Consider the Pharmacist

How Big Pharmacy is screwing pharmacists and putting the rest of us in danger.

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1. BIG

Once upon a time, pharmacists were recognized as an important part of the healthcare chain. Your local pharmacist was someone you knew and trusted. They knew a lot, worked hard, and sometimes held your life in their hands. And because of this they were well compensated.

Today, pharmacists are being turned into glorified Amazon pickers.

All because of the expanding pharmacy monopoly.1

Matt Stoller has a rundown of a workers’ rights movement that has emerged in pharmacist world. It’s called #PizzaIsNotWorking and I had never heard of it until I read his newsletter this week:

From the late 19th century to the 1970s, pharmacies were small-scale, often single proprietor shops or small chains. Pharmacists always played a dual role, operating as small businesses dealing with medical firms, hospitals, and powerful distributors, but also as health care providers for local communities, often the sole such provider in rural areas.

But roughly forty years ago, after we de facto legalized monopoly power by relaxing antitrust law, bigger chains emerged, using mergers and aggressive pricing tactics. . . .

Today, CVS spans not just pharmacies but health insurance, and pharmacy benefit management (PBM), which is a middleman that sits between pharmacies, doctors, and health insurance companies, taking a slice of every prescription pill and treatment sold. The market power of big pharmacy chains had a number of consequences, from lower pay for workers to higher prices and worse service to a slower roll-out of the vaccines. There are still upwards of 20,000 independent pharmacies in America, but every year it gets harder to stay in business.

What this means is that many pharmacists are now employees of big chains. And yet working as a pharmacist for a giant chain has also become increasingly difficult. Work loads have doubled over the last ten years, pay is down, and student debt loads are up (to nearly $200,000 for a recent graduate), even as the profits of Walgreens, CVS, and Walmart skyrocket. . . .

The worker stories coming out of the chain pharmacy world are awful. No bathroom breaks. No time for meals. Unforgiving corporate metrics like demerits for taking too long to answer the phone or fill prescriptions, requirements to ask a certain number of people per week to get a flu shot, and always a relentless push for more items to do than time to do them. And these sweatshop conditions for medical professionals don’t just mean an unpleasant day for a pharmacist or technician, it means more mistakes, and accidental deaths.

It is very much worth reading the whole thing. (And subscribing.)

Corporate pharmacists have tried pushing back because the sweatshop metaphor seems pretty apt in that it makes the pharmacists dangers both to patients and themselves:

“I am a danger to the public working for CVS,” one pharmacist wrote in an anonymous letter to the Texas State Board of Pharmacy in April. . . .

I spent some time speaking with Tanoe, who is an unlikely rebel against corporate power. “I have never thought of being anything else but a retail pharmacist,” she told me. “That’s all I wanted to do, because I want to be right there with my patients, to know them, to be present for them.”

And yet, in August, Tanoe had had enough. She quit her job, because like a lot of pharmacists, she felt she was becoming a danger to the very patients she sought to protect “I was too tired,” said explained. Then, after quitting, she used her voice to effect change. The goal was to bring the problems to the attention of the firm leaders themselves, in hopes they would change the situation.

Tanoe has become something of a reporter, explaining publicly what is going on at these stores. A few weeks ago, Tanoe wrote about an unnamed pharmacist at an Indiana CVS who began having chest pains during her shift treating patients. Neither the family nor CVS will release her name, and fellow employees are afraid of retaliation for speaking out. But according to Tanoe, this woman was told to stay in the store until a replacement could arrive, roughly two hours later. She died of a heart attack, her head held by a technician, after a patient tried CPR on her.

