Addicted to Opioids and want a pill that reduces cravings? Call now, or not.

[ch33zw1z]

https://www.masslive.com/living/201...nd-heroin-users-denied-medical-treatment.html

*disclosure - this site may contain many ad's

Anyways, this came across my local news feed, but covers many states and many American's battle with opioid's

"I found it surprising how many calls I had to make before being offered an appointment," said graduate student Tamara Beetham who encountered both compassion and scolding from clinic staff. "Whether you have cash in your pocket can determine whether you have access to life-saving treatment." The study appears Monday in Annals of Internal Medicine .

Well, that's America, maybe Ms Beetham is just a commie pig dog?

Callers tried reaching 546 prescribers with working numbers listed on a government website , which also included hundreds of outdated contacts.

They made calls during 2018 to prescribers in Massachusetts, Ohio, Maryland, West Virginia, New Hampshire and the District of Columbia.

Hmmm, tell me again what the current admin plan to battle opioid addiction epidemic was?

 

[TheVrolok]

Poors are second class citizens, I thought this was well understood. If they wanted higher quality treatment, they'd be richer and could afford it. Obviously they don't work hard enough.

 

[brycejones]

Poors are second class citizens, I thought this was well understood. If they wanted higher quality treatment, they'd be richer and could afford it. Obviously they don't work hard enough.

Shame on them, they must be of low moral character.

 

[TheVrolok]

Shame on them, they must be of low moral character.

And deficient in bootstraps!

 

[ch33zw1z]

And deficient in bootstraps!

BDS is real. There's a pill for it, bit you can't afford that either.

 

[TheVrolok]

BDS is real. There's a pill for it, bit you can't afford that either.

The ironing!

 

[Hayabusa Rider]

Poors are second class citizens, I thought this was well understood. If they wanted higher quality treatment, they'd be richer and could afford it. Obviously they don't work hard enough.

So what do you do to make the costs of care less expensive for providers?

I know one of the best pediatricians in MD, well she was but had to close her practice and work for the government until retirement. Why? Because she was one of the good guys and was in the high 90% Medicaid. She wasn't making a ton of money from a professional status, could have done better financially but that wasn't what she was after.

But then reimbursements were cut and cut again. She let staff go. Rinse and repeat (she had a large practice) until she was putting in 16 to 18 hours doing her and the staff's work. Then it came to the point where she was bleeding funds from her own personal savings. Bad management? No, her husband oversaw that, someone with a big name school MBA specializing in medical cost savings, a successful consultant in his own right for hospitals and private practices in the US. In every scenario, black turned to red ink.

In the end she left along with a lot of other pros because of reimbursement meaning an impossible scenario.

The grad student who was "shocked" had no idea of what the reasons are for reluctance. In some cases sure, it's greed, but if that's the first go-to, then the economics of providing care are utterly lost on people with strong opinions.

I don't like people being refused treatment for addiction, but how about some help to allow for the possibility?

Don't invoke magic, make suggestions not phrases and explain how they work.

Running in the red is a non-starter and not one of you could do it.

Go.

Edit, I have one suggestion right away.

 

[dank69]

So what do you do to make the costs of care less expensive for providers?

I know one of the best pediatricians in MD, well she was but had to close her practice and work for the government until retirement. Why? Because she was one of the good guys and was in the high 90% Medicaid. She wasn't making a ton of money from a professional status, could have done better financially but that wasn't what she was after.

But then reimbursements were cut and cut again. She let staff go. Rinse and repeat (she had a large practice) until she was putting in 16 to 18 hours doing her and the staff's work. Then it came to the point where she was bleeding funds from her own personal savings. Bad management? No, her husband oversaw that, someone with a big name school MBA specializing in medical cost savings, a successful consultant in his own right for hospitals and private practices in the US. In every scenario, black turned to red ink.

In the end she left along with a lot of other pros because of reimbursement meaning an impossible scenario.

