The Duchess Rants: Health “care” in the USA…

When my husband was still in charge of the remote control we fast forwarded through all the ads on the things that TiVo taped for us to watch. He was positively allergic to those things and there were many (annoying!) occasions where he fast forwarded too enthusiastically and bit into the show and then had to rewind and overshoot again but now we were in the ads so fast forward… honestly, sometimes this was more of an impediment to watching something than the ads themselves. I can tune them out, kind of – I just let them run on the periphery of my attention, paying JUST enough attention to know when my show starts again and no more. They’re also useful to have actual conversations during, or to get up and retrieve a cup of coffee, or whatever. so yeah. We lived ad-free for a long time in this house.

But then he went away, and I’m not a manic ad forwarder, so they just run until they annoy me SUFFICIENTLY for me to scroll past (which happens sometimes, but not nearly as often as before). But because there is no other person here to have those extracurricular conversations with, and there are just so many cups of coffee one can have of an evening, the ads have insidiously crept inside my attention sphere. And I have learned (or perhaps confirmed…) that healthcare in the United States of America is more weird than ever.

It’s the drug ads. (You know I mean medicins, stop that.)

THEY ARE CONSTANT. And incessant. And APPALLING. And this business of “ask your doctor if this drug is right for you” makes me spit tacks.

Here’s an unpack.

  1. you itch, or you hurt, or you have a rash, or a cough, or a fever, or you have issues with digestive, blood clotting, or breathing apparatus issues. Every single one of these things is a SYMPTOM. You, as a sufferer, are suffering from the SYMPTOMS. The reason your doctor spent a lot of money and many years going to medical school is because (s)he can put those syumptoms together in a coherent DIAGNOSIS. This is why you GO to a doctor – for them to look at the random stuff that is bugging you, and tell you what is it that you have, by name. And the other reason those doctors spent that money and time in medical school is…
  2. …once they use their training to figure out what you’re suffering from, IT IS THEIR JOB TO FORMULATE A TREATMENT. *Their* job, not yours. They are supposed to know what the diseases are, what sort of thing cures or even just alleviates them. That’s what they’re there for. Why in GOd’s name would I even need to “ask a doctor” if I could just diagnose myself according to my symptoms and start swallowing pills that sound like they might help. How do I know? I have no medical training. I have NO knowledge of pharmacopoeia. I have zero idea what drugs might be “right for me”. I don’t know what I have. How could I possibly ask for a drug to treat it? in other words *what is the point of advertising these drugs to the patients*? I t isn’t to keep them “informed” because “information” isn’t happy smiling people running around on beaches flying kites because this drug is so fabulous that it makes EVERYTHING possible. The models in these ads wouldn’t know the diseases these drugs are urporting to cure if those diseases came and bit the noses off their faces. They’re running from a script – “be happy”. Information comes from people who have empirical knowledge – i.e. medical professionals – and not ad agencies. This is just so upside down that it makes me INSANE. (there’s probably a drug for that. I should ask my doctor about it.)
  3. And the ads. they’re for “moderate to severe” [insert condition here] – I think I can remember things like psoriasis, rheumatorid arthrits, asthma… others are there too. This begs the question – how would you know? I mean, what is moderate? Do you have a yardstick to measure this? What you might consider just a slight impediment may in fact be shading into moderate without your knowing it and stoics will call things that are in fact severe “moderate” in order to minimise them. Again, a patiend should not be self diagnosing here. It’s the doctor’s job to determine what you have and how badly you have it – and at this stage of developemnts in your healthcare it should be the DOCTOR’s job to prescribe the correct medication for the synrdome and the severity of syndrome that you are afflicted with. It’s the DOCTOR who should be telling YOU, not the other way around. And I just have to ask – the people who just have, you know, “less than moderate” symptoms… are they just not of interest? Are they not to be helped? should their disease, if caught early, not be treated in order to PREVENT a worsening into moderate or god forbid severe? Where are the drugs which are treating MILD psoriasis, for instance…?
  4. …and honestly, even moderate anything starts to sound really good by the time they start listing the side effects. They range from the downright unpleasant (nausea, vomiting, diarhhea, headaches) to the seriously concerning (infections (including cancers), which can be “serious enough to require hospitalization”, uncontrolled muscle movements “which may be permanent”, increased risk of dementia, depression, blood clots, stroke, or heart failure, confusion, thoughts of suicide, and death). The thing that is supposed to cure your “moderate” disease can give you the trots, the twitches, and possibly can kill you. I pariticularly love it when they tell people that if they develop confusion they should “call their doctor immediately” – seriously, have you tried reaching a medical professional in this country WITHOUT being in a state of confusion? It’s bad enough. Press 1 if you want this and press 2 if you want that and press 3 if you want service in spanish and so sorry but you wanted the cardiac ward but somehow ended up at the ob-gyn department wondering if you just had a baby. Add “confusion” into the mix and you are out on a limb and sawing yourself off of the tree. Also, you have to love the fact that sometimes drugs which you have to ask your doctor about, the ones which are supposed to help depression, have… deeper depression as a side effect. What exactly are we trying to cure here?
  5. all the drugs advertised as brand names and as such they cost… well, a lot. We had reason to find this out because my husband was taken off a generic blood thinner (they had  LOT of trouble with this at the rehab home…) and put on a new drug called Eliquis which happened to be the one advertised while I was watching TV so I did know about it before they slapped him on it. The spiel said “don’t stop taking Eliquis” and threatened dire conseuquences – but when I asked if there was a generic equivalent because we COULD NOT AFFORD the prices for a brand drug if they ever let him out of there  at all (and he didn’t have drug coverage) they said no they didn’t think that there was and it was possible he would have to go off the drug again if he was released to go home, and presumably back onto the blood thinners which had proved problematic to begin with. Are you beginning to glimpse the Moebius strip here? There’s no way off this carousel. (and the side effects of “going off” Eliquis, par for the course, seem to be an aggravation of the symptoms you’re taking the drug to prevent. so can you see why I was concerned, here?) And while we’re on prices – there are a bunch of apps and programs out there (like GoodRx) which, when presented to pharmacies, somehow automagically bring down medication pricess to manageable levels. My question is, if these things exist and this is possible, then why aren’t the drugs at those price levels to begin with? And who’s paying for the padding that is being removed from the prices here? Where does all the “saved” money go? And why make the consumers jump through more hoops with apps and stuff if you are in fact able to *dispense the drug at the lower price*?


