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David Whitesock

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New health care law will improve access to care for addiction, but treatment system is ineffective and broken.

In the U.S., 22 million people suffer from the disease of addiction. Only a fraction ever get the help they need. Part of the problem is that most insurance companies do not cover many treatments for addiction. The Affordable Care Act designates certain treatments for addiction as eligible for health insurance coverage. This previous barrier to care gets torn down January 1. However, it is projected that 4 million more people will seek treatment. This massive influx which will likely result in greater harm than good because our nation's current, overburdened addiction treatment system is ineffective -- it does not address the chronic nature of the disease. Sending more people to an ineffective system will not help people get well.

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  • Sep 24 2013: David -- I agree. The new health care law will only lead to a bigger train wreck. Why do many people with addiction return to "treatment" multiple times? Why do 75% of all people with the disease never get help? Why can't a primary care clinic help people with this disease when it can help people with almost any other chronic disease? The solution: all community sectors, especially health care, employers, and insurance companies, must recognize the chronic nature of addiction. Systems, institutions, and people must act accordingly.
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      Sep 24 2013: I cannot agree with you more, Jim. There can be numerous health issues that accompany the disease of addiction -- co-occuring disorders or co-morbidity. Oftentimes, the co-occuring disorder is another mental health illness (depression, anxiety, etc.) Right now, the health care system is not "integrated" fully to treat both of the health problems that originate from the brain. Thus, if an individual did go to the primary care clinic (PCC), the individual would (likely) get sent to two separate facilities -- one to address the addiction issue, the other to address the mental illness. This is neither efficient nor humane.

      Similarly, a person with the disease of addiction will also suffer from hypertension, diabetes, and other chronic disease (not to mention various acute health issues directly related to the effects of physical substance use). Currently, PCC doctors focus on the other physical health problems, treat them, and leave the addiction issue alone. Imagine, if a person went into a PCC that was educated and equipped to screen and treat (or refer to treatment) and manage the patient's disease -- like is being done with diabetes and hypertension (called chronic disease management) -- now the patient has a chance at significantly improved health outcomes (exactly what the ACA was designed to accomplish).

      Unfortunately, because the chronic disease management of addiction through integrated primary care does not exist, the only ready place for those suffering is the current treatment model (which, by the way, has a failure rate of approx. 70 percent).

      Thanks for the insightful comments, Jim.
    • Sep 24 2013: Jim,
      Nothing you say will change the Morals of this Nation.
      As long as there is a Welfare System, there will be those who milk it dry.

      A Health Insurance Plan that pays for Addiction?
      ..What Nonsense.
      Health Insurance Corporations probably suggested it.
      Much Larger Premiums.
      More premium dollars mean more net profits.
      ===
      Those in opposition to the Affordable Care Act are right.

      Already this nation has a tried and true Veteran's Administration's
      Nationwide system of Hospitals and Clinics that need only to be
      expanded by vetting existing facilities. There is a Patient's Bill
      of Rights, and a Billing System for Co-pays for RX medicines.

      Our Tax System should be able to handle the increases without
      failures.

      So, Why Obamacare? It makes no sense. A Boondoggle.
      Someone got paid off.

      When 30 million new Healthcare Policies are issued without any
      Acquisition Costs, such as 15-25% agent commissions, and no
      ongoing 2.5-10% renewal agent commissions to be paid, someone
      got paid off.
      ===
      Believe it Or Not.

      Houston, we have a problem..
  • Sep 26 2013: I agree with the new health care law - primary physicians, special services (like addition centers), etc will be slammed. ON the short term, the local certification agencies need to be on top of the situation. On addiction, everything I have read indicates that the person going into treatment needs to realize that they have a problem and want/need to change. Without both, the failure rate seems to be quite high.
  • Sep 25 2013: Thank you David.
    If they were the only losses, but of course they were not.
    ===
    I grew up in a society without Drugs and only a little alcohol.

