>In July, a notice appeared on the front door of The Drug Store, the only pharmacy in rural Kernville, Calif.
>That leaves Kernville residents in what researchers call a pharmacy desert, defined as living more than 10 miles from the nearest pharmacy in rural areas, two miles away in suburban communities, or a mile away in urban neighborhoods.
Kernville, CA is not a city, town, or even a village, it is a census-designated place with a population of 1,549 (2020). Is this really the best example of a
'pharmacy desert' that the reports could find?
The definition of "pharmacy desert" is so aggressive that I wonder who came up with it. I technically live in one, despite living in a urban area with a walk score of 91 and walking distance to stores, restaurants, and transit.
News articles like these often cherry-pick their anecdotes to maximize outrage (therefore increase engagement). The NY Times is not above this -- they are losing eyeballs in an era where people are getting news from social media, so it's a survival strategy in part.
I'm a paid subscriber of the NYTimes and from reading it daily, it obvious to me that it's imbalanced. I still read it to gauge what the elites of America are thinking, but also to understand the blind spots that NYTimes readers have.
I hang out with NPR/NYTimes types every so often, and knowing their discourse helps me avoid certain faux pas in social situations and helps me to engage better (I start with a good baseline of their Bayesian priors).
Also in terms of opportunities... NPR/NYTimes folks are purveyors of words and symbols, which means many of them are not super connected to how the world is really perceived by blue-collar folks. There are sometimes business opportunities that white collar folks don't perceive -- they can't understand why some people would want a downmarket product/service instead of an upmarket one. So many of them ignore low-end competition, and as Clay Christensen predicts, they sometimes end up being disrupted by them. If you can identify these opportunities, they're ripe for the picking because they're completely absent from (or disdained by) elite discourse.
Example: take the whole kneejerk narrative about "crap Chinese culture" that prevails in NYTimes/NPR circles as well as here ("crap Chinese products on Amazon"). Yes, there are some low quality products from China, but there are actually a ton of mid-range to high-end quality stuff available at a discount because they don't yet have the cachet of Japanese brands. I get these off Amazon often and am often surprised by their functionality and quality at such low prices.
The average HNer or NYTimes reader would not even pay attention to these (because "vibes"), but if you run in hobbyist circles, the acceptance of these products is much higher and there's a sizeable market that is a complete blind spot to elite types. Therein lies your untapped market.
I bought these "cheap Chinese products" off Amazon recently and was more than happy with their quality.
Another example: I bought a Hyundai car when the prevailing narrative in the US was the Hyundais were low-quality Honda knockoffs (which was never true, and Hyundais were improving at good pace, but Americans are slow to update their priors) -- and I got a car fully loaded with accessories with a 10-year powertrain warranty at a price lower than a Toyota. It was purely a perception discount. And the Hyundai turned out to be more reliable than a Toyota! (at the time -- Toyota was having quality troubles circa 2007). I got a deal because I saw the blind spots in people's perceptions.
Opportunity lies where you can read the blind spots in the prevailing narrative.
From the intricacies of preferred places (whatever that is) to shoplifting at in-store pharmacies..
My personal guess: The millennial working population with two working parents just drives to the 12-mile-away pharmacy on their commute; Or they choose lower prices and mail delivery.
I doubt vertical integration, insurance plans or theft can be an issue.
In the German state of Schleswig-Holstein, the number of "Apotheken" declined by 25% in the last 10 years. And we share none of these hyper-special US problems.
This website is owned by a US company so that makes sense to me. I would say a large amount of stories that are regularly posted here, are also US-specific.
That it's all discussed in this context is fine. The NYTimes and it's commentators are obviously also mostly US.
I'm just saying it doesn't make sense to limit one's reasoning to one country alone. When one sees a phenomenon in multiple countries, a shared cause is often likelier than unrelated national causes.
Is 12 miles a long drive for a pharmacy? It's certainly more out of the way, less convenient, but I think you could still drive there for your monthly refills or etc?
I used to work in Houston. In Houston, almost everything (maybe not pharmacies, but the average destination) is at least 10-12 miles away and people are used to it. And Houston is highly populated.
Kernville (pop. 1549, just outside Bakersfield) seems very remote, and if one elects to live in such a remote place, one is implicitly signing up to be far away from civilization, and traveling 10-12 miles ("going into town") every now and then is part of the deal. Having a car is also part of the deal. That is one's free choice.
