The New Yorker has a wonderful story this week about the only pharmacist in Nucla, Colorado (population 700). His name is Don Colcord, and he does his best to serve an area of 4,000 square miles. Somehow he manages in spite of Medicare Part D, George W. Bush’s unfunded gift to the insurance industry and the nation’s deficit:

…He keeps watch-repair tools behind the counter, and he uses them almost as frequently as he complains about Walmart, insurance companies, and Medicare Part D. Since 2006, the program has provided prescription-drug coverage for the elderly and disabled, insuring that millions of people get their medication. But it’s also had the unintended [Editor’s note: my ass] effect of driving rural pharmacies out of business.

Instead of establishing a national formulary with standard drug prices, the way many countries do, the U.S. government allows private insurance plans to negotiate with drug providers. Big chains and mail-order pharmacies receive much better rates than independent stores, because of volume. Within the first two years of the program, more than five hundred rural pharmacies went out of business.

Don gives the example of a local customer who needs Humira for rheumatoid arthritis. The insurance company reimburses $1,721.83 for a month’s supply, but Don pays $1,765.23 for the drug. “I lose $43.40 every time I fill it, once a month,” he says. Don’s customer doesn’t like using mail-order pharmacies; he worries about missing a delivery, and he wants to be able to ask a pharmacist questions face to face. “I like the guy,” Don says. “So I keep doing it.” Don’s margins have grown so small that on three occasions he has had to put his savings into the Apothecary Shoppe in order to keep the doors open…