    We had One Town Drunk. Never a problem.
    ===
    On Saturday nights, The Cotton Pickers, would come into the south
    part of town where the Blacks lived. But on Saturday Nights they
    were not allowed into the main part of town itself. I thought it was
    because of the Indians, but I never found out the reasons.

    After picking cotton Monday through Friday, they would drink and
    fight their way to trouble, and be incarcerated before midnight.
    Put before a judge Monday mornings they were sent back to the
    cotton fields in an old bus, indentured to the field owners who paid
    their bails..
    ===
    Indian Braves would come into town from wherever they lived in the
    desert, or on their reservation. On horseback, riding proud and alone,
    or upon the seat of a buck-board wagon with wife and papoose (wee child)
    resting on a "back-board".

    On their way to town, they passed by my house on the dirt road bordering
    the railroad. Their wives would shop and gather in the town's park, green,
    but treeless, as this was a desert community. They never once looked at me,
    or even acknowledged me, as I waved to them when they passed.

    The Indian men drank whiskey from bottles someone purchased for them,
    as they were prohibited by law, from buying alcohol. They looked to a small boy
    as ferocious wild Indians, they remained peaceful. Lots of laughter, and slept
    in the park..
    ===
    Hobo's came through town and would knock and ask for a drink of cool water,
    or something to eat. My Mother always treated them nicely. She never refused
    them, and they were never a problem.

    We didn't have a Drug problem because we didn't have Drugs.
    As I grew, I heard faint rumors of Tijuana and reefer cigarettes.
    Nothing more.

    Drugs are a recent terrible thing. Addiction is not a disease.
    It is a lack of personal responsibility.
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    Sep 25 2013: I think your point on the available treatments for addiction is well taken. Even the most noted facilities like Betty Ford Clinic have sketchy results and repeat customers. I hate to think what the clinic down the street can do. You're right, current treatment is not really that effective. But,
    I am not sure that there will be the millions of addicts to seek treatment. The new law is not medical treatment. It is medical insurance. The law directs medical insurance companies to provide funding for services that were previously not addressed. So, how are the insurance companies going to make a profit. And they will make a profit. They can do that by limiting the number facilities that will be available for treatment to make it difficult for people suffering from addiction to reach. They will only provide the minimal services. And of course, there will be copays involved. Most addicts have little left to address their problems. Any difficulty will discourage addicts.
    When I first heard of Affordable Health Care, I had imagined clinics all over the country that would provide basic health services for little or no cost to the poor. I had thought that these clinics somehow would tip the health care economics so that all services for everyone would be more available and affordable. OK,.it was a pipe dream.
    It wasn't clinics, it was insurance.
    It is a scary proposition. Already, my cardiologist and three successive primary care physicians have quit their practices. One doctor told me that with all the expenses of a practice, he could have made more working at WalMart. He went on to say the new AHA did not give him any hope and he was getting out while he had the chance.
    It is all a sad state of affairs
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      Sep 25 2013: Mike -- You present a major barrier to care that the ACA, in part, attempts to address. There are physical and psychological barriers to care. The psychological barriers are enormous and have their roots in the stigma, fear and shame that accompanies the disease of addiction in our society. Individuals and families feel that they cannot admit to this health problem because of the negative response from family, friends and society. The physical barriers are many, but as identified, a major barrier is the fact that health insurance (pre-ACA) largely would not cover addiction treatment. Thus, even getting treatment from the broken 28-day model was not possible because most could not afford it. With the ACA, at least individuals and families will have options with coverage for care. Because of this reality, undoubtedly more people will seek treatment. Certainly, there may be "difficulties" navigating the health insurance realm, but securing coverage for the majority of costs is a dramatic step in the right direction.

      The 4 million estimate comes from the Associate Press. Largely, that number is based on two factors (as I understand it), the increased number of people covered against the number of people who suffer from the disease (23 million). 4 million is really the tip of the iceberg of those that NEED care.

