Category Archives: opioid abuse

Midterm Mashup

Well, the 2018 Midterm elections are over, and the analysis is beginning as to what this all means.

For those who wanted to send a message to the Russian puppet in Washington, the election meant that the House of Representatives will be controlled for the next two years starting in January by the Democrats.

For the Republicans, it means a greater control of the Senate, with at least one race, the one in my current state of Florida undecided and headed for a recount, as per state law.

However, there were many defeats for the party of Obama, Bill Clinton, Jimmy Carter, LBJ. JFK, Truman and FDR. Andrew Gillum lost to a nobody for governor of Florida who is connected to the Orangutan by an umbilical cord. Beto O’Rourke made a valiant, if futile effort against the worse person to hold a Senate seat, Lyin’ Ted Cruz. And a few Democratic senators lost seats in Indiana, Missouri and North Dakota.

But as far as health care is concerned, the change in the leadership of the House of Representatives means that the ACA is safe for another two years. and Medicare and Medicaid will not be cut, as the Senate Majority Leader has indicated he wanted to do.

Medicaid, in particular, came out of the Midterms a little better than expected before the election, as the following posts from Healthcare Dive, Joe Paduda, and Health Affairs reported this morning.

First up, Healthcare Dive, who reported that Red states say ‘yes’ to Medicaid . Idaho, Utah, and Nebraska said yes to expansion; Montana said no.

Joe Paduda echoed that in his post, “And the big winner of the 2018 Midterms is…Medicaid“. However, Joe stated that results in Montana were not final; yet, they had decided to expand Medicaid two years ago, but the vote was temporary, and yesterday’s vote was to make it permanent.

And lastly, Health Affairs reported in “What the 2018 Midterm Elections Means for Health Care” that besides blocking repeal of the ACA, Democrats may tackle drug prices, preexisting conditions protections, Opioids, Medicare for All, Surprise bills (unexpected charges from a hospital visit). regulatory oversight, extenders such as MACRA, Medicaid Disproportionate Share Hospital (DSH) payments, and Medicaid expansion, especially since gubernatorial wins in Maine, Kansas, and Wisconsin will make expansion more likely in those states.

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Trump and the Social Determinants of Health

Here’s a little light reading for your weekend, courtesy of Patricia Illingworth, writing today in Health Affairs blog about the Social Determinants of Health and the take on it by the current administration.

Ms. Illingworth rightly points out that those below the poverty level and without a college degree, both whites and minorities, suffer more serious illnesses such as diabetes, asthma, heart disease, as well as smoking, drinking and using illegal drugs more than those with college degrees.

She also states that cuts to education, energy, the environment, housing and urban development, among other social sectors, impacts health, and that if these social determinants are underfunded, people will need more health care. And now that the health care reform debate is stalled, the current POTUS is still trying to destroy the ACA, and has threatened members of his own party, including the Senate Majority Leader, Mitch McConnell.

Ms. Illingworth cites a study published by the Brookings Institution, that showed that “deaths of despair”—those associated with drugs, alcohol, and suicide—have risen significantly among middle-aged white non-Hispanic Americans without a college degree.

Living conditions, Ms. Illingworth reports, also affects rates of asthma, which are the leading cause of children’s visits to ER’s, hospitalizations, and absenteeism. And, it is more prevalent in poor and minority communities.

All of this is not surprising, since 1980, this nation has waged a relentless war against its poor and minority citizens. This war began the day Ronald Reagan took the oath of office and began dismantling not only the New Deal programs, but cutting back the programs created under the Great Society of the 1960’s.

With each successive Republican administration, as well as the rise of Republican power  in Congress since the ascension of Newt Gingrich to Speaker of the House, and in many states, especially in the formerly solid Democratic South, poverty and illness among the poor and minority, as well as whites have increased. And the loss of manufacturing and other support services jobs associated with manufacturing have resulted in the current opioid crisis, which only yesterday was addressed as a national emergency by the POTUS.

But Democrats are not without fault here too. Failure to stand up to the Reaganite Counter-Revolution, the pursuit of a failed “free trade” policy that has outsourced jobs or allowed companies to offshore jobs, as well as paying deference to the will of Wall Street and Corporate America, has brought us the current occupant of the Oval Office.

In the recent health care debate in Washington, many placed their confidence in moderate Republican senators to defeat the repeal and replace measures, but as Andrew Sullivan wrote four years ago in his blog, The Dish, “What Moderate Republicans?”, Sullivan says the following:

“There is effectively no Republican party any more. There is a radical movement to destroy the modern American state and eviscerate its institutions in favor of restoring a mythical, elysian, majority-white, nineteenth-century past. This crisis is proving that more powerfully than even watching Fox. We need to see what is in front of our nose: a cold civil war has broken out between those properly called conservatives, defending the credit of the government, empirical reality, and adjustments to modern life and those properly called radical reactionaries declaring our current elected president and Senate as illegitimate actors, bent on the destruction of America, and therefore necessitating total political warfare, even to the point of threatening to destroy the global economy.”

The current architect of this destruction is not the man with the orange hair, but one Stephen K. Bannon, the former head of Breitbart. Bannon’s radical agenda is to destroy the “deep state”, and to create what Sullivan so rightly predicted four years ago, as he said above.

Bannon has been identified as a racist, anti-Semite, and has no business in the White House. Another member of this cabal is Stephen Miller, who a few weeks ago, revealed his true colors by openly defending restricting legal immigration, something that brought his family, and mine, as well as millions of others, to this country.

I could go on, but this post is about health care.

The main point is, we need to stop playing games with people’s health and do what other Western and developed countries provide to their citizens, health care for all.

If you don’t believe me, then maybe the words of a billionaire will convince you. Warren Buffett, one of the richest men in America, and an astute and very successful businessman, unlike a certain neophyte politician, has said the following with regard to single payer.

“…government-run health insurance “probably is the best system” because it would control escalating costs. We are such a rich country. In a sense, we can afford to do it, … In almost every field of American business, it pays to bring down costs.”

It is time to give every American health care. Then we will see a vast improvement in the social determinants of health.

Big Insurer to Put Dispensing Docs on Notice

An article in Healthcare Finance yesterday reported that Aetna has put more than 900 opioid prescribing physicians on notice that they fall with the 1 percent of top opioid prescribers.

Here is the link to the article:

http://www.healthcarefinancenews.com/news/aetna-puts-more-900-physicians-notice-they-fall-within-top-1-percent-opioid-prescribers

What does this mean for workers’ comp?

It means that other insurers need to do the same for the physicians who prescribe opioids for injured workers, but as Joe Paduda recently reported, the drug spend is going down.

But he also said this, earlier this week,  “Medical services for people with opioid dependence diagnoses skyrocketed more than 3,000 percent between 2007 and 2014.”

This was for privately insured people, he continued.

“The dollar cost of the drug itself is the least of the cost issues; dependency is strongly associated with much higher utilization of drug testing, overdose treatment, office visits and (my assumption) higher usage of other drugs intended to address side effects of opioids.”

So just because Aetna is watching does not mean that the problem is going to go away any time soon.