My Weekend as a Drug Dealer
My daughter buttered English muffins while I made bacon and eggs. We sat around the table late on a Saturday morning. The bacon was especially good after a meatless, Lenten Friday. I’d made extra so my wife could use some that afternoon in a quiche made with her aunt’s recipe and, after talking a bit about school and plans for summer camp, I got up and put soapy water in the frying pan. Then I grabbed my coat, took a zip lock bag from under the sink, and stepped out into the sleet and rain to complete a drug deal.
A few of my friends, like me, have bipolar disorder and rely on medicine so we can keep our moods level enough to work, care for our families, and avoid doing the damaging things that often accompany episodes of mania and depression. Doctors write prescriptions for us, pharmacies fill them, and health insurance companies help us pay for it all. It works well, until it doesn’t.
The medicine certainly helps. It’s very effective at assisting people with mental illness lead productive, rewarding lives. Bipolar disorder, when treated with medicine, has an 85% treatment effectiveness rate. That’s better than diabetes, hypertension or any cancer. Yet nearly half of all people with bipolar disorder don’t take their medicine as directed and don’t get the benefit of stable moods.
One of the reasons these people don’t take their meds is cost.
A friend had just started a new job as his pill bottle emptied. He ran out of medicine on a Friday, three days before his new company-provided insurance was to kick in. The pharmacy wouldn’t give him three pills to hold him over. To get any, he’d have to take the whole refill and pay for it in cash, which would have been hundreds of dollars. He risked possible seizures from suddenly stopping the medicine, the overwhelming nervous excitement of anxiety, and a dangerous mood swing just as his new boss flew in on Sunday and their work together began. He desperately needed the drug.
Healthcare as an issue is still there, although it only seems to get attention in the run up to elections as each party clamors to convince voters that they have a solution that, if elected, they will implement. But they don’t. They make promises over and over again to no result. So we end up with a confusing system under which a small group of people get subsidized insurance from the government and most people get insurance from their employer. Very few people in the United States actually don’t have access to affordable healthcare. Yet everyone seems dissatisfied with the system we have.
We’ve attached healthcare to employment for most people for better or worse. We’ve also made public options provided and subsidized by a combination of private health insurers and the government inordinately complicated. The disincentives are nearly insurmountable. People with chronic health conditions have to make decisions that aren’t always the best ones just to keep their health insurance. Some decide not to work so that they don’t lose their Medicaid. Others decide not to start their own businesses since the risk of leaving a job that provides good healthcare is too great.
Some decide to give it a go without their medicine. Still others, just to get by, will do whatever it takes to keep the medicine, and the money, coming in.
Another friend of mine has a pliant doctor who will write her a script for anything she asks for. Even things unrelated to her own bipolar disorder. She has never thrown out a bottle of unused pills, and she fills a lot of prescriptions for drugs she doesn’t need. Instead, she sells them. She’s going through a nasty divorce, her ex-husband has completely cut her off, and she struggles to pay the mortgage and feed the kids. So, from her cul-de-sac home in a desirable suburb, she sells prescription medication to anybody who wants it for $10 a pill.
I’m a solid conservative, but healthcare has always been the chink in my armor. Medicare for all sounds great on the surface. Everybody would be covered and somebody else would pay for it. My parents and my aunts and uncles seem satisfied with their coverage. What could be so wrong?
Well, the seniors in my life spend an awful lot of time and money finding coverage that will fill in gaps left by Medicare. They, too, spend a lot on this so-called free benefit. And, as the government borrows more and more into steepening inflation to pay for these benefits for a relatively small percentage of the population, it’s legitimate to distress over what would happen if we covered everybody with this patchwork system.
So, perhaps the solution lies in the free market. While there is a perverse incentive in attaching profit to people becoming sick, most people who receive insurance from their employers are satisfied with it. But it gets more and more expensive every year. And it seems to cover less and less.
My impulse is to seek solutions in the free market. We have two examples of why I feel this way in our response to Covid, the biggest healthcare crisis we have seen in a long time.
On the one hand, Operation Warp Speed serves as an example of how private enterprise can create a solution and solve a problem. The government defined the problem and set a goal. It established incentives and removed regulations. Then business took over. We had an effective vaccine against the virus, available to anyone who wanted it, in mere months. The businesses succeeded with benefit for all and, as is justified, they made a profit and their shareholders were rewarded.
On the other hand, we had the debacle of sending every family four free test kits. It took the Department of Defense and the Post Office many weeks to deliver the kits. More weeks than the government had promised. In the meantime it was hard to find kits in drug stores. Few disagree that a couple of private companies working together for a profit could have had the kits in every house in a couple of days. And the availability of kits would have remained plentiful.
The free market works better than government solutions, and I believe we’ll find the answers, the answers both cost-effective and profitable, to good healthcare for all there. Yet, as our attention turns to a war in Europe, the January 6th Commission, the gender identity of swimmers on the Penn swim team, and the confirmation of a perfectly qualified Supreme Court Justice nominee, no one is addressing the issue of healthcare at all. Yet the issue remains, and it affects more people than any of those other issues.
In the meantime, I had one friend who needed a medicine and one who had the medicine for sale. Our patchwork healthcare system had failed them both. So I visited the one with the overflowing medicine cabinet and, in the driving wind and sleet, set out west on the turnpike with a few pills in the zip lock bag in my pocket to see the other.
One way or another, while politicians and special interest groups continue to fail at addressing the healthcare issue, an issue more often ignored than considered, individuals will find solutions and do whatever it takes to take care of themselves. Whatever it takes.
Please consider buying a copy of my book, Practicing Mental Illness. In it I write about using meditation, movement and meaningful work to manage challenging moods, and absolutely nothing about politics. Pick up a copy here.