Study finds 46 percent of U.S. counties have pharmacy deserts

You're really stretching by assuming rural Americans have the option of living somewhere else.

I live in a relatively small town (~3000, though it's much bigger than other towns nearby). Most people here have never gone more than 100 miles from town. They have shit jobs (when they get them), live below the poverty line, have poor education. There is no transportation but rotted-out 20-year-old trucks or whatever $500 used car you could find in a nearby town. Their families have lived here their whole lives. They have no savings, no retirement, usually no health insurance.

This isn't "an appeal" or "a deal" they took, like they decided it would be cute to live a libertarian dream in the sticks. They have no other choice. This is what being poor is: a lack of options and no recourse.

Rural people who aren't poor still live there because... it's their home. You don't just decide move away from your family, friends, support structure, and entire way of life, because you want easier access to a pharmacy. Expecting people to just put up with pharmacy deserts or move, is a pretty hostile and careless position. It would be like expecting city people to get mugged every so often because that's the price you pay for wanting to have a pharmacy nearby.

These things shouldn't be expectations, they are problems to be solved, as in most other developed nations they largely are solved. We're the freaks for putting up with ridiculous amounts of crime, death, inconvenience, and needless expense.

I grew up in a fairly rural community. Every common service has basically collapsed.

The town I lived in had a grocery store, full service station, restaurant, hardware store, and even a bowling alley. Those are all completely gone. This was in a town with about 300 people.

How the collapse happened is actually pretty simple. As suppliers slowly consolidated they started raising prices for smaller business as somewhat of a "go away, you're annoying to deal with" policy. It's simply far easier to sell 1000 items to walmart than it is to sell 10 items to 100 different stores. That in turn collapsed businesses in the town as you could literally go to the walmart a 45 minute drive away and get things for half the price.

Medicine is mostly due to privatization of education and consolidation of medical offices. There are simply limits to how many students medical schools can take and as a result they've simply continued to raise tuition prices to try and limit demand. That has put huge debt burdens on new doctors which makes working in rural locations particularly unappealing (they can't afford the salary a doctor needs to afford the debt they've taken on).

15 minutes from my hometown, there's a medical center that used to employ about 10 doctors when I was a kid. Now it's mostly staffed by 1 or 2 nurses with a doctor that comes in 3 times a week. Where they used to have to tools and equipment to handle most medical needs, now they are effectively just a stabilization location while patients wait for life flight to take them to one of the more major medical locations.

I personally blame weak anti-trust enforcement and mass privatization and deregulation for the current state of things in rural America. These communities are dying because they have no capital power. That causes them to be steam rolled by basically everyone. Big business has wrecked that part of america.

Very few completely eschew the option to get medical services when they decide they need them.

I remember a documentary on China and apparently they let people study medicine for free if they play Medicine Woman Quinn in the boonies for a few years in exchange.

Rural America certainly votes that way. I’d be curious if the people in these counties view this report as more than bashing.

Not really, it doesn't have to be a binary, and wasn't always that way, and doesnt have to be this way.

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Not just likes to mail things, they basically try to force you to use the mail pharmacy service that they own.

My Aetna policy will deny all prescriptions for anything greater than 30 days supply or multiple refills unless you go through their mail pharmacy - it's the only way to get a 90 day supply.

And yup. Their online service often is "unable to determine status" of a prescription that they are filling, which means I can't even order a refill through them.

Putting pharmacies in all those places when door to door delivery exists would be insanely wasteful. Just make it easier for pharmacists to mail you your medicines.

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Which party is that? Both of them?

Walgreens is being taken private in a $10B deal, and is planning on closing 1200 locations in the near future.

Rural resentment of cities is as old as the hills. I don’t know what the solution is. Price supports to keep small pharmacies alive? Heavy regulation of e-commerce? I’m no free-market zealot, but it’s hard to see how you blunt this impact in a non-heavy-handed way.

What regulations specifically?

Sure, but the point of Chapter 11 is to restructure so you can hopefully get back to operating profitably.

> Sounds like Bartell's in the Seattle area.

To be sure, Bartell's is a subsidiary of Rite Aid.

> they will only give you three months of it at a time and the freaking GPs office charges $20 each time to receive a "please can I have some more" request on their web site / app and forward the order to the pharmacy.

I take it you are outside of the US? For all the criticism of the American health system, this has never been a problem.

For most maintenance medications, which this sounds like it is, the doctor will authorize one year's supply, for which you pick them up every 30 or 90 days at a time. When you run out of refills the pharmacy will usually contact your doctor for re-authorization, typically at no charge.

Often the doctor wants to see you anyway to check your progress before you run out.

During your yearly visit there is usually a short conversation about getting medication refilled.

The exception to this are when the doctor wants to order tests to see how you are reacting to the medication, or periodic tests for long term medications (in case they need to adjust the dosage).

Things like pain medications or for urgent issues are dispensed as a one-time thing.

It’s only 12% of women of childbearing age on the pill - under 10 million. Another smaller chunk uses depo or norplant, but the CDC figures lump those in with IUDs so it’s hard to tell exactly.

Either way a small number compared to e.g. statins.

> The rural parts consistently prefer a tax cut over anything else.

No. They do not prefer tax cuts over eating, for example.

> Rural people elected the current federal government.

When the entire country acts as if you and your problems don't exist (for several generations), burning it all down doesn't feel like much of a catastrophe.

I've heard from Indigenous Americans who aren't overly bothered by our massive ongoing crises. Their position is something like 'you might experience a tiny sliver of what we've had for centuries'. And they have a point.

>brick and mortar shops aren’t allowed to charge a premium over the online pharmacies.

What is this referring to? Is there some law that prevents pharmacies from setting their own sales prices?

There is no law against a pharmacy owner from charging whatever they want.

However, most pharmacies enter into contracts with various groups, such as the government, insurance companies, etc so that they effectively give away their right to charge what they want.