Chuck-En-Stein
Ron Stouffer and Rosie Skomitz are writers and bloggers on the Healthcare 4 All PA board. Here is a post they wrote on drug addicts struggle with health insurance companies for the online journal CommonSense 2. You can read other posts by them there on health care.
ReCOVERING: Chuck-En-Stein on Addiction & Health Care
CS2 editor Chuck Brown’s dear friend, Tina (not her real name),
suffers from degenerative disc disease, a fairly common problem. Many
Americans share this affliction and can relate to the pain that
accompanies back/disc issues. Tina’s doctor prescribed OxyContin, a
highly addictive narcotic, and for over two years Tina took narcotic
drugs in increasingly higher doses to deal with the agony of her back
pain. Chuck shared with us the story of her downward spiral into the
world of addiction and his anguish in seeing a close friend caught in
the throes of this disease.
Addiction and the Medical Establishment
Chuck calls the medical establishment in
the U.S. an assembly line. Even though safeguards are put in place to
protect the patient, those safeguards are often lost in the assembly
line. Here’s how Chuck describes it: You go to the doctor’s office; go
to the receptionist, sign in, and show your insurance information; sit
in the waiting area; you’re shown to one of several
exam rooms, all of which contain patients waiting for or being seen by
the doctor; a nurse or practitioner preps you; then the doctor comes in.
“Doctors are like airlines,” Chuck says. “They overbook and there’s
overflow in the waiting room. This is your typical doctor’s office.”
When seeing someone complaining of pain,
doctors will often whip out their prescription pad – that’s what they
think of first. Tina was eventually prescribed the maximum allowable
amount of highly addictive drugs so she needed careful supervision,
according to the safeguards in place to protect patients. Chuck
describes the procedure: Each time you go to the pharmacy to renew your
prescription for narcotics, the pharmacy is required to call the
doctor’s office. Even if you are allowed five refills, they still must
make the call. Chuck does not believe that call ever reaches the doctor.
The likely scenario, as he sees it, “A woman at the desk (in the
doctor’s office) handles this kind of thing, looks in her file and sees,
oh, yes, this woman is allowed to have this refill and tells the drug
store to go right ahead.” There’s no discussion about any problems or
red flags, no questions about possible problems such as running out of
her supply before the end of the month.
Watching his friend deal with the horrors
of addiction prompted Chuck to learn more about it. One thing he
discovered is that running out of the drug supply before the end of the
month is one of the main tell-tale signs that you’re on the road to
becoming an addict, and once you’re addicted to OxyContin, it’s harder
to break the addiction than for a coke-head. “It’s much harder,” Chuck
says. “It’s one of the most difficult withdrawals of drug addictions. So
you would think doctors and the medical establishment would be
interested in making sure that this doesn’t happen, with follow-up calls
with their patients.” But the addiction experts Chuck consulted told
him there’s an epidemic of people in this country hooked on drugs. Some
believe doctors over-prescribe.
Chuck believes the system doesn’t encourage
doctors to avoid prescribing potentially addictive drugs. “Why would a
doctor want to treat you with holistic ways to address your pain when
you’re not going to be coming back to him with your pain? They get these
people on drugs, and they’re on drugs for the rest of their lives.”
Withdrawal
Withdrawal occurs on the discontinuance of
the use of a drug to which one is addicted. The portrayal of withdrawal
in the Ray Charles movie is not at all exaggerated, Chuck tells us. He
says, “I’ve watched my friend in withdrawal, and it’s horrifying.
Addicts will do anything to avoid that. They’ll stick up their mother.
That’s why there’s so much crime in Reading and places like that. They
can’t help themselves. They will take your purse, knock you over the
head, whatever they need to do because they know what that withdrawal is
like, and they’ll do anything to avoid it.” Often, these are people who
end up in jail. Addictions counselor Cheryl Dawson (not her real name)
contends, “They shouldn’t be in prison. They should be in treatment.”