Look I”m not telling you to kowtow to every white coat you see and say yes sir no sir three bags full sir to EVERYTHING a doctor tells you to do. Keep yourself informed, for certain. It’s the doctor’s job to tell you what you have and what the options are to treat it – you can research those options and make educated agreements or refusals. But for the love of all that’s holy why are patients being made to do the work here? Why are sick people in America so often treated not as a human being to be helped but as a bizarre cross between an idiot (who is nonetheless supposed to know about as much about their conditions as their doctor does which begs the question of why the doctor is necessary, in this case) and a walking ATM from which as much money as possible must be extracted before the ATM ceases to be ambulatory (or succumbs to “confusion”). And somewhere in the middle of this medical mess sits a layer of insurance vultures with no medical training or knowledge whatsoever but which is somehow in charge of deciding of where a patient may go to be treated, who will treat them, and whether in fact the insurance people consider the medical treatment  to be “necessary”. This is where things go from mild to moderate, from curable to perhaps potentially only TREATABLE, because the insurance people, somewhere along the line, saving the $$$ which are supposed to go to their CEO’s annual bonus instead of an insured patient needing medical intervention, stamp something DENIED. (or don’t do it at the time, which is worse, and then the patient who had no choice BUT to have that surgery or undergo that procedure or, yes, take that drug, gets annihilated by HUGE bills that come in months later which the insurance shrugs and simply calls “not covered”…)

It’s high time that healthcare is overhauled in the good old US of A. Into something that more closely resembles the care for the health of actual human beings as opposed as Insurance Client #13XXR5L, insurance denied, please cough up a hundred grand at your earliest convenience, thank you, good bye.

I could go on. But the rant endeth here. Feel free to expound and expand if you find cause.



may 12


About Alma Alexander

Alma Alexander's life so far has prepared her very well for her chosen career. She was born in a country which no longer exists on the maps, has lived and worked in seven countries on four continents (and in cyberspace!), has climbed mountains, dived in coral reefs, flown small planes, swum with dolphins, touched two-thousand-year-old tiles in a gate out of Babylon. She is a novelist, anthologist and short story writer who currently shares her life between the Pacific Northwest of the USA (where she lives with her husband and two cats) and the wonderful fantasy worlds of her own imagination. You can find out more about Alma on her website (, her Facebook page (, on Twitter ( or at her Patreon page (


The Duchess Rants: Health “care” in the USA… — 5 Comments

  1. I want to have a job where I sit in a room and come up with patent names for new drugs. The more Ys and Xs the better: Rybellsus! Trintellix! I’ll bet it’s highly paid, and they could give work to a lot of underemployed poets.