I grew up with friends who lived in rural Canada and this is normal for them, and they would gladly make this choice even now. In fact, this is idyllic for some.
Making some assumptions here about mobility, access/ability to drive, and of course financial circumstances. All of which effect older people.
Another comment mentions pharmaceutical deliveries, common in my country abut then I have 3/4 pharmacies in a 1-2 mile radius and they are either cheap or free. Not sure of the availability or costs in the US
Most of the older folks I know get their meds in the mail these days, even from the pharmacy that’s closer than that. The pharmacist is happy to talk to them over the phone.
> They also determine which pharmacies are in network for insurance plans, and which of those are “preferred,” offering patients lower co-pays.
[…]
> Dr. Qato argues that Part D plans should not select preferred pharmacies at all.
“Allow patients to choose which pharmacy to go to, with the co-pay the same, regardless,” she said. “So the pharmacy is reimbursed fairly, whether it’s preferred or not.”
I must be missing something, but what is unfair about passing along cost savings to consumers (in the form of lower copays) when they patronize pharmacies efficient enough that they can accept lower reimbursement rates?
Sorry missing something here as a non Americana person. Why should someone have to understand and negotiate co-pay, or having to chose more efficient pharmacies and reimbursement rates when they just want the pharma that like keeps them alive?
I’ve tired to resist giving up on physical pharmacies but the quality of service is absolutely atrocious in the ones near me, and I live in a prosperous city. So I’ve moved on to online pharmacies for convenience. We used to have more local pharmacies that were amazing. Unfortunately government bureaucracies and ideological wars have killed most of them. See California’s war on compounding pharmacies.
>In July, a notice appeared on the front door of The Drug Store, the only pharmacy in rural Kernville, Calif.
>That leaves Kernville residents in what researchers call a pharmacy desert, defined as living more than 10 miles from the nearest pharmacy in rural areas, two miles away in suburban communities, or a mile away in urban neighborhoods.
Kernville, CA is not a city, town, or even a village, it is a census-designated place with a population of 1,549 (2020). Is this really the best example of a 'pharmacy desert' that the reports could find?
The definition of "pharmacy desert" is so aggressive that I wonder who came up with it. I technically live in one, despite living in a urban area with a walk score of 91 and walking distance to stores, restaurants, and transit.
News articles like these often cherry-pick their anecdotes to maximize outrage (therefore increase engagement). The NY Times is not above this -- they are losing eyeballs in an era where people are getting news from social media, so it's a survival strategy in part.
I'm a paid subscriber of the NYTimes and from reading it daily, it obvious to me that it's imbalanced. I still read it to gauge what the elites of America are thinking, but also to understand the blind spots that NYTimes readers have.
What do you do with that understanding? Has it had any utility in some situation?
Yes, it can be helpful in subtle ways.
I hang out with NPR/NYTimes types every so often, and knowing their discourse helps me avoid certain faux pas in social situations and helps me to engage better (I start with a good baseline of their Bayesian priors).
Also in terms of opportunities... NPR/NYTimes folks are purveyors of words and symbols, which means many of them are not super connected to how the world is really perceived by blue-collar folks. There are sometimes business opportunities that white collar folks don't perceive -- they can't understand why some people would want a downmarket product/service instead of an upmarket one. So many of them ignore low-end competition, and as Clay Christensen predicts, they sometimes end up being disrupted by them. If you can identify these opportunities, they're ripe for the picking because they're completely absent from (or disdained by) elite discourse.
Example: take the whole kneejerk narrative about "crap Chinese culture" that prevails in NYTimes/NPR circles as well as here ("crap Chinese products on Amazon"). Yes, there are some low quality products from China, but there are actually a ton of mid-range to high-end quality stuff available at a discount because they don't yet have the cachet of Japanese brands. I get these off Amazon often and am often surprised by their functionality and quality at such low prices.
The average HNer or NYTimes reader would not even pay attention to these (because "vibes"), but if you run in hobbyist circles, the acceptance of these products is much higher and there's a sizeable market that is a complete blind spot to elite types. Therein lies your untapped market.
I bought these "cheap Chinese products" off Amazon recently and was more than happy with their quality.
https://www.amazon.com/dp/B08K2G5Y78
https://www.amazon.com/dp/B07R3YC1BC
Another example: I bought a Hyundai car when the prevailing narrative in the US was the Hyundais were low-quality Honda knockoffs (which was never true, and Hyundais were improving at good pace, but Americans are slow to update their priors) -- and I got a car fully loaded with accessories with a 10-year powertrain warranty at a price lower than a Toyota. It was purely a perception discount. And the Hyundai turned out to be more reliable than a Toyota! (at the time -- Toyota was having quality troubles circa 2007). I got a deal because I saw the blind spots in people's perceptions.