Withdrawal without medical supervision is
extraordinarily difficult. In fact, even when taking withdrawal medicine
(known as a taper) in a treatment center, it’s nasty. The physical pain
of the withdrawal process is very real.
Addiction and the Health Insurance Industry
Tina wanted to get help to kick her
addiction, one of the hardest battles she will ever face. But the harsh
reality of health insurance in the U.S. kicked her in the teeth. She
discovered that her insurance company, at its whim, can decide if
they’re going to pay for her rehabilitation or not. “Why is this choice
left to a private, for-profit company?” Chuck wonders. “Who are they to
say whether treatment for addiction should be paid for or not? Why is it
their decision?” Chuck explained that in the Netherlands, the
government writes the insurance policy and private insurers bid on
selling it.
Furious, and rightly so, Chuck lashed out
at the U.S. health insurance system. “In America, not only do we let
insurance companies make decisions on whether or not we get covered,
they make decisions on what drug you can take. They also make decisions
on your care – how many days for treatment. If the doctor says you need a
month in rehab and the insurance company says they’ll pay for three
days, how’s that their decision? Why do we allow this to be in the hands
of private industry?” For this reason, some of the most prestigious
(and expensive) treatment facilities do not accept insurance. They
refuse to take treatment orders from insurance companies. Consequently,
these facilities are financially out of reach of poor and many middle
class addicts.
Like Chuck, we are old enough to remember
that it wasn’t always like this. Chuck reminds us, “There was a time in
this country when there was a social contract. When our parents came
home from World War II, they got a job.If they kept their nose clean and
worked at that job for 30 years, they got a nice pension/retirement.
And during that 30 years they got their health care paid. They didn’t
get it taken out of their paycheck every two weeks. It was paid for. In
return, you gave your loyalty and your hard work to the company. That
social contract doesn’t exist any more…No one will stand up for the
average person in this country.”
So Tina’s insurer refused to pay for the
treatment she so obviously needed, deeming that her addiction was not
life-threatening. Her request denied, Tina had to pay out of her own
pocket to check herself into a facility. This young, professional woman
in her early 30s took out as much of a loan as she could to pay for as
much of a program as she could afford. Her doctor thinks she needs a
longer treatment program, but she can’t stay longer because she can’t
afford to. What’s more, there are programs that will teach her how to
deal with her back pain without narcotic drugs, but, no surprise here,
the insurance company won’t pay for those either.
We can only hope that the brief stint Tina
spends in rehab is sufficient to help her conquer her disease. If it is
not, then her health insurance company surely has sentenced her to more
misery down the road. A worst case scenario: Her employer knows about
her addiction since she tried to use employer-provided health insurance
for treatment. Chances are the employer will keep a closer eye on her
job performance when she returns to work. Her previous stellar
evaluations may matter little. Miss a few days of work or have an
occasional bad day and she’s looking at a pink slip. This could open a
Pandora’s box of nasty possibilities. Unemployed, uninsured, she cannot
afford her expensive pain medication if she isn’t in recovery. Chuck
informs us that heroin on the street is 1/3 the price of OxyContin.
Heroin users have only a 5% success rate of beating their addiction.
Chuck sums up the dilemma, “So we make them into heroin addicts, and
their life is in jeopardy. Then when they’re on the street with nothing
left, then I guess it’s life-threatening and insurance might pay.”
What About the Affordable Care Act?
“There’s nothing in Obamacare that changes
anything that I just described,” Chuck stresses. The ACA, according to
some estimates including President Obama’s own assessment, will leave at
least 26 million uninsured. And there’s no guarantee that those who do
get coverage will have a quality plan with deductibles they can afford.
Insurance companies can still decide what’s covered and what’s not
covered. A system, now codified in law, that puts profits over people
makes Chuck see red. “It’s outrageous, and to have this situation in a
country as rich as we are says something about who we are…I see the
reality of what’s happening to the people. You know, my friend didn’t
have $20,000 or credit for treatment – tough luck! Most people don’t
have that much credit…so they’re out of luck. This country doesn’t give a
damn that they’re out of luck…They tell us (ACA) is the American
version of health care. What is it? It’s Wall Street’s version of health
care, and there’s nothing American about it. You want an American
program?…Medicare’s an American program.”
