Country Roads by Pat Conrad MD

Well, I guess this is a different spin on it…

The Senate is pretzeled into a fine mess, with Dems shrieking about the GOP slaughtering hundreds of thousands with Medicaid cuts, and wimpy Republicans believing them.  Last October, the Kaiser Family Foundation predicted that Medicaid spending GROWTH would decrease from spending 10.5% to 4.5%, an electoral design of ObamaCare, wherein the federal share of spending would very conveniently drop just as the Great Compassionate was to leave office.  Congressional Republicans claim that their ObamaCare Lite will only slow the growth of Medicaid, leaving plenty of slop in the trough and more deficit and debt as far as the eye can see.  Add to that the billions more the Trump Administration is promising to fight opioid addiction, which will achieve the twofer of further punishing docs, while wasting more taxpayer money.

Never to leave a heart un-bled, Yahoo News has an innovative way to scare us all over any potential cut in this massive welfare program.  If we flirt with cutting Medicaid, this could threaten opioid addicts’ survival in West Virginia.  The article begins with a sob story over an ambulance crew being helped with a flat by a roadside mechanic save, only to then go to his house and save his OD’ing daughter.  That Lifetime Channel setup then leads to the real meat:  the EMS service “pays the bills largely through patient insurance — which in this mostly poor, rural area is Medicaid, a program that could see massive cuts under the health care bill championed by Senate Republicans anxious to deliver on their campaign promise of repealing the Affordable Care Act.”  They also fear the loss of the state grant that buys Narcan, even as that drug’s price has spiked.  I wonder if the drug maker saw a spike in demand as cover for a price jack?  After all, it worked for EpiPens, the Mylan CEO responsible being none other than the daughter of West Virginia Sen. Joe Manchin.  But I digress…

The EMS director laments, “If there are more Medicaid cuts, and no other help, this would be catastrophic for us, I don’t know if we could survive. We are talking about a potential situation where people would call 911, and there would be no one to help, whether it’s an overdose or a heart attack or a car accident or a broken hip. There would be no one. Can you imagine?”

Yes, as the EMS medical director in a very rural county with plenty of drug addicts, I certainly can imagine that a poor area can only provide scant resources over which different patient groups will compete.  And yes, I imagine without a blank check without end, some folks will actually die for lack of rapid medical attention.  The Hatfields vs. McCoys have now become the Cardiacs vs. the Addicts.  And what response does this silly author elicit?

“Not only are rural health care providers heavily dependent on Medicaid, many of those covered by Medicaid are the ones being treated for drug abuse. According to the West Virginia Department of Health and Human Resources, roughly 50,000 of those who are covered through the Medicaid expansion were treated for substance abuse last year — a number many state officials expect to increase amid a drug crisis that appears to be getting worse by the day.”  I read that as journalistic extortion, flatly threatening that if we don’t increase Medicaid funding (with money we don’t have), there will be even more untreated addicts prowling the backyards.

It is arguable that the existence of Medicaid has abetted and encouraged many self-destructive behaviors, including inappropriate demand for and access to opioids, often provided by the very docs who now worry they would be cut off from the government teat.  This story is another example of single-wing emotionalism that overpowers other serious questions.  For instance, who is going to pay for all of this?

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  8 comments for “Country Roads by Pat Conrad MD

  1. Tad Hominem
    July 17, 2017 at 5:23 pm

    OFFS!! Are you honestly suggesting that someone, or thousands of someones, CHOSE OR WILL CHOOSE to become addicted to heroin or any opiod BECAUSE they know that they will be able to get Medicaid to pay for their rehab ??!!!!! You said “arguably” so I’d love to hear that argument! Remember W. Va.?? That expose about the 900 million pills sold and shipped there?? And the fact that they might get Medicaid doesn’t mean a bed in rehab since there aren’t nearly enough!!
    Go ahead, doc, let’s hear it, how people are thinking far enough ahead to consider how to pay for rehab?? BTW, which would only help the poorest becuz of the Medicaid eligibility requirements.
    Ohio, Ky., W.Va., In.,are all red states and at ground zero for this. Since there are very few 1st time “cures” in rehab (I think the # is more like 3-4x) how do these and other states pay for this?? Or is the epidemic “fake news”?

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    • Pat
      July 17, 2017 at 6:44 pm

      Tad, I wrote, “It is arguable that the existence of Medicaid has abetted and encouraged many self-destructive behaviors, including inappropriate demand for and access to opioids…” I never said anyone chose to become addicted, an statement you completely imagined.

