but in my body I was thinking, “But I also really would like to stop coughing up jelly-like deep-sea creatures into my dinner napkins.” So I walked three minutes to the pharmacist and picked up my antibiotics, and then my oxy. My pharmacist looked at me gravely: “You know, you’re very lucky your doctor gave me this discount coupon on your oxycodone prescription.”

“Oh — why’s that?”

“This drug [use drug name; get sued] is $900 a pop.”

“What?!”

“Yes, but for you, with a coupon this first time, it’s $90.”

“For a cough suppressant?”

“Not just any cough suppressant. This is oxycodone.”

“I suppose so.”

“And there’s a bit of decongestant added to it as well.”

“Hard to argue with that.”

Well, the bronchitis does not clear up, and it turns into pneumonia, and our fearless protagonist finds that he has developed a physiological dependence on the Oxy.

He then gets back to his doctor in Canada:

So I stopped. [the Oxy] And I returned to Canada, where my doctor looked at my prescriptions, puzzled. First, my antibiotic: “Your Florida doctor prescribed you this? [Name drug; get lawsuit.] We used to give this to two-year-olds and, even then, for your body weight, this ought to have been at least three times a day at quadruple strength.” [emphasis mine]

“OK, but what about oxycodone? You have to admit, it did stop me from coughing.”

“Yes, but you also almost became addicted to a $900-a-pop drug.”

“True.”

“And just to be clear, you were deliberately underprescribed antibiotics to keep you from getting well so as to ensure that you’d keep going back for more visits and repeat oxy prescriptions. And your doctor was obviously in on some kind of racket with the pharmacist — all that coupon nonsense.” [emphasis mine]

“All true.”

Within 48 hours, my pneumonia essentially vanished thanks to two azithromycin tablets. But it took almost a week for The Hand to permanently unclasp itself from my skull. [Oxycodone dependency] Now that the experience is over, I feel as if I’d driven through a speed trap in a small Ozark town and had been at the mercy of the local Boss Hogg. All of this because of bronchitis. What if I’d had something bigger than mere bronchitis? What bigger and scarier speed traps would await me or you or anyone else down the US medical road?

The system does not just prey on Canadians, you know, it preys on all of us.

What's more, my guess is that there was no (illegal) kickback arrangement, but rather that the pharmacy was either owned in whole or part by the doctor, or operating as a part of the clinic (my money is on the latter), so there were no illegal payments per se, just business.

To paraphrase Sal Tessio, "It's nothing personal it's only business."