      Re: primary care clinics ... of course, these docs (especially, independent practices) cannot treat addiction on their own -- it takes at least the following: an integrated health care system utilizing a patient-centered, team-based chronic disease management model. It is this last part that is foreign to the current treatment system. Addiction is a chronic disease and requires a continuum of care, not acute or episodic care, which the current system provides.
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        Sep 25 2013: Do you think the degree of stigma is less with so many public figures publicly seeking intervention for addiction?
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          Sep 25 2013: No. To some extent, the attention given to "public figures publicly seeking intervention for addiction" perpetuates the stigma because the media present the disease using stigma perpetuating language (alcoholic) and images (homeless people and needles). However, there are some public figures like Kirsten Johnston, Matthew Perry and Patrick Kennedy who are strong advocates and doing great work around awareness and celebration of recovery. The needle is moving, but as you can see from some of the comments here, stigma and misunderstanding remain very strong.
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        Sep 25 2013: I just happened to read today an interview with Robin Williams in Parade, in which recovery is discussed. When I think too of Betty Ford or even in the later years Elizabeth Taylor, I would have thought that the public impression of their decency as people would have reduced the stigma of seeking help.
    • Sep 26 2013: Mike,
      I have a background in both Insurance and Healthcare.
      Health Insurance is a poor substitute for a national healthcare program.
      A terrible thing to impose on needy citizens.
      Medicare is a prime example.

      Health Insurance is only a Pot filled with Premium Dollars,
      predetermined by highly paid men know as Actuaries.

      Health Insurance is also a bunch of Claim Adjusters shuffling paper.
      They syphon from the Pot, payments to reimburse service providers.

      Regulators require Reserves be posted as Insurance. (good ole boy clubs)
      Unpaid Claims remain pending, until paid or denied.
      Heath Insurers also Pay Premiums for Excess Claims Insurance,
      provided by yet another type of Insurance Corporation. (an Onion).

      The normal Costs of Business require payment also,
      Administration salaries,
      Taxes, and then,
      Generous Profits and
      Dividends.
      If anything is left over, it goes back into the Pot.

      Premiums are determined by historical actuarial studies.
      Put your own pen to the paper, it is certainly easy to do so.

      There used to be crooks in the Health Insurance business.
      Gee, I wonder where they are today?
      ===
      It won't be long now, 10 years or so, and everyone will find out the truth.

      Obama and these congressmen will be long gone.
      Enjoying their golden parachute's and sunny retirement.
      Kind of like the people who gave us these ageing leaking
      Nuclear Plants.
      ===
      It makes no difference to the Health Insurance Corporations
      what they must insure against. There is a Premium to cover
      any Health related risk. That's why the Actuary get the big bucks.
      ===
      Now that Bush is gone everyone can vote Republican again.
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        Sep 29 2013: Thank you Frank for putting it out there as it is. This will be a tough road to travel. A few people will make a lot of money and the rest of us will be worse off.

        This is a disaster in the making and we will be in the middle of it. However, the present system is not working. This will cause the present system to implode upon itself. I can only hope what arises from the ashes will allow for health. Oh who am I kidding. That's at least 50 years away.
        • Sep 29 2013: Linda, I had written a lot to you, and it disappeared... Windows 7 - dang it.
          The answer to Medicare, Medicaid, Obamacare, and a host of others.
          A Single Plan - Tax Paid, and let the Taxed Payers do what they are best at doing.

          Expand the Veteran's Administration's Nationwide Hospitals and Clinics.
          complete with their Patient's Bill Of Rights, and replace everything else.

          The VA could Vet the private Hospitals and clinics as they join the system.
          The Congress can provide a carrot to attract their full participation.
          ===
          Today in many mailboxes.
          Your "2014 Medicare & You handbook",
          Explore the explanations of benefits, coverage, exclusions, co-pays,
          who pays first, supplemental, blah blah. I administered a healthcare trust,
          I cannot understand this.
          ====
          Today -- This is true and happening right now.
          Last Wednesday,
          I received a postcard from my Veteran's Administration Health Care Clinic.
          I have an appointment to have a (fasting) Lab Test at 8am, Tomorrow,
          Sept 30, 2013 at the local clinic. (Blood letting, ugh, I hate needles.)

