The Opioid Crisis: Insurers Say No

By Jason Taylor

Although there is no doubt several factors underlying escalating prescription drug costs and how insurers handle patients’ access to more expensive drugs, the motivation driving this crisis is the same: profits. Pharmaceuticals are among the highest profit business sectors; as for-profits, they care about our shareholders and executive compensation, not patients.

When Americans say they would distrust the government to run a single payer or “Medicare for all” system, my question is why would anyone trust a for-profit company for whom the bottom line is how its stock does versus a neutral system in which delivery of service is the key component. Every other civilized nation has a form of universal care that is not solely driven by profit as ours is. Those systems deal with “patients,” whereas ours calls us “consumers” hyping the myth of choice and a free market that doesn’t exist.

Here’s another issue: There is little to no advice out there about how to wean yourself off of opioids. I was prescribed opioids following surgery and was vaguely told to extend the time between taking the pills, but was never given a clear protocol. When I went online, all I could find was information about detox and rehab — which is what I am trying to avoid. Luckily I had access to a family friend who has training in palliative care and she provided advice on a specific protocol to get off opioids, but without that, I would still be floundering. I can’t help but think this is a contributor to the crisis.

We often assume that patients choose their insurance plan. However, insurance companies can use often invisible and insidious methods to choose their patients. For example, if an insurance company holds an information seminar for its Medicare Advantage program on the third floor of a walk-up, how many wheelchair-bound individuals will enroll?

It doesn’t take a rocket scientist to figure out that individuals with chronic pain have higher overall medical costs due to whatever is the cause of their chronic pain. Create enough hassles for them and they will leave your insurance company and go somewhere else. Insurance companies like to tout that they invest in keeping their enrollees healthy. But how much of their obscene profits is due to policies which in the end throw patients overboard? Yet another argument for ending the current system of incentivizing insurance company profits before care. An enlightened system would measure the total costs to society of today’s coverage against tomorrow’s medical and societal costs.

A contributing factor to opioid addiction is the failure by manufacturers to provide information on how to get off the drugs safely. Visit the website for any opioid drug, and you’ll find extensive information on how to take it but nothing on how to stop taking it. There are often warnings not to stop cold turkey, but that’s about it. Stopping the drug provides no further profit for the manufacturer. Coincidence?

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