The
Machine

A state attorney general is looking into one of the big insurers. Part of it, reportedly, is a prior authorization that was approved and then taken back after the surgery was already done.

Sit with that a second. The doctor asked permission. The company said yes. The patient went under, had the operation, woke up. Then the yes went away.

I don't know how a person is supposed to plan around a yes that comes with an expiration date nobody can see. You can't un-have a surgery. You can't go back and decide not to.

Most of us were raised that when somebody gives you their word, that's it. You shook on it. You don't come around the next week and say you've been thinking it over.

I'll be interested to see where this goes. I'm not holding my breath. But somebody official finally asking the question out loud is more than we usually get.

Here's a thing I don't understand. A doctor looks at a patient, decides on a medicine, writes it down. The insurance company says it needs a prior authorization. Fine. They get it.

Then, some months later, they want another one. Same patient. Same medicine. Same doctor. Same reason. Nothing changed but the calendar.

I've heard people describe doing this over and over for a diabetes medicine. The doctor already approved it. The body already needs it. The paperwork just likes to be asked again.

Now one of the big insurers says it's cutting back on prior authorizations, and plenty of folks are calling it a publicity move. I'll wait and see. I'd like to be wrong. But I've been around long enough to know a promise isn't a policy.

It doesn't take much to undo a careful life in this country. One hospital stay will do it.

You can spend ten years doing it right. Bring your lunch. Drive the old truck another year. Put a little back every month. Then one envelope shows up and all of it is gone, and you didn't do one thing wrong except get sick.

I don't have a big speech about it. I just think about all the people who did everything they were told and it still wasn't enough. That's not a personal failing. That's the machine working the way it was built.

Someone wrote about showing up at college and finding almost every girl in the dorm already on an SSRI. Inside jokes about the prescriptions. Grateful for them.

Under that post, a reply said the quiet part. They want you sick and medicated. A customer for life. Medical spending is about a fifth of the whole economy.

Your doctor isn't the villain in that sentence. The business model is. A pill you stay on is a better product than a morning you don't need one.

A biochemist named Fred Kummerow said in 1957 that the fat in margarine was turning up in the arteries of the dead. The government acted on it in 2015. He was 100.

That's not a conspiracy. That's a calendar. Fifty-eight years between a man looking at tissue and a rule catching up. Ask who needed those years. Then look at what's still on the shelf with a stamp of approval.