Jan 27, 2022Liked by Matt Stoller

I work at a place that does research using medical records and surescripts stopped sending prescriptions to a "health information exchange" (something designed to make it easy for different health IT systems to exchange information). I assume it was because there was a "dispute over costs" ... Like when a tv station and cable company fight it out over fees and you see stuff like "call blah blah blah now or you'll lose CBS!" ... Anyway, this can make it harder for doctors to see a patient's medication information (which is absolutely terrible) and it can make it harder for researchers to include medication information in their research (which has impacts far in the future).

To me, and I could be wrong, the surescripts situation probably calls for handcuffs for the executives who monopolized the market. It's not like they cornered the market on candy canes. They knew what they were doing and the impact it would have.

As for the systems, if it weren't monopolized, there'd be more incentive for the businesses to do a better job and focus more on making sure their systems were stable. Yeah, there will always be mistakes and systems will always go down. But, there would be a lot less if one company didn't run it all.

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A part (just a part) of this problem is the following. Most programmers are not that good. Maybe 15% of them are in the top tier and that all work for big tech, startups, or Wall St. this is similar to Hollywood where there are a ton of directors, writers, and actors, but only a small subset are capable of creating a brilliant film.

And so, just like most output from Hollywood is mediocre or worse, most software systems are mediocre or worse. They eventually get hacked into a usable state but the system is brittle and substantial changes will break it.

And then, with an acquisition or merger, you now need to have these two fragile systems interconnected. And to make the interconnection work, you have two teams of mediocre programmers.

Of course these combined systems are going to fail.

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Jan 27, 2022·edited Jan 27, 2022

That's true of every profession. The most crucial unfortunately is medicine (I'm saying doctors), followed by programmers, depending on their application.

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It would be great if the guy with a cast could easily sue CVS for big bucks for pain and suffering. It doesn't really matter if the pharmacy that left him on the floor was a monopoly with IT problems or a neighborhood business that took an extended lunch break.

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Matt, have you seen the framework of https://www.lunarmobiscuit.com/efficiency-vs-resilience-texas/? I’ve only heard it mentioned once, by one obscure impact-focused think tank, despite how good it explains why monopolies and oligopolies are so harmful beyond pricing power.

This CVS example fits the framework. If only that patient could simply call their doctor and have the prescription filled at Safeway next door, then CVS might itself invest in redundancy so that they don’t lose business when their software crashes.

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Jan 29, 2022·edited Jan 29, 2022

CVS and Walgreens has the most burnt out employees. They've been working in hellish conditions for 2 years straight. How did they get recognized for their dedication and hard work of 6 days a week 12 plus hour days? A $250.00 bonus that they were taxed on. Meanwhile after a mass exodus of staff. Both offered a higher base pay and gave most a huge sign on bonus. Those other employees that slaved away 6 days a week and only got $250. Got to train them and make less.

I've seen one pharmacist covering the whole department while dispensing medications, administering covid testing, and providing boosters and vaccines!! That's 4 full-time jobs people!! The government needs to do something about the monopolization of healthcare and pharmacies.

The workers are suffering. It's insane and unsafe.

Walgreens has had multiple workers walk out of the pharmacy. So it was closed to catch up on the 650 prescriptions that they were behind on. Meanwhile both companies made record profits. Report 1 pharmacist in the pharmacy to your state medical board. This is illegal and completely unsafe. It's only a matter of time before some dies from a mistake.

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The disasters related to EMRs, algorithms, & mergers in medicine are just beginning.

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The overall point of this piece is well-made. I just want to point out Walking in with a paper prescription wouldn’t have helped in this situation, it wouldn’t be able to be processed, and they couldn’t get it through insurance, and they couldn’t give you a cash price because that info comes from the mighty computer

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