You Want to Know Why Medical Care Is So Expensive?

You Want to Know Why Medical Care Is So Expensive?  Because the government has passed numerous laws to help medical practitioners enforce their monopoly on numerous medical services.

Today I encountered an egregious example.  1-800-Contacts will not ship my contact lens order.  Seeing that my 1-year prescription was about to run out (but still valid for another week, it expires on the 18th), I ordered a bunch of boxes of my daily lenses to see me through some more months.  The retailer called my eye doctor, who confirmed that the prescription was still valid but that the doctor would only allow me to buy one box because he wanted me to return for an exam soon.  They confirmed this by email:

Thank you for choosing 1-800 CONTACTS. While we were verifying your prescription, your eye care provider informed us that your prescription will be expiring soon. Unfortunately, this means that we are unable to ship your order....

But then we get to the real point

Also, if you would like assistance scheduling a new exam, we can help! We have a network of doctors with convenient locations and hours....


The Doctor Network Team at 1-800 CONTACTS

So the email is not even from the customer service department.  It is from their doctor network.  Its clear the requirement is all about pumping up the eye doctor business.

I remember a Dilbert cartoon (or maybe it was the Far Side) where one copier repairman was pointing into a copier and telling the other that he should "set this dial for when he wanted to return."  We all have suspected something like this exists in copiers, but for all the dark humor, it really exists in the medical profession.

Why should the government force me to pay the doctor for as many visits as the doctor wants just to be able to purchase contact lenses?  One could argue this is for eye health or some happy BS like that, but we don't require everyone to visit the eye doctor at the doctor's pleasure, just people with bad vision who have daily wear contacts.  There is not, to my knowledge, any correlation between glaucoma and contact lens wearing, so why do I face such a government mandate while someone with 20/20 vision does not?

Further, why can't I self medicate on contact lens selection?  I know people who have been raised to be submissive sheep deferring to the almighty medical degree gasp at such a suggestion, but why not?  Because I have problems with both near and far sightedness, my choice of contact lens strength is a tradeoff anyway.  If I can see well long distance, I can't read anything without reading glasses.  Back off a bit on the far vision, allowing a little blurriness in one eye, and I can read in an emergency without my glasses.  I chose my own lens strength, and my doctor then wrote a prescription for it.  Why can't I just do this on my own, say with a trial kit of lenses from the manufacturer.  (for those who think it might be a size issue, there are only about 3 sizes in this type of lens, and they are far enough apart that once a size is selected, they are likely that size forever).  It's fine if people want to do this under a doctor's supervision, and I would certainly get into the doctor every two or three years, but why must the government mandate I go in more frequently, at the doctor's pleasure, not mine?

This kind of thing exists ad infinitum in the medical profession, with government mandates helping to protect over-educated professionals from lower-cost competition.  Why do I have to go to a dentist's office to get my teeth cleaned?  Why do I need someone with 12 years of medical training to put three stitches in my knee?  Why do I need a fully trained doctor to take me through the basics of a routine physical?  Why does Viagra require a prescription -- I mean, doesn't the doctor just take my word there is a problem, or is there actually a doctor out there who sends in hot nurses to prove whether I have an erectile problem?  OK, I might not begrudge that particular doctor visit.


  1. me:

    Spot on. And glasses/contact lenses are one of the areas where it can hardly be argued that restricting access is for the common good (ie: antibiotics).

  2. Charlie B:

    You were on a great roll until you got to Viagra which has lots of nasty side effects. A couple of years ago, my doctor lost a patient who was buying his Viagra off the Internet.

    To a minor extent, Internet Viagra has increased the cost of ordinary medical care. My internist does a Viagra side effect tolerance check regardless of whether or not you report ED to him as more than a few non ED guys who should not be taking Viagra are.

  3. Esox Lucius:

    Coyote, Walmart has $25 eye exams. Take your exam results and buy online. Also, if you shop around, 1800 contacts is not the least expensive. Finally, you need to buy your prescriptions from several sources at the same time. So get your exam and buy 1 year supplies from 4 sources and you will have 4 years supply. That's what I do.