The grad student who was "shocked" had no idea of what the reasons are for reluctance. In some cases sure, it's greed, but if that's the first go-to, then the economics of providing care are utterly lost on people with strong opinions.

I don't like people being refused treatment for addiction, but how about some help to allow for the possibility?

Don't invoke magic, make suggestions not phrases and explain how they work.

Running in the red is a non-starter and not one of you could do it.

Go.

Edit, I have one suggestion right away.

Um, why were reimbursements cut and cut again?

 

[Hayabusa Rider]

Um, why were reimbursements cut and cut again?

To reduce the cost of care. That's SOP. What would you expect cost containment bean counters would do? You might also bone up about cost avoidance, where insurance (including government systems) place the burden of paperwork on providers, a major cost to them. No, Medicaid/Medicare has not reduced that to a single bill in a drawer, quite the opposite.


So preventing that would be nice but that shifts cost back to insurers who don't want to pay more, they want to put out less.

I'm game for a working system that improves care, provides better access which means supporting providers, and provides better care.

So within our legal and political environment, as it exists, someone come up with concrete ways to achieve this, a nuts and bolts solution. Neither "free market" nor "Medicare for all" as dog whistles provides that.

I'll make this easy. Name one significant thing that could address the problems as they are, and I mean of great and effective substance.

 

[dank69]

To reduce the cost of care. That's SOP. What would you expect cost containment bean counters would do? You might also bone up about cost avoidance, where insurance (including government systems) place the burden of paperwork on providers, a major cost to them. No, Medicaid/Medicare has not reduced that to a single bill in a drawer, quite the opposite.


So preventing that would be nice but that shifts cost back to insurers who don't want to pay more, they want to put out less.

I'm game for a working system that improves care, provides better access which means supporting providers, and provides better care.

So within our legal and political environment, as it exists, someone come up with concrete ways to achieve this, a nuts and bolts solution. Neither "free market" nor "Medicare for all" as dog whistles provides that.

I'll make this easy. Name one significant thing that could address the problems as they are, and I mean of great and effective substance.

I obviously can't since I have essentially no knowledge of the healthcare system. I'm just wondering why you think the systems that work in every other country will not work here. For example, what is the difference between Medicare for All and Canada's healthcare system?

 

[IronWing]

Kind of a whack system if one can afford heroin but can't afford heroin treatment.

 

[glenn1]

I obviously can't since I have essentially no knowledge of the healthcare system. I'm just wondering why you think the systems that work in every other country will not work here. For example, what is the difference between Medicare for All and Canada's healthcare system?

One main difference is the U.S. lacks Federal and Provincial VAT taxes that are in the 15% range for most that are on top of regular income taxes that are roughly in line with the United States. This isn't an argument for one system or against another, but the idea that socialized medicine systems are clearly superior in every single respect is clearly incorrect. You pay for medical care one way or another, whether it's in taxes or via the crazy tax subsidized employer benefit scheme the U.S. uses. Even then how you think about "how much you pay" for medical care drives interesting conversations - why should "percentage of GDP spent on healthcare" be the primary metric for what's "good" spending or "bad" spending? In many cases healthcare is a luxury good that we willingly spend more on - just as we don't live in the slums with the cheapest possible rent we spend more "as a percentage of GDP" to live in nicer houses when we can afford it. Likewise if we only paid for the cheapest and lowest quality healthcare, the percentage of "healthcare spending to GDP" would be lower but would we necessarily be better off? Should people forgo healthcare spending that improves their lives (like orthodontics or vision correction surgery) because they don't "need" it and thus we could celebrate "Yay we spend less on healthcare as a percentage of GDP last year"? Clearly that would be absurd.

 

[Hayabusa Rider]

I obviously can't since I have essentially no knowledge of the healthcare system. I'm just wondering why you think the systems that work in every other country will not work here. For example, what is the difference between Medicare for All and Canada's healthcare system?