      What I cheerfully state is that the Medicaid program encourages a great many bad behaviors, including seeking treatment, often at the ER, for the most minor complaints, because it is “free.” Medicaid encourages its recipients NOT to go the the clinic or to keep appointments, but to run to the ER, or even call EMS, if the mood suits. Medicaid subsidizes and encourages the underproductive to be overly procreative, and to teach subsequent generations to expect “free” care as a right. I do state and have seen that a great many Medicaid beneficiaries run to the doctor for minor aches and pains with such frequency that they eventually get their hands on narcotics, and often repetively so, authorized by tired, inattentive, or even corrupt docs. I do not think the addicts are planning for their rehab because I don’t think they give a damn at that stage about rehab either way. I do however think that the instinct for free care leads many to expect all pains to be alleviated to the satisfaction of themselves, their families, and neighbors – some of whom may enjoy the fruits of those prescriptions – without any acknowledgement of responsibility for any part of the process.

      It is also very arguable that bloated welfare infrastructures without local accountability encourage the existence of communities that are not economically sustainable, trapping even more into that locale, without hope of improvement. Yes, I think there should be social safety nets, administered at the most local level possible. No, I do not think that the federal government should have any involvement in the daily provision of care, nor subsidize events or actions that we should hope to see less of.

      And I still wonder who is to pay for it all.
      Cheers,
      Pat

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    • Bridget Reidy
      July 18, 2017 at 11:54 pm

      Agreed. It’s another case of association being confused with cause, or reverse causation as I see it. It’s the poverty, childhood trauma and abuse often predating, with it’s unceasing problems and complete lack of opportunity to generate natural endorphins that makes people prone to addiction, and being on Medicaid. It’s Medicaid that makes them more prone to addiction. Free doctor visits, free narcs as long as you play the game. Doesn’t matter where they get their first opiate, if prone to addiction and not careful and forewarned they’ll continue to seek it however they can. More visits, more visits where the patient compliantly helps you in time management by not dwelling on topics other what gets them what they came for, the doctor gets enough to compensate his other Medicaid patients in a place with high prevalence and manages to make overhead and them some despite being somewhere the deck is stacked against her. I’ve seen it locuming. It takes more than just pill mill doctors to generate a crisis this large.

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  2. Seneca
    July 17, 2017 at 8:24 am

    The cost of Narcan alone is straining budgets to the point where the leaders of some municipalities are trying to decide if it is worth it to revive an addict for the fourth , fifth or nth time.

    https://www.washingtonpost.com/world/as-opioid-overdoses-exact-a-higher-price-communities-ponder-who-should-be-saved/2017/07/15/1ea91890-67f3-11e7-8eb5-cbccc2e7bfbf_story.html?utm_term=.9046becd01fc

    I was talking to a friend who is the local Methadone Doc and he felt that the OD’s should always be reversed regardless of the cost. He also felt that the government should step in and mandate a lower cost of Narcan–obviously, he is not a constitutional scholar.
    After the expansion of Medicaid during the last administration, it is a politically Herculean task to pull back anything from the voting bloc of the FSA. Regrettably, even those who want nothing to do with it will be paying for it with our taxes and our children’s future.

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    • Perry
      July 17, 2017 at 9:35 am

      I revived an addict in my office parking lot about 3 months ago with CPR. I run an Occ Med clinic and the reason his girlfriend stopped in front of our clinic was because there were ambulances in front (the firefighter/paramedics were getting their annual physicals) and she figured they had Narcan on board. I am betting strongly the guy has OD’ed again since then. Even if you make the meds more affordable, there is still going to be a huge outlay of money to constantly save these people.

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      • Tad Hominem
        July 17, 2017 at 5:40 pm

        So do you suggest a no revival policy?? let ’em die?? you’re just puttin’ them out of their misery?? Or maybe a limited narcan use rule?? any person only gets 2 narcan revivals. 3rd strike and you’re out! really out! and a hole is punched in right ear for each use??
        BTW, since we are all good Repubs here, no complaining about the price of Narcan!! Supply and demand, remember the simplistic Repub economics!
        Oh, and if no Narcan, what do EMTs do when ambulance arrives?? Transport to ER? where patient is now dead OR ER doc admins Narcan, and who pays for cost of ER??
        AND if you are, pray that it isn’t your kid, grandkid, niece or nephew on the ground.
        As for Medicaid, keep in mind that 2/3s of nursing home residents are on Medicaid which my mother subsidized directly, and me indirectly, by being a private pay patient.

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        • Seneca
          July 18, 2017 at 2:20 pm

          All good points, and I don’t think anyone advocates executing opioid addicts, even by their own hand. Do you see any upper limit of resources to spend on them? Would you concede that some of them chance the moral (and literally mortal) hazard when they perceive a generous welfare state will generally revive them? Unfortunately, we are already out of money to the tune of $20 trillion, admittedly only a fraction of which is from Medicaid. If it ever comes down to paying for Mom’s NH bed vs. reviving John Q Addict for the 30th time, which would you choose?

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    • Bridget Reidy
      July 19, 2017 at 1:50 am

      Just saw a study housing the homeless reducing ER visits by about 10% and similar savings in less arrests. There are other solutions. It was on CBC The National news tonight, coincidentally while I had this page open.

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