THE BEST WAY FOR THE GOVERNMENT TO HELP MIGHT BE TO GO AWAY.

Common Dreams contributor Rosalyn Vellurattil, with the University of Illinois at Chicago's pharmacy program, weighs in on the ongoing work-to-rule pharmacists at the major drug store chains have been engaging in.

I worked as a community pharmacist early in my career more than 20 years ago. I dreaded times when I was alone in the pharmacy—every shift—haphazardly filling prescriptions while getting tied up on the phone adjudicating insurance claims, all the while running from one end of the pharmacy to another inputting, verifying, and dispensing prescriptions rapidly.

I was also answering doctor calls, attending to the drive-through, and hurriedly ringing up and counseling patients as fast as I could, without any help for half of my workday. Admittedly, I did not have the added stress of administering vaccinations while performing those duties at that time.

Pharmacy walkout momentum has been on the rise since 2021. Chronic understaffing coupled with higher prescription volume and growing additional duties exacerbated by the Covid-19 pandemic, with vaccinations and rapid test appointments, have led to unsafe working conditions for both employees and patients.

Downsizing is a false economy. If a retired economics professor isn't convincing, dear reader, maybe somebody who is on the line will be.

Read on, though, and discover that Government is only making conditions worse.

Additionally, abusive business practices by pharmacy benefit managers have not only resulted in thousands of pharmacy closures nationwide, but inflation in the amount paid for prescription drugs by seniors due to a loophole in Medicare regulations. According to Centers for Medicaid & Medicare Services, retroactive direct and indirect remuneration fees have increased by 107,400% between 2010-2020.

To be sure, drugstore chains have been struggling over the years with rising competition from mail-order pharmacies and lower reimbursement rates for prescription drugs, leading to the elimination of multiple locations and bankruptcy filings.

However, the pharmacy closures are now leaving gaps in communities for medicines and essentials. An assessment of pharmacy closures revealed one in eight pharmacies closed from 2009-2015, with pharmacies located in low-income, urban areas at greater risk of closing. The closures can create pharmacy deserts, further worsening the problem of disparities and access.

There's a lot going on in that excerpt.  I'm not sure whether those direct and indirect remuneration fees are the analogue to indirect cost return in sponsored research and defense contracting (the reason, dear reader, that $14.95 Craftsman hammer allegedly costs the Air Force $600) or whether its a division of rents.  I'm troubled, though, by the headline, "DIR Fee Relief: Reducing Costs, Improving Health" from whence that 107,400% number came.  There are several research papers in that "competition from mail-order pharmacies and lower reimbursement rates," and it's not as if the government can pretend it's "lowering drug costs" when it's behaving toward pharmacies the way Peabody Coal behaves toward miners.

Don't say I didn't warn you.  "Apparently, the government wishing that hospitals and clinics accept a greater discount, or requesting hospitals and clinics to lower their usual and customary charges, is by some magic transmuted into lower outlays for taxpayers. Whether fees rise for cash patients or for participants, if any remain, in private insurance plans, is apparently for another day."

Don't say I didn't call attention to what was likely to happen.  "Yes, and what happens when that Federal Insurance Provider takes sole control of the reimbursement rate to health care providers? Does anybody seriously expect that Wal-Mart-like methods to bend down the cost curves are going to work any better because it's Washington optimizing against the marginal factor cost schedule?

But when it's an insurance company, rather than politically reliable commissars in Washington, using those Wal-Mart methods, the griping comes through loud and clear.

And so it is in the second paragraph.  In the third paragraph comes the obligatory, for Common Dreams, lament about retail "deserts," or as Chicago's genial communist mayor has it, "disinvestment."  That the pharmacy technicians are doubling as stock chasers because self-service retail only works with mannerly people well might shift the blame from those evil corporations to the local shoplifters, and you surely can't blame the victim and get published by Common Dreams.

Yes, pointy-haired bosses and suits obsessed by quarterly metrics create lousy work environments. So do decaying cities.

Pharmacists are highly skilled and trained, obtaining six to eight years of formal education with an additional one to two more years for possible post-graduate training. They enter the workforce eager to use their expert drug knowledge and provide patient-centered care.

For many, the excitement quickly dissipates in a highly volatile, pressurized environment. Inadequate staffing and burnout are truly a prescription for disaster.

As are government interventions For Your Own Good.

They are asking to not have to put patients’ lives at risk every day. They are asking not to have to place their mental health and well-being at risk every day. They are asking for improved work-life balance and sustainable working conditions to keep patients safe.

They are asking retail employers to do the right thing and set realistic goals for performance with adequate resources and staffing in place. They are asking pharmacy benefit managers to do the right thing and stop the assessment of exorbitant direct and indirect remuneration fees on retail prescriptions that are pushing pharmacies out of business.

No government paying for indirect cost returns, no politicized indirect cost returns? There has to be a research paper in there somewhere.