    You are right. It is a scam and what is more, they should have a machine or kiosk that does the eye test whenever you want it.

    It's like having to see a podiatrist once a year before being allowed to buy shoes.

  4. zwerdlds:

    I've never had a problem with this, but perhaps it's to do with your eye correction preference. I only wear glasses, and doctors are required to give you your eyeglass prescription without requiring you to purchase from the same location. Then, you just order from an online house like Zenni, and voila: $20 eye correction with no commitment.

    I'm not an optometrist, but I'm willing to concede that I don't know much about eyes. Glasses are one thing, but I imagine there could be a lot of variables when it comes to something that sits on top of the lens. Maybe something that actually does require an annual adjustment to keep the prescription accurate.

    I don't think your doc was in the clear by deauthorizing your purchase though. That's just silly. If I were you, I'd call the doc up and explain why he just lost a patient.

  5. NormD:

    Why do you have to get a prescription for Propecia?
    When taking statins you need to get periodic blood tests for Lipids and Liver Function. Why does a doctor have to interpret these? The acceptable ranges are right on the lab results form.

  6. colson:

    Hi Coyote - this isn't a cheap ploy to link spam, I am a regular reader and I recently got pissed off about the same thing. There are some vendors who will ship them without going through the process of adhering to the monopoly rule.

    I changed the link in my name to direct you to who I used and have had no problems with. I thought they were a bit sketchy at first but tried it and had no problems getting the lenses I wanted without going through the whole hassle of the prescription verification process.

  7. Will H.:

    Some things are getting better. I can now buy some types of insulin over the counter without a prescription along with the syringes, and Walmart has by far the cheapest price on these items.

    The home meter manufactures has now come out with meter to test your A1C reading from home. Thus saving a doctor trip and lab test.

    By using OTC products that once required a prescription I have reduced some of my medical cost.

    My wife uses Prilosec OTC for here acid reflux and eliminate the need for a Doctor prescription.

    Companies like Walmart are setting up mini-clinics to using Nurses and Nurse Practitioners to treat common things not requiring a doctor. Flu shots are now available without going to a doctor.

    My Orthopedic Surgeon uses a nurse practitioners to do some of the procedures. When I was having Rooster Comb Injections for my knee (required three injection a week apart), he did the first and the nurse practitioner did the last two. She was in less of a hurry and there was less pain.

    BTW I can sew up you cut if you want me to, but it will have to be without the local. :-)

  8. NJconservative:

    Scan your prescription and then e-mail it to 1-800 Contact's competitor. They might sell you lenses. And if you have a bit of a lawless streak, just change the date on the prescription using any paint program.

  9. Jim Collins:

    That's why doctor's pay to belong to the AMA.

    In Pennsylvania we have something like this in a different area. Every year we are required to have a "safety inspection" of our vehicles. The problem is that the inspections can only be done at certified garages. The State has no inspection facilities of it's own. Every year thousands of people pay for repairs that they don't need or are not required, just to get a sticker for another year.

  10. dave:

    I agree with the sentiment, but it's a liability matter for the doctor. Although you may take responsibility yourself for any maladies that occur with self medication/self contact-ing, the vast majority of the population does not. So whether government mandated or self imposed, medical practice is more or less defensive. Of course I will admit that requiring regular checks is good for bussiness.

    By the way, in some states you can see a hygienist without having to also be seen by a dentist. Colorado is one.

  11. Not Sure:

    "I agree with the sentiment, but it’s a liability matter for the doctor." - dave

    If allowing a customer/patient to order lenses in the last week of a 1 year prescription is a liability factor, then why are they giving out 1 year prescriptions in the first place?

  12. bobby b:


  13. Bob:

    I was delighted to find that optical dive masks are self service. Just walk into the store and pick your lenses from a box, -10 .. +10 diopters. Separately for each eye.