Single-Payer to the Rescue
The PA Family and Business Health Care
Security Act is a state-wide single-payer (improved Medicare for all)
bill that would cover all Pennsylvanians. Among its many other benefits,
it covers 100% of addiction treatment. That’s it – plain, simple,
straightforward. Responding to the current lack of such coverage, Chuck
says, “Every civilized society has single-payer. We are uncivilized. We
don’t take care of our people…There’s no lack of money for drones. We
have all the money in the world when it comes to doing something
destructive. But we have no money to take care of our own people.”
The PA single-payer legislation recognizes
that addiction is a disease even though some in our society consider it a
moral weakness. We urge you to learn more about single-payer
legislation and become part of a grassroots movement
to achieve it. Also, save the date of October 27 for a single-payer
forum at St. Barnabas Episcopal Church in Kutztown. More details will
follow later.
Addiction, the Land of Equal Opportunity
Addiction does not discriminate. It hits
people in all socio-economic levels, from those living in the streets to
the middle class and the well-to-do. Middle class people like Tina,
with legitimate health issues, get tossed into this spiral. So, too, do
the poverty-stricken who turn to drugs to deal with hopelessness. Author
Chris Hedges, in a report published by TomDispatch, tells of the poor
who inhabit abandoned West Virginia coal towns whose drug of choice is
OxyContin – “hillbilly heroin.” According to Hedges, “…The speech and
movements of those we met were so bogged down by opiates that they were
often hard to understand.” Many of these unfortunate souls get by on
relief checks such as Social Security, Disability, Assistance for Needy
Families, retirement or unemployment benefits.
Al-Anon is a support group for those whose
loved ones suffer from addiction. Chuck has attended Al-Anon meetings in
an attempt to better understand his friend’s situation. There, he has
seen people ranging from the very poor to corporate executives. Yes,
indeed, addiction does not discriminate. Standing room only at Al-Anon
meetings indicates the breadth of the problem.
More on Al-Anon
Chuck found that Al-Anon is concerned not
only with the addict, but the survival of the family. The difficult
lesson to be learned by friends and family members of addicts is that
you can’t help. The inclination to intervene by confiscating pills or
other attempts at helping actually enable the addict. The inability to
help is “a hard thing for friends and family to accept,” Chuck
discovered. The addict is the one responsible for his/her sobriety.
The Nature of the Beast
The hard reality of addiction is that no
matter how you arrived there, you cannot be cured. You can only be
recovering – a constant struggle. Drug counselors have told Chuck that
these drugs get into the brain. As he describes it, “They take over the
reasoning center, and they trick you. In the brain is a survival center.
When the drug stops, the brain goes into survival mode – we are going
to get that drug. If the person doesn’t listen, the pain is so severe, it feels like appendicitis…The brain must go through several months without drugs to readjust.”
According to an article in the Reading
Eagle, reporter Dan Kelly spoke with Dr. William Santoro, director of
detoxification and rehabilitation services at Reading Hospital. Kelly
writes, “Santoro explained that heroin, morphine, OxyContin, Vicodin,
Percocet and generic versions of oxycodone are all opiates. They are
made from the opium poppy plant and then are manufactured into different
forms, but the effect on the brain and the body are the same.”
Final Thoughts
One thing Tina will have to understand in
recovery is that she can never have narcotics again. As counselor Dawson
put it, “Once you’re a pickle you can never be a cucumber again.”
For all the Tinas in our country, it
behooves each and every one of us to do our utmost to promote
single-payer legislation in Pennsylvania (and in the 20 other states
working toward state-based legislation). We simply cannot continue to
allow insurance companies to dictate if, when, and for how long an
addict may receive treatment. The current asinine system is
unacceptable!