Canada has a health care system. Medicare isn't that but a financial construction without consideration to care itself in any real way. Part of that is the inherent nature of their government having more control over all aspects of the economy. coupled with more taxes. The other thing about a true system is that it must take multiple factors into consideration. What it costs to provide care is lower while Medicare does nothing but put more pressure on providers to quit. Their considerations aren't even a distant thought. People do go into care for care sake but expecting martyrism isn't smart- at all.

One can also opt out if one is wealthy and get better care (sound familiar?) . What will have to change is the low cost of government overhead often cited due to cost shifting and people not wanting to wait for prior authorizations. They'll have to absorb the outlays of private insurance although I'm not arguing that there's no profit in insurance. We'll need the largest bureaucracy we've ever had and it needs to be responsive and subject to easy reformation. Just the sheer volume of work involved is immense.

Again I'm not saying that we don't need reformation, I'm the most radical one posting in this forum at least one who considers cause, effect and what happens next.

First thing is stability. Our "system" is more like an inverted pyramid with no intelligent and cohesive mechanism behind it.

So let's start with what I proposed, buying us time, in the "Best system" thread and that is to allow up to 100% deductions of medical costs and the specific amounts to be determined on financial considerations.

Then fully pick up the tab for medical insurance and offer a period of "indentured servitude" for costs of education. PAY FOR THE FUCKING RESIDENCIES, the real block to having more physicians and other specialists.

Right there coverers the outstanding long term costs for people and providers while improving financial access and accessibility to qualified practitioners.

This does not mean "you bill anything and we pay everything". Surprisingly that's not done and instead the costs are passed onto people which is why insurance doesn't protect against financial ruin. Set up a system of payments that takes into consideration the real costs of treating a patient. Know what will absolutely ruin finances? Obese people. They are at higher risk from all causes but they are reimbursed as if a healthy person (other than the primary complaint) were admitted. Since providers won't get paid for costs that means spreading them over everything and everyone.

So get some people who know what the hell is going on, the equivalent of rocket scientists of the care world to figure out a viable reimbursement scheme instead of jumping into the quicksand without a rope to pull yourself out.

Absorb costs federally, address the fundamental and systemic problems everyone wants to bury under a stump, then implement a well modeled and tested series of options (because one size will NEVER fit such a diverse and large nations such as ours)

We can have a better system, or at least better for us than someone that of someone else.

Someone mentioned Israel and their system. They also have a highly effective wall. Let's not be as stupid with care as Reps are with the wall.

 

[dank69]

One main difference is the U.S. lacks Federal and Provincial VAT taxes that are in the 15% range for most that are on top of regular income taxes that are roughly in line with the United States. This isn't an argument for one system or against another, but the idea that socialized medicine systems are clearly superior in every single respect is clearly incorrect. You pay for medical care one way or another, whether it's in taxes or via the crazy tax subsidized employer benefit scheme the U.S. uses. Even then how you think about "how much you pay" for medical care drives interesting conversations - why should "percentage of GDP spent on healthcare" be the primary metric for what's "good" spending or "bad" spending? In many cases healthcare is a luxury good that we willingly spend more on - just as we don't live in the slums with the cheapest possible rent we spend more "as a percentage of GDP" to live in nicer houses when we can afford it. Likewise if we only paid for the cheapest and lowest quality healthcare, the percentage of "healthcare spending to GDP" would be lower but would we necessarily be better off? Should people forgo healthcare spending that improves their lives (like orthodontics or vision correction surgery) because they don't "need" it and thus we could celebrate "Yay we spend less on healthcare as a percentage of GDP last year"? Clearly that would be absurd.