    I had just bought some goggles with prescription lenses, and they washed out in Hawaii in the first big wave that tumbled me. An expensive loss. Then I walked into a shop to buy a flat lens mask, and there they were -- do it yourself optical masks.

    I love them. They work great, even in rough water. And (compared to prescription ones) they are cheap cheap cheap.

  14. T J Sawyer:

    Want to reduce health care costs?

    Instead of passing a thousand pages of new legislation, repeal a thousand pages of existing regulation.

  15. ParatrooperJJ:

    Viagra can have major life threatening side effects when mixed with the wrong medications.

  16. Dan Smith:

    I can't speak for ophthamologists, because I am in Famil Practice, one one big reason doctors are being so hard nosed about requiring visits for things like medication refills is the decline in payments from third party payers and the simultaneous insistence on meeting "quality guidelines" issued by the same group. The guidelines generally mandate that doctors and patients go one on one to discuss chronic diseases. Here is an anectdote from my practice: we hired a nurse and trained her in how to advise diabetic patients about managing their blood sugars, diet, foot checks, etc. She made frequent phone calls to the patients and they loved her. Unfortunately, Medicare did not accept any billings that she submitted. We lost money every time we had her see a patient. So we had to let her go, much to the dismay of her patients.
    The other major factor in forcing reluctant patients to come in is so that we are not in court one day listening to a plaintiff attorney tell the jury: "Can you believe that this arrogant physician prescribed "X" drug without seeing my poor disabled client and monitoring him/her for side effects. Please award him/her one million dollars.

  17. Jerry:

    I too can't stand the contacts thing, I have worn contacts since 1991 and have recently moved (stocked up on contacts but now running out) and going to the eye doctor, they don't want to give me my prescription until I try out a pair of contacts and see if I like them. If I don't I'll buy a different kind to try. What a pain in the ass.

  18. Bob Smith:

    I can now buy some types of insulin over the counter without a prescription along with the syringes

    Oddly, you can't buy metering strips without a prescription, at least around here. I'm not saying you should need a prescription for insulin, but if you're going to control distribution of anything, why require a prescription for harmless paper strips yet allow the far more dangerous insulin to be purchased OTC?

  19. marvel:

    I agree with Dan Smith re physicians keeping patients on short leases b/c potential liability issues. As a patient, I hate it. As a doctor, I do it all the time.

  20. Dr. T:

    Give me a break. Optometrists are not part of the medical profession. They're just technicians trained to measure vision defects. Ophthalmologists are eye doctors. They diagnose and treat eye diseases such as retinal detachment and glaucoma. They aren't responsible for the idiotic state law that makes you get your eye prescriptions confirmed annually.

    Some of us in the medical profession prefer fewer restrictions: many prescription drugs should be converted to over-the-counter drugs, physician assistants and nurse practitioners should be allowed to practice independently, patients should be able to request lab tests, etc. Of course, with the advent of ObamaCare, we'll be lucky to avoid government servitude.

  21. marvel:

    Dr. T: I, too, would prefer far fewer restrictions and mandates. Don't get me started on what we were required to do for well child-care checks to get reimbursed for Medicaid patients. (The patient has poorly controlled asthma, allergies, is prediabetic and failing the 4th grade for the second time and I can't get paid for this visit unless I do an (unnecessary) hearing exam? Please, can I spend time on what the patient needs? Pretty please?)

    What do you mean with the advent of ObamaCare we'll be lucky to avoid government servitude? I don't think there's anyway to avoid government servitude with ObamaCare--government servitude of both patients and doctors is the point of the whole enterprise.

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  25. Sarah

    I have been using Nike+ Running for years now. It is a good application to motivate yourself. Certainly with a developed technology like this, people could easily use this and increase their quality of life. This is a good thing right?

    Sarah -

  26. Sarah

    Some doctors do that while some others don't. You can't generalize this kind of thing because someone ruin this profession. Although I have to admit that some doctors want a return I think for what they have paid for at med school, don't you think?