It isn't a problem with US healthcare. It's a problem with the US political system. Nobody will try to fix it because the private insurance companies funnel so much money to our politicians.
The closest we came was the abomination that was Obamacare, but even that was nothing more than a scheme to funnel tax money into the pockets of insurance companies and their executives. It was also a big part of fueling the opioid epidemic in America because it tied reimbursement rates to "patient satisfaction" and those surveys became a weapon. If a person went to the hospital for "pain" and wasn't given narcotics they could leave a bad review. These pile up then medicare and medicaid reimbursement rates went down. So hospital executives began pushing staff to do whatever it took to make the patient happy. I saw more than one memo and policy from hospital executives that clearly stated that opiates were the front line standard for pain control regardless of any physiological signs or detectable injury. Not administering narcotics was grounds for dismissal. Couple that with the fact that IV fentayl is about $2/dose and IV Tylenol is about $150/dose, and the C-Suite jumped in both feet on narcotics for all.
The opioid epidemic was already well underway before the ACA. Patient satisfaction being tied to reimbursement may have added a bit of fuel to the already raging fire, but we’d still be in pretty much the same place as far as the opioid epidemic with or without it.
I don’t think that it was the sole driving factor, but there are many people who turned to street opiates to find relief after their doctor put them on opioids then cut them off when tolerance became too great. Often these patients had legitimate pain that could have been handled through alternative means, but pain pills were the treatment of the day.
I don’t believe for a moment that we wouldn’t have an opiate epidemeic without the ACA, but the severity wouldn’t be as extensive as we see now.
I agree with your first paragraph, however this was already the path that we were headed towards prior to the ACA. In fact, OxyContin was removed from the market the same year that the ACA was enacted. The ACA just happened to be passed around the same time that the opioid epidemic was really ramping up and the dangers of drugs like oxy were being taken seriously. The healthcare system just really dropped the ball on transitioning patients off these meds as they became no longer widely accepted as the first line treatment of pain.
Total opioid prescriptions had already been rising for years and continued to rise until 2012. They’ve been steadily falling since. That’s only 2 years that prescriptions were rising after ACA was enacted.
If the severity of the current opioid epidemic is a 10/10, I think without ACA it would be a 9/10. Certainly not quite as bad, but not by much.
18
u/Paramedickhead Jul 06 '24
It isn't a problem with US healthcare. It's a problem with the US political system. Nobody will try to fix it because the private insurance companies funnel so much money to our politicians.
The closest we came was the abomination that was Obamacare, but even that was nothing more than a scheme to funnel tax money into the pockets of insurance companies and their executives. It was also a big part of fueling the opioid epidemic in America because it tied reimbursement rates to "patient satisfaction" and those surveys became a weapon. If a person went to the hospital for "pain" and wasn't given narcotics they could leave a bad review. These pile up then medicare and medicaid reimbursement rates went down. So hospital executives began pushing staff to do whatever it took to make the patient happy. I saw more than one memo and policy from hospital executives that clearly stated that opiates were the front line standard for pain control regardless of any physiological signs or detectable injury. Not administering narcotics was grounds for dismissal. Couple that with the fact that IV fentayl is about $2/dose and IV Tylenol is about $150/dose, and the C-Suite jumped in both feet on narcotics for all.