Your argument would be valid if we didn't pay nearly double that of other nations for care that is actually worse. I think someone mentioned earlier 37th place worse. As for paying, yes obviously we have to pay but it seems to me buying in bulk saves tons of money. Have the US government buy all the healthcare as opposed to thousands of corporations and millions of individuals. I honestly don't understand why every corporation that is not part of the healthcare industry is not lobbying heavily for single-payer. You would think they would love to slash all healthcare benefits for employees from their operating costs. I think all of the research and data says that will we pay substantially less for equal or better outcomes if we go to single-payer and it isn't magic. Think about how much more we would all pay if each one of us had to shop around for police/fire protection or roads and other infrastructure. There are certain systems where socialism just makes a ton more sense than capitalism and something like healthcare where every single person needs it is one of those cases.

 

[Hayabusa Rider]

Your argument would be valid if we didn't pay nearly double that of other nations for care that is actually worse. I think someone mentioned earlier 37th place worse. As for paying, yes obviously we have to pay but it seems to me buying in bulk saves tons of money. Have the US government buy all the healthcare as opposed to thousands of corporations and millions of individuals. I honestly don't understand why every corporation that is not part of the healthcare industry is not lobbying heavily for single-payer. You would think they would love to slash all healthcare benefits for employees from their operating costs. I think all of the research and data says that will we pay substantially less for equal or better outcomes if we go to single-payer and it isn't magic. Think about how much more we would all pay if each one of us had to shop around for police/fire protection or roads and other infrastructure. There are certain systems where socialism just makes a ton more sense than capitalism and something like healthcare where every single person needs it is one of those cases.

Buying in bulk applies when there is a market surplus. There is no such thing in care. Cardiac nurses are doing 16-18 hour shifts as it is as I can personally attest to as a patient.

Of course we could impliment an AOC like tax scheme as well for a hundred billion a year or so and amend the tax code for a minimum no-exemption corporate minimum tax and cut military spending by a third. That's easy peasy compared to actual heal care reform.

What can be done is to legislate that the VA pick up the slack and have clinics for this purpose.

 

[dank69]

Canada has a health care system. Medicare isn't that but a financial construction without consideration to care itself in any real way. Part of that is the inherent nature of their government having more control over all aspects of the economy. coupled with more taxes. The other thing about a true system is that it must take multiple factors into consideration. What it costs to provide care is lower while Medicare does nothing but put more pressure on providers to quit. Their considerations aren't even a distant thought. People do go into care for care sake but expecting martyrism isn't smart- at all.

One can also opt out if one is wealthy and get better care (sound familiar?) . What will have to change is the low cost of government overhead often cited due to cost shifting and people not wanting to wait for prior authorizations. They'll have to absorb the outlays of private insurance although I'm not arguing that there's no profit in insurance. We'll need the largest bureaucracy we've ever had and it needs to be responsive and subject to easy reformation. Just the sheer volume of work involved is immense.

Again I'm not saying that we don't need reformation, I'm the most radical one posting in this forum at least one who considers cause, effect and what happens next.

First thing is stability. Our "system" is more like an inverted pyramid with no intelligent and cohesive mechanism behind it.

So let's start with what I proposed, buying us time, in the "Best system" thread and that is to allow up to 100% deductions of medical costs and the specific amounts to be determined on financial considerations.

Then fully pick up the tab for medical insurance and offer a period of "indentured servitude" for costs of education. PAY FOR THE FUCKING RESIDENCIES, the real block to having more physicians and other specialists.

Right there coverers the outstanding long term costs for people and providers while improving financial access and accessibility to qualified practitioners.

This does not mean "you bill anything and we pay everything". Surprisingly that's not done and instead the costs are passed onto people which is why insurance doesn't protect against financial ruin. Set up a system of payments that takes into consideration the real costs of treating a patient. Know what will absolutely ruin finances? Obese people. They are at higher risk from all causes but they are reimbursed as if a healthy person (other than the primary complaint) were admitted. Since providers won't get paid for costs that means spreading them over everything and everyone.

So get some people who know what the hell is going on, the equivalent of rocket scientists of the care world to figure out a viable reimbursement scheme instead of jumping into the quicksand without a rope to pull yourself out.

