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Kitchen Table Kibitzing Dec 2, 2023: The Great American vision care racket [1]
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Date: 2023-12-02
Like millions of my fellow Americans, one of the first things I do in the morning is put my contacts in. I’ve worn some type of corrective lenses since about the age of eleven. And although the lenses specify they’re supposed to be changed or discarded every three weeks or so, I’m on my third month with this set. I’ll continue to wear them until one tears, and then I’ll dig into my stash for another to replace the torn one. On the day that my supply finally peters out, I’ll wear my glasses (which haven’t been replaced since sometime prior to the pandemic) and grudgingly schedule an appointment, because it’s been more than a year since my last exam. Way, way more than a year, in fact. So if I try to call 1-800 Contacts, I know they’ll reject me, saying my prescription isn’t up to date and I need yet another eye exam. In effect, I’ve been putting off the inevitable.
Admittedly, it’s difficult to compartmentalize the feelings of guilt that accompany this pathological behavior. In fact, I often struggle to cope with the insomnia-inducing anxiety that by behaving this way I am keeping some hard-working optometrist working for substandard wages in my local strip mall eye-care center. However, I console myself with the certitude that I’m absolutely the only person in America who does this.
Let me explain further. Unlike (I am certain) all of my other fellow Americans who dutifully follow the rules, I do this simply out of habit, probably a vestigial echo of the years I spend living hand-to-mouth. Yes, full disclosure, I can afford new contacts and glasses. But every trip to the eyeglass shop still ends up with me spending something close to $200-300, for a new prescription and the cost of obtaining new lenses of any type. And I have what passes in this country for decent vision coverage.
Most folks are shelling out as much or more than me, I assume, passively acquiescing to what is in effect a national institution of often superfluous and unnecessary eye care. Yascha Mounk, writing for the Atlantic, has a good point about the hoops Americans have to jump through to receive the vision care requisite to simply obtain a pair of corrective lenses, be they glasses or contact lenses.
Apparently Yascha has some pretty bad vision, and he lost his glasses on a kayaking trip down the Connecticut river, between New Hampshire and Vermont. As he was pretty much helpless without them, he tried to get another pair as soon as possible. Alas, he was in the United States at the time, where the only way to get a new pair of corrective lenses — if you don’t have an up to date ‘scrip handy in your wallet or elsewhere — involves seeing an optometrist to test your eyesight and provide a prescription.
Mounk identifies this as a uniquely American conundrum.
The ordeal led me to look into a fact that has puzzled me ever since I moved to the United States a dozen years ago. In every other country in which I’ve lived—Germany and Britain, France and Italy—it is far easier to buy glasses or contact lenses than it is here. In those countries, as in Peru, you can simply walk into an optician’s store and ask an employee to give you an eye test, likely free of charge. If you already know your strength, you can just tell them what you want. You can also buy contact lenses from the closest drugstore without having to talk to a single soul—no doctor’s prescription necessary.
(As an aside, the older I get, the more frequently I see references to what “other” developed countries do far better than this country. It happens so often now I have to psychologically compensate for it by watching TV sports, where the commercial advertisements always assure me I’m living in the best of all possible places, a place where beer and Dodge Ram pickups are plentiful and people everywhere are smiling and laughing, enjoying the benefits of remarkable pharmaceutical products that I should ask my doctor about — during our thirty seconds of actual facetime).
Got to get that eye exam!
As Mounk observes, the stern rejoinder by the eye care industry is that it’s important to identify vision problems as soon as possible, because, by golly, 2.2 billion people on the planet have some type of vision impairment, and that necessitates early detection! See? They’re doing all of us a big favor!
Mounk isn’t buying it, though:
But this argument rather begs the question. After all, the added cost of having to see an optometrist presumably stops many Americans from accessing the corrective lenses they need to improve their vision. Is the desirability of an eye exam performed by a medical professional a sufficient reason to prevent Americans who would rather not—or cannot—visit an optometrist from buying glasses and contacts? We can only answer this question by acknowledging a trade-off between competing goods.
The strange thing though, as Mounk notes, is that the rest of the world hasn’t reached the same conclusion. What the American “solution” does is to effectively keep people — particularly people who don’t have good vision care insurance (and that includes millions of people who have otherwise decent health coverage) — from seeing an eye doctor because of the often-exorbitant cost involved.
Why does this happen? Mounk thinks he knows:
One possible reason for such strict vision-wear rules is that many people have a financial interest in this burdensome system. If Americans no longer needed to book appointments with optometrists to buy glasses or contacts, many optometrists would see their salaries cut, and some might go out of business altogether. [***] It is little wonder, then, that American optometrists spend a lot of money on lobbying. According to the Center for Responsive Politics, for example, the AOA spent $1.8 million on lobbying and another $1.4 million on campaign contributions in 2016. And although the AOA was unsuccessful in its attempt to block the laws requiring optometrists to give patients a copy of their prescription, any attempt to remove the need for frequent office visits (the exact figure depends on whether you wear glasses or contacts, among other factors) is likely to meet with stiff resistance.
Mounk thinks this is ridiculous and that these mandatory eye exams should be abolished. He acknowledges that a few people will have some serious eyesight problems diagnosed in furtherance of this oppressive regime. But he (sensibly, I think) cites the millions of Americans for whom the cost of these repetitive exams (“Your prescription has changed very, very slightly, but we’re running a special where every third pair of new frames you didn’t really need is free!”) is simply a financial burden they shouldn’t have to contend with just to get a pair of lenses. His point is that somehow the people in every other developed country in the world manage to navigate through their lives without this mandate Americans have been conditioned to internalize and accept.
And then he goes really off the rails and suggests that such a change might even receive “bipartisan” support in Congress. And believe me, if I could stop the tears of laughter at this suggestion from blurring my vision, I’d explain to you the reasons he believe this, because I’m sure they’re in his essay somewhere. Something about “free enterprise” and “healthcare for the disadvantaged” converging to represent the interests of both parties. But as things currently stand, try as I might, I just can’t see them.
So maybe I’ll revisit his article after I go for that next prescription.
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