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Sunday, July 30, 2017

Obamacare pushes opioids

Small minds like Kevin "Whelp" Williamson write off rural America as hopeless losers who deserve to die because we won't move to the big cities where the jobs are.

I suppose we could all move to Yuma, Arizona, where the unemployment rate is 18%.

Or El Centro, California, where the unemployment rate is 20%.

But that is Williamson's plan:
“If you spend time in hardscrabble, white upstate New York, or eastern Kentucky, or my own native West Texas, and you take an honest look at the welfare dependency, the drug and alcohol addiction, the family anarchy — which is to say, the whelping of human children with all the respect and wisdom of a stray dog — you will come to an awful realization. It wasn’t Beijing. It wasn’t even Washington, as bad as Washington can be. It wasn’t immigrants from Mexico, excessive and problematic as our current immigration levels are. It wasn’t any of that.
“The truth about these dysfunctional, downscale communities is that they deserve to die. Economically, they are negative assets. Morally, they are indefensible. The white American underclass is in thrall to a vicious, selfish culture whose main products are misery and used heroin needles. Donald Trump’s speeches make them feel good. So does OxyContin. What they need isn’t analgesics, literal or political. They need real opportunity, which means that they need real change, which means that they need U-Haul. If you want to live, get out of Garbutt, New York.” 
The unemployment rate in Monroe County, New York, where Garbutt is located, is 4.6%.

But chronic unemployment is a problem, as are opioids.

One reason is the government bought Big Pharma's line that opioids are the only way to manage long-term pain.

Which leads to this story from the Association of Mature American Citizens newsletter:
41-Year-Old Father: ‘Obamacare Won’t Pay For My Back Surgery, But It Will Pay For Opioids’
Most days, Joe Cato is confined to sitting in a chair or lying in bed, heavily medicated or asleep, debilitated by back pain that’s left the 41-year-old husband and father of four unable to work, attend seminary, or run his construction business. He has degenerative arthritis in his lower back and pelvis, a condition brought on after years of working on construction sites as a stonemason and hauling music gear as a worship leader in his church. Even riding in a car is painful, which he must do to get to his health-care provider 30 miles from his home in Waxhaw, North Carolina.
Joe is one of the many victims of Obamacare. His doctors say he needs surgery to repair the nerve damage in his lower back and pelvis, but his insurance company, Blue Cross Blue Shield, won’t cover it. In most of North Carolina, including Union County where Joe and his family live, Blue Cross is the only health insurer still offering coverage on the exchanges established by Obamacare. The only treatment Blue Cross will cover for Joe is pain medication—a battery of prescription drugs he must take daily, including what he calls “comatose-inducing” muscle-relaxers and opioids.
Waxhaw. Population 9,859.

Yea, Joe, just pack up your family and move to Chicago. No drug problems there. No poverty.

It's the take two-aspirin-and-call-me-in-the-morning approach to medicine. Except these aspirins cost a lot more. Still, it is cheaper than surgery.

Except in the human cost.

Just so everyone is clear about opioids: we are doing it wrong.

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  1. Under Medicare it is possible for a hospital to make more money if the patient dies immediately after a procedure than if he lives even a few days. The MDs may still care but in a way as long as ones ass is covered by hiring enough quality control empty suits the administration may be stirred but not shaken.
    Morphine is dirt cheap, surgery huge. The rehab alone for this guy would be thousands. Or a complication hundreds of thousands. The level of caring in medicine is declining all around the world, largly driven by economic pressures and the growing impersonal nature of the modern age.

  2. Don's main point is further reinforced by the fact that about 8-10 years ago (now, remember, temporal coincidences don't imply causation) NIH started doing a massive 180 reversal in their recommendation for "back problems." They went from data driven invasive procedure outcomes to "rest and meds." So, because the insurance companies will always cop out and determine "allowable's" based on *.gov, there ya have it. It doesn't hurt that Big Pharma is also the largest funding agent of the John McCain system in DC.

  3. This is just what Obama promised - at some point a patient's medical needs don't justify (to Obama) the expense and he will just receive a pain pill. No concern for human life - other than his own, of course.

  4. My understanding is that the origin of the opioid overuse business began not with any study but with a letter written to the New England Journal of Medicine and published therein where an informal study of sorts in which a physician described his experience with opioid use in inpatients who had followed up at some time after hospitalization and were found to have no higher rates of dependency than people in the general population despite exposure to, in some cases, very high doses.
    This letter, despite the fact that it was written in reference to the use of these drugs in highly controlled hospital situations, ended up being used as a reference to justify the use of higher doses of opioids than had been used previously, in outpatient populations. In other words an informal letter was used as if it had been a major piece of definitive research and was used to justify practices that were not even in use in the original letter.

    As to the death panel aspect of Obamacare, any highly controlled and managed program can result in scenarios like those described above. Back in the HMO days there was a notorious case in a California HMO that got discussed in meetings all over the country where a woman who had large bilateral kidney stones was denied treatment until she developed renal failure and had to go on dialysis because at that point Medicare took over as her primary insurer and the HMO was off the hook for everything. How much of this was urban legend I am not sure.
    The point is that the more control over your life you give up to others the less your life is going to be respected. Something liberals either deny knowing or lie about every minute of every day.

  5. I call BS. Waxhaw, NC, is NOT out in the country somewhere. It is a nice middle-to-upper middle class suburb of Charlotte NC, which (HQ to 7 Fortune 500 companies, including Bank of America and Duke Power.) If Obamacare is tanking this badly in Union County (which is also home to some VERY nice suburbs such as Weddington), then it is not just the rural small towns. It has come to the big cities.

  6. The other side of the coin for whose condition has advanced and mess are the only option:
    If your doctor givrs you enough for 24-hour relief, the bureaucrats are on him like white on rice.

    My spine is deteriorating and there is no treatment except medical marijuana -- oops, can't have that. However, Vicodin has relieved the pain for 30 years. I blew through the high within weeks and it works great. But DC wants me on Percocet which leaves me drooling in bed, so it makes it as difficult as possible to get what works and allows me to function. And people wonder why I despise the government.

  7. Dear Mr. Surber,
    I don't know how your digestion is, nor do I want to know, however, if you ever find yourself in need of an emetic Williamson wrote a column in December of '16, titled "Manners, Even in the Age of Trump." In it he compares POTUS's two eldest sons to Uday & Qusay Hussein, and his entire family to a cast of extras for the movie American Psycho. This in a column about the bad manners exhibited by a lawyer and his husband towards Ivanka, on an airplane during the holiday season. Again, if in need of an emetic Williamson's column should fit the bill. Cheers. :).

  8. I hate to be the guy peeing in the punch bowl, but if you look at publicly-available data, the correlation between Medicaid spending and the opioid "epidemic" is, well, awesome.

    And before the chorus of "Correlation is Not Causation" is taken up by the Medicaid Choir, I'll just own up to being a retired scientist who made a good living doing statistics. Ive heard that tune, and it's true and as dear to me as "Dixie".

    But after Fat Lady sings the last coda, the correlation still needs to be explained.