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Happy weekend everybody!  I wanted to put in my 2 cents worth about this
subject because I think it's important and that good dialogue is valuable.
I'm the pharmacist in Texas that writes in occasionally and reads posts
daily.  This list is so great and I learn so much from it.  Thanks to all
for your posts.

When Clinton came to office we had a golden opportunity to change the
health care system in this country.  Mrs. Clinton had some of the greatest
minds in health-care and open brainstorming was encouraged and they looked
at health-care systems all over the world.  I thought it was an excellant
idea to have the most successful, and effective insurance companies in the
various states become the 3rd party payers for our healthcare and to have
universal coverage for all citizens.  It sure was a can of worms though and
all the little insurers freaked and some of the big ones, and lobbiest took
over and the fear of the government becoming the controllers for our
health-care kept any action from taking place.  Since then pharmaceutical
companies have bought insurance companies (Pharmacy Benefit Managers or
PBM's) and are now dictating to doctors and pharmacists what drugs they
will pay on by inforcing closed formularies.  And guess what?  The drugs
they choose on their formularies are the drugs they produce.  Sure, you can
get the drug you and your doctor think is the right one, but you may have
more out of pocket cost.  Not all insurers have resorted to this but many
have and more do every day.  It contains costs for them, and brings in
bigger profits.  Now the pharmaceutical industry that has always had a huge
lobby power, (and huge profits) has the insurance companies lobby combined
with it and I don't think single payers for healthcare will ever become a
reality in this country.  Now we have people sitting at desks that have
never been to medical school deciding for insurance companies what
protocols are cost efficient and which tests will be paid for and how much
is a fair price.   So a person may be charged for a procedure and the
insurance company will only pay their going rate then the individual is
charged for the rest.  It has happened to be and my 20% turned into 40%.
Doctors are plagued with paper work and less profits because of additional
office workers required to do all the excess involved in billing 25
different insurance companies.  I don't know how it is in other states, but
here in Texas the government alone has 4 different payers requiring 4
different ID# for providers for billers like my pharmacy.  Most pharmacies
won't accept the programs that supplement medicaid for children of indigent
parents who can't afford things medicaid doesn't cover, like bandages and
tape, or diabetic supplies because of the hassle of billing.  It would have
been so much easier and cost efficient for all healthcare providers to bill
everyone's tab to say PCS and have their health-care needs met.  Sounds
simple but it's a red-herring now because the lobby to keep the status quo
for pharmaceutical companies like Merck who owns PCS now by the way is so
strong and in place I think the health-care system has taken on a life of
it's own and the managed care companies are now beginning to show big
profits and those of us not covered by them or those not covered by any
insurer are suffering from healthcare neglect because it is unaffordable.
The doctors, pharmaceuticals, and hospitals, and labs all continue to jack
their prices up in an effort to make their ends meet and the insurers that
have all the contracts with employers that pay these health care entities
continue to pay a fraction of that cost.  So if your not covered and you
don't have a doctor willing to take a loss on a cash paying patient you get
billed outrageously, and in most cases I think people stay away from the
system and self-treat, and have sub-optimum healthcare.   There is no easy
answer I know and all in all we do okay here and have great medical schools
and research engines in Universities and freedom to choose and learn and
have access to libraries and learning tools on the net and access to
pharmacists who can be very helpful in many ways, and home health care.
But I guess at the same time I see room for improvement and am curious how
it will pan out in my lifetime.

To close I'd like to say that to think that our healthcare is not
controlled by politicians in the United States is ridiculous.  It is all
political, and I think that it is each persons responsibility to take care
of themselves and take responsibility for their health-care, but realize at
the same time (because I see it everyday) that alot of people and their
children are falling through the cracks and I hate to see our country
become like a poor 3rd world country with starving, sick, and hopeless
human beings laying in the street dying while the rich get richer in this
great, abundant nation of ours, with so much to go around.

Cindy Laney-Fisher,RPh in Texas