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Government, Politics & Issues

Commentary: Rash decisions

This article first appeared in the St. Louis Beacon, June 16, 2011 - I recently had an epiphany of sorts while at Walgreen's. The experience was not quite as dramatic as Saul's on the road to Damascus, but it did offer sudden, unexpected insight and, like Johnny Cash, "I came away with a different point of view."

Allow me to assure the reader at the outset that I have no intention of becoming one of those annoying old farts that regale hapless strangers with detailed recounts of their ailments. In fact, I favor amending the HIPAA law to make it a federal crime to discuss your health with anyone except an attending medical professional or a prospective mate. That said, I will have to share certain intimate details to explain what happened.

I spent Memorial Day weekend in Chicago. Because I hate to pack, I invariably put the task off until the last minute, ensuring that I neglect to bring at least one critical item per trip. This time, it was my deodorant. In place of my normal aerosol spray, I wound up using an obscure brand of stick deodorant for three days.

By Monday, prominent blotches of angry red rash had sprouted beneath both arms. In unhappy coincidence, just when I went on the deodorant DL, the temperature soared into the 90s. I sought to counter that problem by splashing extra doses of aftershave on the unafflicted portions of my torso -- a strategy that yielded mixed results at best.

Initially, I tried to treat the outbreak with over-the-counter remedies. Alas, within days it became apparent that my homely nostrums weren't up to the challenge. I would either have to go to a doctor or move to France, where perfume is reputedly considered to be an acceptable alternative to hygiene.

The girl who answered the phone at the dermatologist's office cheerfully advised that the doctor could see me on June 29 - 27 days hence. With daytime temperatures now hovering in the mid-90s, I desperately pled for an earlier appointment; stressing the hardship that relocation to Europe would pose for my family. She relented and worked me in for the following day.

The doctor confirmed the obvious by diagnosing the rash as an acute allergic reaction to some unspecified ingredient in the new deodorant. He could perform a battery of tests to identify the offending agent, or I could simply go back to my old brand once the irritation cleared up. We both agreed that the latter course seemed to make the most sense, and he gave me two vials of prescription ointment to be applied to the affected areas twice daily.

The vials were apparently professional samples furnished by a pharmaceutical salesman. From their size, one would conclude that the drug company was giving this stuff away as though it were radioactive. I subsequently ran out of ointment before I ran out of rash.

The following Monday -- Day #8 of the au naturel underarm experiment -- I called my new friend at the dermatologist's office to see if she could phone a prescription for more of the stuff to the Walgreen's near my home.

Like my Irish grandmother, I've always subscribed to the theory that most minor discomforts can be effectively treated with a glass of Jack Daniel's and a good night's sleep. It had thus been more than three years since I last had a prescription filled. In the interim, my employer had -- of course -- changed insurance carriers so my file at the store had to be updated.

The pharmacist worked on the computer at the rear of the store and posed the usual questions over her shoulder. While I talked to her back, she typed in my answers. She wanted to know if I'd switched jobs, if I'd moved, if my date of birth was still the same, etc ... At some point during this dreary and anonymous interrogation, she mumbled something about $75. I remember thinking that was a lot of money for a 4-ounce bottle of cream. At least I have good health coverage -- pity the sucker who had to pay full price.

She finally returned to the service counter with the salve and a bill for ... $75. I asked why she needed all my insurance info if the medicine wasn't covered. She told me that my policy had saved me quite a lot -- the total cost for 4 ounces of rash relief was $523.

My insurer probably didn't pay that amount because these companies negotiate prices with suppliers -- a sound business practice that Congress will not allow Medicare to engage in directly. But if I didn't have insurance, that's what the prescription would have cost me.

For a guy making $27,000 a year, that's more than a week's pay -- before taxes. And workers on the lower strata of the economic pyramid are the least likely to have adequate health coverage. How can these people possibly cope?

As I left the store with my precious cure, it dawned on me that insurance made it possible for the pharmaceutical industry to charge exorbitant prices. How many consumers could, or would, pay $523 out of pocket for armpit grease?

Insurance enables Big Parma to price gouge, then cites escalating costs to justify higher premiums, thus making insurance both less affordable and more necessary. Catch-22.

Meanwhile, the only serious effort at reform -- so-called Obamacare -- seeks to please everyone and in doing so, pleases no one. It tries to maintain private profit to placate Republicans, provide universal coverage to pacify Democrats and pledges not to reduce services or increase prices to keep the middle class on board. The architects of this plan might as well have concocted a recipe for fried ice.

On second thought, maybe moving to France isn't such a bad idea. There, socialized medicine should pay to treat your underarm rash. And if it doesn't, nobody will notice that you're not wearing deodorant.

M.W. Guzy is a retired St. Louis cop who currently works for the city Sheriff's Department. His column appears weekly in the Beacon.

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