          I received another postcard, yesterday, that asked me to be available
          for a phone chat with my Nurse Provider. on October 7th at 8am.
          We will be discussing my results of the Lab work.
          ===
          I missed my last appointment with my Eye Doctor because I fell that
          morning and injured my arm. And, I forgot to call.
          They rescheduled me, a new appointment for this Thursday. Oct 3rd at 1:30pm.
          and sent me a post card notice.

          There is a local number to cancel or to re-schedule.
          ===
          I get a bill for co-pay prescriptions. It is $8.50 per 30 days of meds.
          If I have a money problem, they have programs to solve those issues.
          There are no co-pays for my appliance needs.

          I spent 6 months as an cancer in-patient. I never once heard a harsh word
          from any VA employee, nurse, doctor, or administrator. Not One.
          GREAT PROGRAM
          ===
          Our nation can do wonderful things.
          Charities when run a well as Rett, can too.
  • Sep 24 2013: I HAVE ANOTHER VIEW.

    People do not suffer from addiction.

    People suffer from a personal lack of restraint.

    After sticking into their bodies for a period of time
    --feel-good--- chemicals, people no longer desire
    to do otherwise.

    I would prefer to say "the Hell with them".
    Get Real
    Get a Life
    Get a Job
    --or--
    Get Gone, and bother someone who cares.
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      Sep 24 2013: Thank you for this view, Frank.

      The notion that addiction is a moral failing has been tossed aside for more than 60 years, replaced, of course, by the disease theory of addiction, which has been accepted by the medical profession for just about as long.

      If I may impart the following personal experience with this disease. I knew I had the disease immediately. How? When the people with whom I consumed alcohol with were able (and desirous) to have just one or two drinks, my brain told me otherwise. For a long time I could not explain it. I did, I thought I would a worthless loser for wanting to to pump more chemicals in my body, despite another part of my brain saying this is just wrong. Stop doing this to yourself. For a long time, I suffered. For a long time, I suffered with the disease AND had a life and a job. Of course, along the way, I nearly lost the former and lost the later a couple times.

      The problems associated with addiction are well beyond a lack of restraint. There were numerous times I restrained for the sake of my life. But in that restraint I lived a dark and lonely life. A life society told me was wrong and shameful and morally corrupt. I hid in that shame for years because I thought nobody cared. I tried to get gone many times.

      Fortunately for me (and my family and the few friends who did care) someone had other plans for my life.

      Addiction is a disease. It is shrouded in shame and fear. These are immense barriers to care. Breast cancer was once the same way. No look where society is at after 25 years of Susan G. Komen and other organizations.

      I am confident that 25 years from now, addiction to drugs and alcohol will be perceived and care for in vastly different ways than it is today.

      Thank you for your comments and this opportunity to respond.
      • Sep 24 2013: David, I sound harsh, and I mean to be.

        I lost my wife and family to Alcohol.
        I lost 2 sons-in-law to Drugs and Alcohol.
        Both are dead. One of Aspiration of Vomit
        when too Drug loaded to care, and the other
        from an Alcoholic's diseased liver.

        I spent 5 years in depression over my losses.

        When my Doctor started going over the same ground
        he had gone over before, I thanked him. I told him that
        I would solve it myself. I did so.

        Today I have the love and respect of my family through
        3 generations. Everything I ever wanted, I have.

        2 Grandsons are today imprisoned at ages 26 and 24.
        Victims of Alcohol and Drugs. I hope they survive to live
        free of their addictions.
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          Sep 25 2013: Frank -- I and those I work with are passionate about this issue because of those that did not survive the disease. We are also equally passionate about this issue because of those that suffer and need better care.

          This nation's number one health problem will see a solution only when exchanges such as this take place and people equally concerned come together to discuss all aspects of the problem without fear of judgement or failure.

          Very sorry for your losses.