The New Yorker magazine features a report from Nucla, Colorado. Writer Peter Hessler tells us about the “life of a small-town druggist,” Don Colcord.
He keeps watch-repair tools behind the counter, and he uses them almost as frequently as he complains about Walmart, insurance companies, and Medicare Part D. Since 2006, the program has provided prescription-drug coverage for the elderly and disabled, insuring that millions of people get their medication. But it’s also had the unintended effect of driving rural pharmacies out of business. Instead of establishing a national formulary with standard drug prices, the way many countries do, the U.S. government allows private insurance plans to negotiate with drug providers. Big chains and mail-order pharmacies receive much better rates than independent stores, because of volume. Within the first two years of the program, more than five hundred rural pharmacies went out of business. Don gives the example of a local customer who needs Humira for rheumatoid arthritis. The insurance company reimburses $1,721.83 for a month’s supply, but Don pays $1,765.23 for the drug. “I lose $43.40 every time I fill it, once a month,” he says. Don’s customer doesn’t like using mail-order pharmacies; he worries about missing a delivery, and he wants to be able to ask a pharmacist questions face to face. “I like the guy,” Don says. “So I keep doing it.” Don’s margins have grown so small that on three occasions he has had to put his savings into the Apothecary Shoppe in order to keep the doors open.
He is, by the strictest definition, a bad businessman. If a customer can’t pay, Don often rings up the order anyway and tapes the receipt to the inside wall above his counter. “This one said he was covered by insurance, but it wasn’t,” he explains, pointing at a slip of paper on a wall full of them. “This one said he’ll be in on Tuesday. This one is a patient who is going on an extended vacation.” Most of his customers simply don’t have the money. Each year, Don writes off between ten and twenty thousand dollars, and he estimates that he is owed around three hundred thousand dollars in total. His annual salary is sixty-five thousand dollars. Over the course of many days at the Apothecary Shoppe, I never saw a customer walk in whom Don doesn’t know by name.
• The Austin (TX) paper today has a long feature on alt farmers — mostly young people who are trying to scratch out a living (and a way of life) on small parcels.
• Dan Piller attended a hearing in Nebraska Tuesday on the Keystone XL Pipeline and found a stark conflict between farmers and labor.
The Keystone XL Pipeline would carry oil sands oil from Canada through the Great Plains to the Gulf Coast. The U.S. State Department is now holding hearings along the pipeline route before making a final decision on whether to allow construction to begin.
Farmers worry that any rupture along the pipeline’s route could harm water supplies. (Keystone XL cuts across the Ogallala Aquifer.) And farmers in Nebraska carry a lot of weight. Nebraska Gov. Dave Heineman and Sen. Mike Johanns (both Republicans) have come out against the pipeline.
• More Keystone news: Lisa Song at InsideClimate News previews Thursday’s State Department hearing to be held in Atkinson, Nebraska.
Song writes that people in Atkinson worry that busloads of pipeline supporters will crowd out those in the farming town who oppose it. Again, there is a farmer versus labor edge to the story.
We note that Piller says Gov. Heineman opposes the pipeline. Song says he supports it (albeit along a new route away from the aquifer).
• Even as Congress fails to fully fund a new food safety law, as many as 16 people have died from listeria illnesses traced to Colorado cantaloupes. It is the deadliest food outbreak in more than a decade.