Tuesday, October 16, 2018


On the news I see this man who looks like a door-to-door vacuum cleaner salesman from the Fifties with his little mustache and not-quite-aligned teeth and my blood runs cold.  He is a man who wants to put us all in chemical bondage by combining CVS (he's the president) with Aetna insurance company.  It's wrong to mock his appearance, but that is one of his company's techniques as they try to enslave a country.  The merger of CVS and AETNA is approved.

The first step is to medicalize the normal deterioration of aging, the pursuit of beauty and appeal, and our constant struggle for status.  All small things we used to just accept.  Not everyone can be under thirty, blonde, athletic and smelling sweet.  This step is related to the deprofessionalization of doctors.  Once professionals, they are now just high-paid technicians.  Medicine at the people level is no longer a judgment from an experienced and erudite person, but rather a matter of "best practices" by insurance companies and practice managers looking to maximize profit and charging for cotton balls.

All they need docs for is a diagnosis and since that's dictated by the insurance code, it's a snap.  Most everyone has about the same stuff anyway -- high blood pressure, diabetes, lipids out of control, etc.  (No one asks why and they wouldn't ask these guys anyway.  It may be a problem with toxic food supply or air contamination, which are related to profit.)  The answer for all of it is pills, regular pills on a schedule, and if the patient gets worse, it's because they fail to stay on schedule and come in for their regular blood draws for titration and all that.  No need to bother doctors -- a physician's assistant can do it.  They are lower-pay women pleased to be so important.  

Document hell out of it.  Use the Latinate descriptors that describe a bodily malfunction.  The pharmacist is one of the keys.  Once he or she has the insurance code, he knows which pills to hand out.  He's in the back of his little niche -- his female clerk-assistant handles all the actual sales at the counter.

CVS got hold of my name and access once, and soon I felt nibbled to death by ducks -- a constant stream of phone calls, emails and letters all pushing something trivial that was supposed to prolong my life.  They didn't do heart surgery.  They didn't "do" all that stuff I get on my computer about my nonexistent penis. (I'm cisfemale.)  Rather it was small sales: ten cents off toothbrushes with a new alignment of bristles; maybe something to cure toenail fungus.  Just a few dollars each.  It adds up.

I had never bought anything more than dandruff shampoo from CVS.  They had to have been hacking databases or just buying customer lists, including those compiled by insurance providers like Aetna, though I have Medicare now.

That's advertising but there's something much scarier that has been practised and perfected for years.  In the Seventies, dealing with folks kinda on the edge, I ran into people who were on methadone programs.  Some were voluntarily using methadone to kick their habits.  Probably the majority were on the program because the court had ordered them to do so as a condition of avoiding jail.  The program meant that clients had to turn up at a certain time, take a urinalysis test, and then receive the methadone which might have had to be swallowed while someone watched.

There is a brave contingent of women (mostly) who pursue homeless street people daily -- which means tracking them down in strange places -- to make sure they take their tuberculosis meds, because the disease has learned to repel many drugs when they are erratically taken.  This government effort is not to help street people (though it does that) so much as to protect the rest of society from their contagion.  TB can be a terrible plague, as it was in the 19th century when it killed our best and brightest along with others.

The modern version of this is the HIV/AIDS clinic.  If those carrying the virus are diligent about taking the right drugs, they are not so likely to die themselves and will not spread the virus to others.  It would seem like a good thing except that "plus" people are so stigmatized that those who provide their pills also serve them contempt and poor service.  The pills might simply never have been shipped so as to be ready for clients.  Armed guards are there to suppress indignation.  What is meant to be protective becomes a street prison.

The new programs for meds for high blood pressure, high glucose, and lipid control etc. are described as "your choice."  That is, one of the issues is people who don't comply with the protocol, which is assumed to be deliberate.  That means taking your meds is "your responsibility" and that means "blame is on you."  If you don't take your meds on schedule, if you take the wrong ones, if you fail to take them at all, it's your fault.  So far this has been a moral issue, but it could be criminalized.  Probably not jail time, but a money penalty.  Or being excluded from a subsidy program.

You miss, or the pills aren't at the pharmacy, or there was a three day holiday, or a blizzard meant the roads were impassible, or your car is unreliable and there's no public transportation.  The assumption is that you failed to plan ahead properly.  You also are told you shortened your life and you get the same kind of penalty you would if you did something bad or late at your bank.  Because at heart all of this is based on merchandizing.  Not just selling the meds, but also imposing the cost of the little cards that warn you and the bookkeeping that add up costs and whether you obeyed.

When I worked at a nearby medical center one year, I was briefly friendly with the woman in charge of medical coding.  She kept a lawyer on retainer because of the possibility of being sued over coding decisions -- maybe the patient was harmed by mistaken diagnosis or maybe the insurance company was suspecting double-coding (two codes for similar problems that should have been combined) or coding for a more expensive condition than another possibility.

Much of this can be traced to the invention of the computer which makes it possible to handle huge amounts of data and encourages the use of algorythms which can become inscrutable and out of control.  At the least you can be reduced to a number.  This time you will probably not be tattooed, but microchipping can't be far away.  Television plots include evidence of the microchip being cut out of one's flesh.  We still cherish our freedom from control. 

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