Prescription for the Car Czar

Thoughts about the Federal Car Czar from Andrew Singer, M.D.—

I was thinking, now that medicine is moving to socialization, some of its more endearing bureaucratic hurdles may be adopted by the federally bailed-out auto industry .

Some insurance companies (okay, let’s be honest, all of them) have medications that require a Prior Authorization before payment is approved. Although a rational person would consider the prescription to be that document, they give us other hoops to jump through. This is all because the insurance company has contracted with certain pharmaceutical companies to negotiate cheaper prices.

If I want to prescribe a certain asthma medication, I have to prove a less expensive one has failed or provide an Attestation Statement (which requires 30 minutes of waiting on hold) saying that I attest to the fact that this patient may die or end up at least in the ER if the medication is not given. 

It’s a pain for us doctors, patients don’t understand why the medicine they are given at the pharmacy is not what we wrote for initially, as some pharmacies will substitute without checking with the doc. 

If the same sort of process were implemented through the car czar, it would probably look like this:

“Mr. Singer, we understand you want a pickup truck. Have you needed to carry any lumber this past year? Do you have to tow anything?”

“Well, I carried some building supplies last month.”

“Did you try another car, say, a Ford Focus? That would work, wouldn’t it?”

“No, it wouldn’t work.”

“But did you try it? If you try it and it doesn’t work, provide documentation that it didn’t work, and then we’ll authorize the truck.”

Assuming the authorization goes through, and the fax isn’t lost behind a desk, or unreadable due to poor toner, I would then go back to the dealership to buy the truck. Once there, it would be like this:

“Mr. Singer here is your car. It’s a Kia.”

“But I bought a truck.”

“Your bank will only loan you money for a Kia based on what your needs are.” 

“But I can afford the truck, gas and insurance.”

“You can file appeal paperwork, after you’ve proven the Kia is unsafe or does not meet your needs.”

Just some of my miscellaneous ramblings after dealing with three prior authorizations on asthma medication this morning and hearing more about the Car Czar on the radio.

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