MAINTENANCE REQUIRED, JERK

We’ve got a Prius. It’s great. Really, I’m not just saying that. It’s the smoothest car I’ve ever owned. It’s got a tight turning radius, and everybody loves a tight turning radius.

The problem is that sometimes it gets mad at us.

It uses synthetic oil, which is scheduled to be changed ever 5 months or 5,000 miles.

When the time comes near, it will start prompting you on start up.

When the time arrives, every time you turn on the car, this message will appear on the dash:

MAINTENANCE REQUIRED

After you see it about a dozen times, you come to think that the tone has changed. It’s in all caps, after all, and it’s very insistent.

MAINTENANCE REQUIRED ALREADY

Another couple dozen times - keep in mind that we’re not yet at 5,000 miles, and not even two weeks in to the messages - and it feels like the tone is beyond insistent. It’s exasperated.

MAINTENANCE REQUIRED, JERK

So last week I went and got the oil changed. I went to a quick lube place. Guy comes around with the dipstick in his hand. Asks, am I sure that it was due? I said, well, it’s been 5,000 miles.

“And the car said it was time.”

He showed me the dipstick and said the oil looked brand new.

So on the one hand, the car is great, it doesn’t even wear its oil down.

On the other hand, it yelled at us for no good reason.

If only it were just our Prius.

I’m a list guy. I make a lot of lists. I especially make lists of things to be done. I learned this from my dad, who always seemed to have a long list around.

I think keeping lists has changed though. In part it’s because there are new tasks, and I’ll get into that. But also in part it’s because a lot of tasks have turned quasi-urgent. There are reminders. The reminders feel more strident. And we react accordingly.

I had started to write here about other things - About how our other car is older, so it doesn’t tell us shit! About how my 6 year old “needs” a bat, but I can’t figure out how the hell to buy him one! About how insane it must be for single parents with multiple children to be bombarded by reminders!

What I realized though is that I didn’t have a list of all of these things that had been piling up, because they were GIGO: Garbage In, Garbage Out. Once something was off a list, it mostly went out of mind. And so I was kind of stretching to “prove” how tasks and reminders had gotten so out of control.

And then, thanks to Matt Stoller, he of the Substack BIG - which I heartily recommend you subscribe to - I remembered what other thing had been aggravating the hell out of me.

My pharmacy.

We use CVS. Whatever.

I’ve got a couple of active prescriptions right now. Nothing major, nothing interesting.

One prescription is set to refill automatically, so every 30 days, the texts start coming in that my prescription is ready.

Another two prescriptions, for some reason, were not set to refill automatically.

Text from 9 days ago:

HI PHIL, would you like your current and future eligible Rxs at CVS pharmacy to be automatically refilled for you? Text Y to accept!

Text from 7 days ago:

CVS Pharmacy: Phil, remember to text Y to have all of your current and future Rxs automatically filled on time with ReadyFill

Text from 4 days ago:

CVS Pharmacy: PLEASE RESPOND: Phil, you have 2 Rx due to refill. Would you like your pharmacist to refill XX? Text YES or NO. Txt NAME for full Rx name.

Obviously this is a computer system so it’s not exactly being “pushy”. It’s just following algorithms.

And those are just the texts. My phone shows me that the local pharmacy called me 8 times in January. And none of those calls were because I had something waiting. They were all an attempt to get me to automatically refill anything and everything.

Matt Stoller’s piece on all this is “How CVS Became A Health Care Tyrant”, and it expands upon a New York Times piece last week, “How Chaos at Chain Pharmacies Is Putting Patients at Risk”, which hit a lot of chains, but especially CVS.

My Prius insisting it get maintenance? Well, even if the maintenance proved to be frankly unnecessary, it was at least scheduled, and there’s no harm to an extra oil change… assuming it’s done properly.

CVS, though? They’re pushing pills. They’re shoving extra pills on people, much like what has been happening with opioids. Yes, the doctor authorizes all of the prescriptions, but it’s literally an algorithm driving many of the requests. And because of all of the texts and notices and reminders, people are just falling in line. Medications they’re not sure they still need, they’re still going to get them, they’re still using them.

And in turn, not only are we over-Rxed, but the pharmacies are making mistakes, because everything there is a desperate push to squeeze profits.

The thought had never occurred to me before writing all of this. Follow along:

Toyota wants me to bring my car in to a dealership to get serviced. They have a vested interest in pushing that business. So they’re going to roll out conservative numbers for how often service is needed. Better to be safe than sorry, after all!

