Scams, pediatricians, and pharmacies, oh my
A smattering of recent stories
Hi readers! It’s been a little while. Writing today to update to with three stories that I’ve recently published about three slightly different topics: how we’re in an age of scams, why pediatricians are so lowly paid, and why pharmacies are horrible right now. Here are the links:
Welcome to the Golden Age of Scams
Why Your Pharmacy Experience is Miserable
Why You Can’t Find a Pediatrician
The first story, about how we are in a golden age of scams, was inspired by a conversation I had with the attorney general of Connecticut when I was writing about car dealerships. If you’ll recall, I was trying to buy a car and got royally scammed by a dealer in Connecticut, which made me investigate the whole car dealership industry. When talking to the Connecticut AG about car dealers, he said to me, “We have entered the age of scams,” or something along those lines, and the quote stayed with me. After writing about solar scams and financial scams and credit card scams and hearing about pool scams and home-buying scams, I decided to look into what was going on, and why scams seem so pervasive now.
I also was curious about the effects on society as scams seem to be everywhere. We trust strangers less, answer our phones less, and are generally more skeptical as a result. I recently was at a NY pizza establishment that was cash-only and didn’t have any cash and tried to Venmo a stranger money so they would give me cash and they looked at me like I was a thief, so I have experienced this skepticism firsthand. Read my piece to find out why we’re falling victim to so many scams, and stay for the scam baiters trying to do something about it.
Welcome to the Golden Age of Scams
The second story, about pediatrician pay, relates to a story I did back in May about why maternity care is underpaid and why maternity wards are closing across the country. A few doctors had mentioned to me that it wasn’t just ob-gyns who were struggling, but really any doctors that worked with women and children. When I started to hear stories of pediatrician shortages, I wondered if the two were related. They are. Pediatricians are paid less than almost any other specialty, in part because they do fewer procedures and spend more time on preventative medicine, which the reimbursement system doesn’t value. It also can’t be a coincidence that women make up a lot of pediatricians and ob-gyns, and that pay for those types of doctors as a share of the average physician’s salary has fallen as more women entered the fields.
Part of the reason pediatricians don’t make as much as other specialties, some doctors argue, is because of the RUC, a relatively secretive committee of doctors convened by the American Medical Association that makes recommendations for how much different procedures should be valued. The Centers for Medicare and Medicaid then take these recommendations and develop reimbursement amounts; insurers use them as a guidance too. Every interaction I’ve had with the AMA has gone something like this:
Me: Some people allege that the RUC undervalues procedures on women and children
AMA: No we don’t, prove it, you’re wrong
Me: Ok, here are some peer-reviewed studies and some data
AMA: These studies aren’t definitive, prove it more
Me: Can you just give me some sort of comment or response? I don’t want to argue about the premise of the story
AMA: You’re a one-sided journalist, I’m going to complain to your editor
Methinks the AMA doth protest too much… Anyway, I almost made this into a story about how none of the professions that involve taking care of children—childcare workers, teachers, pediatricians—pay very well, because I find it odd that everyone seems to value children and want them to thrive, but no one seems to want to put their money into those values and increase pay for the people taking care of our kids.
Here is the story again, alongside the story about how health care for women is undervalued. Put together, it’s pretty damning to see how we seem to undervalue care for women and children.
Why Maternity Care is Underpaid
Why You Can’t Find a Pediatrician
Lastly, I did a story last year about shopping about Walmart and how the FTC was looking into whether suppliers were giving better deals to Walmart than it was giving to smaller grocery stores. The story made me very interested in the role of FTC action in my everyday life, something I think about every time I go to the pharmacy. I go to the Rite Aid in my town, wait in line forever, and get very cranky. It turns out there’s a reason for that—one that the FTC is looking into.
Hold on here because it gets a little complicated, but if you have health insurance, there is a middleman called a PBM that determines how much you pay for a drug and what the pharmacy gets reimbursed. As pharmacies have lost retail sales since the pandemic, PBMs have been squeezing them more, paying less and less for drugs. The twin forces have meant that pharmacies are cutting staff, pharmacists have poor working conditions, and everyone involved is pretty unhappy. Well, except for the PBMs. They’re making a lot of money. They can do that because the three biggest of them dominate 80% of the marketplace.
I explain it more in the story here:
Why Your Pharmacy Experience is Miserable
Last week, after my story ran, the FTC announced that it was taking action against the three largest PBMs, alleging that they artificially inflated insulin prices, making the consumer pay more. It’s a warning shot over the bow of the PBM yacht, and it will be interesting to see where it goes. Will it make your pharmacy experience better anytime soon? Probably not. But in the course of reporting the story, I switched from Rite Aid to the independent pharmacy across the street and am much happier. Do you have an independent pharmacy in your town? Try it! Maybe you’ll be less miserable.
BTFAT Books to Fall Asleep To
This isn’t a book, exactly, but I just discovered the NY Times Audio App, where you can listen to articles from magazines like the New Yorker, New York Magazine, NYT Magazine, and the New York Times, as well as This American Life and some podcasts. Last week in the Sunday magazine there was an extremely extremely long story about a deserter from the Russian army that I wanted to read but did not have time. But! They have it on the audio app, read by Liev Schrieber, and I’ve been listening to it before (and while) I fall asleep. It’s really well done and I’d recommend it if you have the app.