Opportunity lies where you can read the blind spots in the prevailing narrative.
Very US centric article and comments.
From the intricacies of preferred places (whatever that is) to shoplifting at in-store pharmacies..
My personal guess: The millennial working population with two working parents just drives to the 12-mile-away pharmacy on their commute; Or they choose lower prices and mail delivery.
I doubt vertical integration, insurance plans or theft can be an issue. In the German state of Schleswig-Holstein, the number of "Apotheken" declined by 25% in the last 10 years. And we share none of these hyper-special US problems.
This website is owned by a US company so that makes sense to me. I would say a large amount of stories that are regularly posted here, are also US-specific.
That it's all discussed in this context is fine. The NYTimes and it's commentators are obviously also mostly US.
I'm just saying it doesn't make sense to limit one's reasoning to one country alone. When one sees a phenomenon in multiple countries, a shared cause is often likelier than unrelated national causes.
What phenomenon in multiple countries are you referring to? I cannot read the article as it is login-walled for me.
Counterpoint: Pharmacies that delivery nationally make it faster/easier to get a prescription filled than ever.
Broadly, I'm not sure the virtue of trying to make it artificially cheaper to live in remote areas.
Is 12 miles a long drive for a pharmacy? It's certainly more out of the way, less convenient, but I think you could still drive there for your monthly refills or etc?
I used to work in Houston. In Houston, almost everything (maybe not pharmacies, but the average destination) is at least 10-12 miles away and people are used to it. And Houston is highly populated.
Kernville (pop. 1549, just outside Bakersfield) seems very remote, and if one elects to live in such a remote place, one is implicitly signing up to be far away from civilization, and traveling 10-12 miles ("going into town") every now and then is part of the deal. Having a car is also part of the deal. That is one's free choice.
I grew up with friends who lived in rural Canada and this is normal for them, and they would gladly make this choice even now. In fact, this is idyllic for some.
Making some assumptions here about mobility, access/ability to drive, and of course financial circumstances. All of which effect older people.
Another comment mentions pharmaceutical deliveries, common in my country abut then I have 3/4 pharmacies in a 1-2 mile radius and they are either cheap or free. Not sure of the availability or costs in the US
Most of the older folks I know get their meds in the mail these days, even from the pharmacy that’s closer than that. The pharmacist is happy to talk to them over the phone.
> They also determine which pharmacies are in network for insurance plans, and which of those are “preferred,” offering patients lower co-pays.
[…]
> Dr. Qato argues that Part D plans should not select preferred pharmacies at all. “Allow patients to choose which pharmacy to go to, with the co-pay the same, regardless,” she said. “So the pharmacy is reimbursed fairly, whether it’s preferred or not.”
I must be missing something, but what is unfair about passing along cost savings to consumers (in the form of lower copays) when they patronize pharmacies efficient enough that they can accept lower reimbursement rates?
Sorry missing something here as a non Americana person. Why should someone have to understand and negotiate co-pay, or having to chose more efficient pharmacies and reimbursement rates when they just want the pharma that like keeps them alive?
My pharmacy is at a grocery store. They deeply discount certain common generic meds because they want you to shop there for groceries.
It’s less about negotiating a copay, but rather letting market forces work to people’s advantages
Because if you don’t do such things, you spend more than you have to.
Point being you shouldn’t have to
There are lots of meds that can’t be delivered by mail. Any controlled substances for example.
This seems more like an issue with how controlled substances are regulated. Maybe healthcare should be optimized for patients.
Kernville seems pretty remote from a quick map check. I imagine it’s a rougher 12 miles than many folks deal with.
There are people that can’t drive due to physical disabilities or don’t own/operate a car for financial reasons.
In some areas 12 miles by public transit might as well be on the moon. Impossible to reach.
https://archive.is/42tBB
For $5 a month my local pharmacy delivers to my door.
I’ve tired to resist giving up on physical pharmacies but the quality of service is absolutely atrocious in the ones near me, and I live in a prosperous city. So I’ve moved on to online pharmacies for convenience. We used to have more local pharmacies that were amazing. Unfortunately government bureaucracies and ideological wars have killed most of them. See California’s war on compounding pharmacies.