The thing is, though, that they also have a vested interest in my Prius, and all other Toyotas, staying on the road for a long time. It helps their bottom line that people think Toyota is reliable.

My doctor wants me to come in when I’m sick. It’s billable, after all. She’s got a vested interest in those visits. So if I’ve been really sick, well, maybe I should come back in after six weeks. Better to be safe than sorry, after all!

The thing is, though, that she absolutely has a vested interest in my well-being. It’s not just that she’s taken an oath to uphold standards of care and all that Hippocrates stuff. If I’m ill, and I go see her, and then I’m better, it’s not just good for me, it’s good for business. She wants people to think she’s a good doctor! She wants more patients!

CVS wants me to go get pills. And when those pills run out, they want me to get more pills. They have a vested interest in having me come back for more and more pills. Plus, while I’m there, I might buy toilet paper or deodorant or chocolate or plastic shit or bandages or what-have-you. The Toyota dealership can try to upsell me too, but CVS manages to upsell half the time, even if they only make a couple of cents on the upsell.

The thing is, though, that CVS… has no vested interest in my well-being.

Now, they don’t want to piss me off and lose my business. And they don’t want me to die or anything like that. But so long as nobody there screws up and poisons me with the wrong prescription, I’m probably just going to keep coming in whenever I need to, and that’s all the better for them. Ultimately, the best case scenario for CVS is that I stay indefinitely prescribed to something, in other words, that I am indefinitely just a little sick.

Now I am not being so cynical and crass as to suggest that CVS actively wants all of us to be sick! But a gigantic corporation feels no compassion. If we all get sick and need pills, their quarterly profits will be robust, and they’re not going to feel bittersweet about it in their boardrooms.

After reading the Times piece and reading Matt Stoller’s piece, I feel like we should really go find another pharmacy…

… but CVS is in a good location, and besides we’d have to contact doctors, and change prescriptions… so many more things to put on various lists.

My proclivity for building and completing lists could be taken a couple of different ways. Maybe it means I’m highly organized… that’s good! Maybe it means I’m obsessive-compulsive… that’s not so good? For a long time though, whether it’s good or bad, I’ve just sort of regarded it as, okay, this is how I am. And given that this is how I am, maybe I can leverage it. It’s put me in good stead at work, where I’m regarded as highly productive, getting a lot of things done. I just can’t stand leaving a long list of things around to be dealt with.

What’s never occurred to me so starkly before is how this list-making proclivity might actually be weaponized. The car needs maintenance. I need to renew this prescription. The house needs work done. Needs. Needs. Needs. And if you’re astute enough to figure out how to slide something onto the lists of needs, I’ll get to it. And maybe you’ll make money in the process. Or maybe in some other way I’ll be conforming to your corporate expectations.

The Prius maintenance seemed funny. The CVS barrage of texts and calls seemed aggravating. Now though I’m thinking that there’s something pernicious going on. It’s not that I’m rebelling against regular auto maintenance, or beginning to think my doctor is a quack. But recommendations do seem to have a way of becoming requirements, don’t they? It’s not like the Prius said MAINTENANCE RECOMMENDED. It said MAINTENANCE REQUIRED. REQUIRED by whom? Toyota? What are they going to do to me, exactly? Make me drive a Yaris?

I am told that for my son starting Little League I will need to get not just a bat, but one which has been certified. Excuse me? He’s six! What will happen if I do this wrong? Well, am I willing to find out? Maybe I’m not.

It’s not hard to imagine a flurry of other requirements too. Maybe not things put on lists. Maybe lists of things not to do. Maybe just rules, not tasks. Maybe rules and tasks. And then reminders. Reminders of so many things. So many irrelevant things.

I can begin to understand, at a base structural level, how people would recoil at all of this. And if they began to believe that all of this was being flung at them as part of some kind of nefarious agenda… well, let’s just say that propaganda is employed because propaganda works.

And yet the agenda need not be all that nefarious. CVS may not have a vested interest in my well-being, but they’re not actively trying to make me sick. It’s just that the profit motive trumps all.

I can roll with the conceptual idea of an automobile manufacturer prioritizing profit, so long as they don’t sacrifice safety in the process.

But maybe, when I look at what CVS is doing… well, maybe, I don’t want a top-ten corporation gobbling up multiple sectors in health care, pushing pills as part of an overall profit motive. Maybe there is an intractable conflict there. Maybe this is a failed system.

Maybe my Prius should pay a visit to Washington, park itself in the Capitol, and send a message about the entire for-profit health care system:

MAINTENANCE REQUIRED, JERKS