And as you keep drilling down you wind up with the kinds of vertical integration that is rife for anti-competitive behavior. To wit:

Tanoe expressed sympathy for the independents, because in her view, they have a boss as well, the small group of middlemen known as pharmacy benefit managers (PBM), that set the terms and pricing for reimbursement rates that independent pharmacists receive for prescribing medicine. Since CVS owns Caremark, one of the largest PBMs, CVS sets the prices its competitors are paid, making this dominant firm the boss not only of its own pharmacists it employs, but of the independent pharmacists who must contract with its PBM subsidiary. CVS also owns the insurance giant Aetna, which means it has the ability to drive more business away from independents to its own pharmacies . . .

Capitalism and the free market are good at many things: innovation, growth, creative destruction.

But left alone, most industries tend toward monopoly. Monopoly is, in a sense, the natural end state of capitalism.

So in order to harness the benefits of capitalism, it has to be managed.

That’s what Matt Stoller’s BIG is all about.

2. Woke ≠ China’s Cultural Revolution

Bulwark contributor Nicholas Grossman has his own thing at Arc Digital and, like pretty much everything at Arc Digital, it’s great.

Here he is taking apart current dogma that cancel culture wokeness is the most dangerous force in America:

In a Commentary essay imploring people to “say no to the Woke Revolution,” Bari Weiss argues that, “Just as in China under Chairman Mao, the seeds of our own cultural revolution can be traced to the academy, the first of our institutions to be overtaken by it.”

Analogies to China’s Cultural Revolution are popular among prominent critics of “wokeness” and “cancel culture.” In the Atlantic, Anne Applebaum argues that, “During China’s Cultural Revolution, Mao empowered students to create revolutionary committees to attack and swiftly remove professors” and “this pattern is now repeating itself in the U.S.” Criticizing “woke” efforts to remove statues of slave-owning Founders (e.g. Thomas Jefferson), Andrew Sullivan writes, “That was the case in Mao’s Cultural Revolution, when the younger generation, egged on by the regime, went to work on any public symbols or statues they deemed problematically counterrevolutionary.” Discussing a Yale Law student pressured by administrators to apologize for words in a party invitation that other students found offensive, Washington Post editor Ruth Marcus writes, in what she admits is exaggeration, “Maoist reeducation camps have nothing on Yale Law School.”

The Cultural Revolution was a decade-long campaign of violence and intimidation enforcing adherence to communism via public beatings, property confiscation, torture, and murder that left hundreds of thousands dead. You’ve probably noticed the United States isn’t experiencing anything like that.

But hyperbolic historical analogies are common in political discourse, especially to 20th century tyrants like Hitler, Stalin, and Mao. Nazi analogies are so common that there’s an internet adage about them (Godwin’s Law) and a meme (“Everyone I don’t like is Hitler”). It’s easy to find pictures of every 21st century American president with a Hitler mustache painted on.

Defending Weiss’s analogy, Atlantic writer Conor Friedersdorf tweeted, “The sentence is ‘Just as in China under Chairman Mao, the seeds of our own cultural revolution can be traced to the academy…’ That’s not a claim that our cultural revolution is as alarming as Mao’s. It is a different claim.” The different claim, he later specified, is that China’s Cultural Revolution and what Weiss calls the Woke Revolution “are alike along one specified dimension: the ideas takeover the academy first and then spread to other institutions.”

Whatever one thinks about hyperbolic analogies in general, the problem with this one is it’s wrong. Factually, historically wrong.

The first institution Maoists captured was not the academy, it was the state. The seeds of the Cultural Revolution were not in the academy, but in the perceived weakness of the communist party in China, and Mao’s position within the party, after the failures of the Great Leap Forward. Maoists took over the state first, and 17 years later launched a campaign to force cultural change in the academy and elsewhere.

This historical error not only makes comparisons between 2020s America and 1970s China misguided, it also highlights flaws in the liberal anti-woke position.

Go read the whole thing and subscribe.

3. Blue Hand Group

This last item isn’t a newsletter—just a piece from Hodinkee this week about a true 1-of-1 made by F.P. Journe and it is . . .

Super, duper, double-not-safe-for-work.

Just look at this thing and try to guess what the hand does and how it displays time!

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Or triopoly, as the case may be.