Absorb costs federally, address the fundamental and systemic problems everyone wants to bury under a stump, then implement a well modeled and tested series of options (because one size will NEVER fit such a diverse and large nations such as ours)

We can have a better system, or at least better for us than someone that of someone else.

Someone mentioned Israel and their system. They also have a highly effective wall. Let's not be as stupid with care as Reps are with the wall.

I think it goes without saying that if we were to move toward M4A this "pressure on providers to quit" stuff would have to cease. I would think something like that would naturally go away as there would no longer be any other source of income for providers other than the small segment of the population that could afford to "opt out" and I doubt the goal of M4A administrators would be to reduce the number of providers. That makes no sense. The lack of other income sources I think would drive costs way down.

I'm not saying you have bad ideas, they all sound perfectly fine to an idiot such as myself, but I question the claim that we cannot do what other countries do. The idea that we are some beacon of diversity seems wrong and I can't find any systems that rank the US especially high in diversity as opposed to say, India or something. Obviously we would need better regulations than India but I doubt that is a system killer.

 

[interchange]

Buprenorphine prescribing can be a pretty good gig, but a fraction of the folks who have the position to get certified to do it are pursuing it. I think it's an area where providers would simply rather avoid stepping into the dynamics of it, which probably more relates to our societal interactions with addiction than clinical. If viewed as the disease it is, addiction becomes much easier to treat although not an illness with generally great outcomes.

Structurally, I think some way of mandating training at a minimum would be important. Need to make providers understand it's a duty to treat these people who have a legitimate illness.

 

[dank69]

Buying in bulk applies when there is a market surplus. There is no such thing in care. Cardiac nurses are doing 16-18 hour shifts as it is as I can personally attest to as a patient.

Of course we could impliment an AOC like tax scheme as well for a hundred billion a year or so and amend the tax code for a minimum no-exemption corporate minimum tax and cut military spending by a third. That's easy peasy compared to actual heal care reform.

What can be done is to legislate that the VA pick up the slack and have clinics for this purpose.

Clearly any reform would need to include policies to promote more providers. However, I think you and I both agree that many of our problems stem from corporate ownership of hospitals and corporate ownership of pharmaceuticals, etc.

 

[Hayabusa Rider]

I think it goes without saying that if we were to move toward M4A this "pressure on providers to quit" stuff would have to cease. I would think something like that would naturally go away as there would no longer be any other source of income for providers other than the small segment of the population that could afford to "opt out" and I doubt the goal of M4A administrators would be to reduce the number of providers. That makes no sense. The lack of other income sources I think would drive costs way down.

I'm not saying you have bad ideas, they all sound perfectly fine to an idiot such as myself, but I question the claim that we cannot do what other countries do. The idea that we are some beacon of diversity seems wrong and I can't find any systems that rank the US especially high in diversity as opposed to say, India or something. Obviously we would need better regulations than India but I doubt that is a system killer.

Remember that the goal of any administrative provider to keep costs down. That means already putting providers into worse shape or providing more money than they are willing to promise to look good. The idea of spending more even in the short run will be shot down by people on all sides as "unnecessary".

I am saying that we cannot do what other countries do with the way that they do them. Consequently we have to figure out how to get superior results in ways that work in real life. Intentions? The road to hell when "what happens next" with material consequences is either not understood, not taken into account or simply not cared about.

So in principle I support your goals if they are about doing better, but a canned response as a political slogan is not that solution. Once implimented a bureaucy is more resistant to substantial reform that a cockroach to an apocalypse.

Do triage first, as with financial burdens relieved, use existing agencies to provide relief for opioids and other issues at need, then formulate more than one model and test it before deciding on bloodletting.