    My husband and I have catch phrases for some of the ads as they go by–my favorite (for an antidepressant) featured a woman wandering through her life ignoring, among other things, her large, amiable golden retriever. The tagline: “Depression hurts.” We felt sorry for the supportive dog who was being ignored, and now cannot see the ad without chorusing “Depression hurts THE DOG.” Forget the patient, what about Rover?

    I miss the days of my youth when doctors, lawyers, and drug companies were not allowed to advertise. It’s like high-end snake oil ads.

  2. American healthcare and medicine prices are ridiculously overcharged. The rest of the world tends to pay a lot less for the same medicines or care, often with equal or better health results when you compare similarly wealthy countries.

    One reason is the power that large rich industries have in US politics, through lobbying and campaign contributions. That resulted, among many other things, in Republicans putting an outright prohibition into law on Medicare and Medicaid dickering with healthcare and medicine providers: they have to pay the asking price, and are not allowed to bargain for a reduction in price for their massive orders, as is normal in other healthcare systems.

    Insurance companies can bargain, and squeeze smaller healthcare providers, but as (in the US system) they are commercial companies focused on making a profit, without any state-run not-for-profit competition nor any government-set limits on minimum basic coverage and maximum allowable costs, their incentive is to pay out as little as possible but charge as much as they can. As everyone has need for healthcare at some point, and noone wants to suffer and die unnecessarily, they can set their prices very high – people have to pay up, go bankrupt or suffer and die.

    Meanwhile the healthcare providers that are being squeezed by the insurance companies, and the mandated-by-law emergency care for the uninsured they have to provide, try to recoup their losses and make some profit* by overcharging their patients who are not shielded by their insurance companies, or finding ways to charge them personally for “out of network” services.
    * They too are often commercial companies, and US law mandates that shareholder profits should trump all other considerations for those!

    The underlying cause I see for all these things: the US is in the grip of extreme and predatory capitalism, which according to libertarian dogma tries to let “the market” regulate itself, even when (as with one’s health) the demand is inelastic and lots of laws and rules protect the big business interests and limit the consumer’s options.
    In a true free market there wouldn’t be such long-lasting patents and import restrictions on medicines, and cheap Indian or Canadian generic medicines would give consumers a choice.
    Ditto for “out of coverage” healthcare providers – regulations keep supply scarce while demand is at least partly inelastic. Though cosmetic and luxury treatments are elastic, i.e. can be foregone if too costly or not available, basic healthcare is a basic human need.

    This can be solved in two ways (or three, counting the present US non-solution of letting the rich and powerful companies set the laws and regulations, decide who gets healthcare, and try to fleece the patients and their families for all they can squeeze out of them):
    1- really throwing open the free market, deregulating healthcare, doing away with patents etc.: you’ll get a lot of quacks and snake-oil salesmen, and adulterated medicines that make people worse, but you’ll also get cheap generic medicines produced or imported, and people can research which doctors get good reviews or results (not the same thing, and data might be hard to find) to try to avoid the hacks. This might be worse than the present situation, at least in sparsely-populated areas where you don’t get a choice in doctors and might be stuck with a quack.

    2- Regulating basic healthcare as a basic human need, like all the other affluent Western nations do, and many that are neither affluent nor Western democracies.
    But the US doesn’t like to do that, not for any of the basic human needs, including clean water and air, access to food and drink, shelter, electricity and warmth, or any of the other things our European social democracies consider basic necessities.

    That presupposes the citizens believe that we humans band together into nations for our common good, and not to impose the power of the strongest (richest, most powerful) on the weaker, both within the nation and towards other nations.
    This appears to be against the present libertarian dogma ruling many anglophone thinktanks and a lot of politicians, as well as the Saudi princes and Russian oligarchs, Chinese and other wealthy 1%ers of the world…

  3. I’ve fumed for decades that the industry dropped their work on lyme immunization because it was thought insufficiently profitable.