docu-mentaling CVS takeovers, opera, & southern smarm

your bi-weekly map of the american states of mind

vol. 1 issue 1


Thanks for taking time to read this inaugural issue of docu-mental. I hope you like and share it. I am confident it will be something you will enjoy reading, however, if you don’t wish to be a part of this, please unsubscribe!

For a thorough description of the five tenents of the philosophy behind this newsletter, I urge you to visit the about page. It will frame why CVS, opera, and co-opting the American South, along with the many other items we will explore, go hand in hand, and why it matters to you.

In short, this bi-weekly semi-scholarly newsletter is my attempt to map the American states of mind. I seek to travel the trends of our current events, arts, and cultural happenings to see where those trends might be leading us.

This is not an update on current developments in clinical mental health. It’s an exploration of what sets the tone for mental health: our cultural attitudes and beliefs, and their bidirectional relationship with our collective and individual means of expression.

This newsletter is useful to policymakers, those interested in American Studies, and to citizens who are tired of being prescribed how to think and just want a good conversation.

Thanks for reading. I appreciate you taking the ride with me.

Whitney M. Fishburn
Washington, DC

The CVS Syndrome: Consumerism vs. Citizenship

A DC Circuit Court judge has given the Dept. of Justice until this Friday, February 15, to respond to complaints from independent pharmacists, the American Medical Association, and the American Antitrust Institute, among others, that the DOJ’s decision not to challenge CVS Health’s purchase of insurer Aetna was a miscarriage of justice. The DOJ is expected to clear up whether its condition for the merger that Aetna sell its Medicare drug coverage plan unit, since CVS already has one of those, will turn out to be in the public interest.

Here’s my take:

If anyone has publicly challenged the ulimtate end game for CVS, I haven’t seen it, but here’s what I think it is: to own the entire healthcare supply chain, A to Z.

They already own the formularies, which they impose through their pharmaceutical benefit management arm. They are already distributors through their partnership with Cardinal Health of nearly all drugs dispensed, since more than 80% of drugs in this country are generics. They are the nation’s largest retail pharmacy chain by sales and footprint. If the merger goes through, they will then own the prescription pad and pen of physicians, overseeing who is allowed in-network. The only thing that would be missing then is ownership of drug manufacturing.

To that end, since margins for generics manufacturers are slim (and possibly a contributing factor in the current price fixing scandal) I do not think it’s a stretch to say plenty of generic drug companies would be eager to consider a deal. How the company might move directly into the more expensive and certainly lucrative biologics is less clear to me, but if a bigger, badder CVS ends up the largest gorilla at the bargaining table, it’s hard to say they’d be left out. They already have launched their own clinical trial into in-home dialysis care.

And don’t forget Minute Clinics, which already are displacing care provided in traditional clinical settings. What if under a CVS/Aetna insurance plan, you are told you must go to a minute clinic first before seeing your physician? Will that save money at the expense of quality care?

Are the purchase of hospitals next?

My thought is that even if CVS ends up owning only most of the supply chain, without any elected officials accountable to voters at the helm making decisions over what resources are available Americans, then one-sided cries over the evils of socialized medicine are crocodile tears.

Meanwhile, the danger with such mergers becomes that we are baited and switched into thinking we’ve once again applied a strict market-based approach, and thus been good little capitalists, when what we’ve really done is sold our souls to a system that might not be called socialism, but will function far more like it than it will capitalism, only we will increasingly have less power to oppose it.

Pulitzer Prize-winning economist Steve Pearlstein recently opined elegantly about this threat to citizens, and truly to Capitalism practiced properly, in the Washington Post.

Says Pearlstein:

If mergers like CVS-Aetna continue to get the green light — then our uniquely entrepreneurial form of capitalism will soon give way to the kind of cozy corporate capitalism that has been common in Europe and Asia.

Placards for patients

In related news, last summer, the New England Journal of Medicine ran an op-ed by Harvard medical student who suggested physicians should organize to prevent burnout. It’s protected by a paywall, but here’s the abstract:

There is a link between social determinants of patients’ health and physician burnout, but that association suggests a way forward. If individual powerlessness is the crux of this source of burnout, then organizing toward collective action should be part of the solution.

It does speak to #4 of the 5 guiding principals of docu-mental. Here are a few excerpts I found worthy:

The social determinants of health — and physicians’ sense of powerlessness in the face of them — seem crucially missing from the discussion of burnout.

…we are led (and allow ourselves) to believe that we as individuals have more power than we do.

If individual powerlessness is the crux of this source of burnout, then organizing toward collective action should be part of the solution. Each of us can advocate for our homeless patients to be put on waiting lists for public housing. But what would happen if all doctors with homeless patients organized to demand more affordable housing?

(Nashville at night, Steve Belew on Flickr)

The South’s gettin’ too expensive to be real

If you’ve not discovered the delights of reading essayist Margaret Renkl, Chapter 16 is a good place to start. Renkl writes often about the South, nature, and personal reflection. She also writes columns like this one in the New York Times about how Nashville, her home town, is getting too expensive for the songwriters who made the city what it is, to afford living there any longer.

It captured my attention because it spoke to my growing annoyance of seeing the South, from whence I originally hale, becoming an ersatz version of itself as it is bought, packaged, and sold as reminiscent of the “authentic South”.

I had this experience recently in Baltimore: I despaired to read the promotional signs posted near a construction site by the corporate developers in charge of the area’s “repurposement”. It advertised I would love what was coming soon, that is to say, more of the exact same stores I can already shop and restaurants where I can eat already in my hometown of Washington, DC, not to mention precisely the same stores and eateries, and in the same alignment, I am treated to when I am in Dallas. Oh, and Atlanta. And Orlando. Oh, right, and Jacksonville. And of course, West Palm Beach. And now, Nashville.

The authentic South is, apparently, a mall.

Not just ‘dead white guys’

The Kennedy Center here in Washington is a publicly funded institution, and so has a mandate to serve all. But in a recent press briefing, the artistic directors said that means Beethoven matters, dammit. Read more about it in my review of their 2019-2020 season.

Giffy giggle:

Thanks for reading! See you at the end of the month.