 

[Hayabusa Rider]

Buprenorphine prescribing can be a pretty good gig, but a fraction of the folks who have the position to get certified to do it are pursuing it. I think it's an area where providers would simply rather avoid stepping into the dynamics of it, which probably more relates to our societal interactions with addiction than clinical. If viewed as the disease it is, addiction becomes much easier to treat although not an illness with generally great outcomes.

Structurally, I think some way of mandating training at a minimum would be important. Need to make providers understand it's a duty to treat these people who have a legitimate illness.

There's also the legal clusterfuck one can step into or "dynamics" if you prefer. The government holds itself to a lower standard in that regard so again have government agencies provide this until we clean up the underlying systemic issues.

This is a metric shitton of problems right here.

 

[dank69]

Remember that the goal of any administrative provider to keep costs down. That means already putting providers into worse shape or providing more money than they are willing to promise to look good. The idea of spending more even in the short run will be shot down by people on all sides as "unnecessary".

I am saying that we cannot do what other countries do with the way that they do them. Consequently we have to figure out how to get superior results in ways that work in real life. Intentions? The road to hell when "what happens next" with material consequences is either not understood, not taken into account or simply not cared about.

So in principle I support your goals if they are about doing better, but a canned response as a political slogan is not that solution. Once implimented a bureaucy is more resistant to substantial reform that a cockroach to an apocalypse.

Do triage first, as with financial burdens relieved, use existing agencies to provide relief for opioids and other issues at need, then formulate more than one model and test it before deciding on bloodletting.

Yeah but I don't see anything in your triage suggestions that will address out of control healthcare costs. Of course it is also possible I just don't understand which of your suggestions address that or how...

 

[Hayabusa Rider]

Clearly any reform would need to include policies to promote more providers. However, I think you and I both agree that many of our problems stem from corporate ownership of hospitals and corporate ownership of pharmaceuticals, etc.

We need a paradigm completely independent to the current economic "as usual". A body that is internationally funded but controlled by a board (yes with accounting and oversight with penalties for cause) determines what diseases would benefit from pharmacotherapy and prioritizing them and a vast spending on research and development without consideration for the next quarter financials. There would need to be vast IP reform as lawyers would tie this up until billions die first.

Provide a GNU type licensing agreement with more preconditions than a Trump prenup and let companies bid for manufacturing. Violations would be subject to criminal prosecution of board members including prison and not white collar crime, but willful intent to harm x the number of people threatened.

There's a start for you.

 

[interchange]

There's also the legal clusterfuck one can step into or "dynamics" if you prefer. The government holds itself to a lower standard in that regard so again have government agencies provide this until we clean up the underlying systemic issues.

This is a metric shitton of problems right here.

Linky no worky for me. Regardless, I'm not sure how much legal or liability concerns are affecting things, but it's not something I do although did get training during residency. Being academic I don't have as much of a pulse on the community.

 

[Hayabusa Rider]

Linky no worky for me. Regardless, I'm not sure how much legal or liability concerns are affecting things, but it's not something I do although did get training during residency. Being academic I don't have as much of a pulse on the community.

It's a Schedule III drug as of 2002, and that means the DEA is up people's ass only a little less than with Vicodin or Oxycontin. Although an academic I should think that you have enough contact with people "on the ground" to understand what goes with that in more than a standard of care thing and that includes the cost of providing a controlled substance in terms of legal compliance.

 

[interchange]

It's a Schedule III drug as of 2002, and that means the DEA is up people's ass only a little less than with Vicodin or Oxycontin. Although an academic I should think that you have enough contact with people "on the ground" to understand what goes with that in more than a standard of care thing and that includes the cost of providing a controlled substance in terms of legal compliance.

Buprenorphine requires a separate certification to prescribe but is dispensed at a pharmacy unlike methadone. My impression is that it's generally pretty easily accessed outside of the bottleneck of getting established with a provider. I don't do addiction in my outpatient work and the hospital I'm at isn't a licensed detox facility so we don't start it on anyone and exclude folks with primary opioid dependence.