The ACA, Expanded Medicaid and Substance Abuse Treatment.
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Thread Starter
Join Date: Apr 2013
Posts: 1,405
The ACA, Expanded Medicaid and Substance Abuse Treatment.
Not a political debate. Open to all.
I was reading last night that once the ACA is fully implemented, it will expand substance abuse treatment for 62.5 million people and provide first time substance abuse treatment coverage for an additional 32.1 million people. Additionally, under the Act it seems that substance abuse treatment will be moving away from inpatient (reserved only for the most severe cases) and into a "health home" (not an actual home) where all of the patients doctors coordinate their care together.
My thoughts:
I would guess that roughly 90% of rehabs now are unable to afford to have medical doctors, psychiatrists, nutritionists, and life-coaches on staff. And then additionally enough qualified staff to provide tailored treatment for their patients. So even though many of the treatment methods are archaic, what they are doing is the least expensive way to reach the greatest number of patients.
Of course for the other 10% +/- that can and do provide the premier services can afford to do so by charging their patients upwards of $30k a month. And, yes some do accept partial insurance or sliding-scale payment, but not enough to provide top care for the majority. Many families of addiction have already succumbed to having any disposable income (and then some) spent on addiction. Many/most families do not have tens of thousands to hundreds of thousands to pay out-of-pocket for top notch treatment facilities.
On top of that, how/why would anyone, much less the best and brightest in their field want to work for a facility that only receives a partial payment at best (insurance, state-funded) for services provided? This is why most facilities have a majority of staff who either have minimal or no qualifications. IMO, this is why rehab recovery rates are so dismal, and most who do recover will do so on their own.
Now, if only 10% of the newly eligible 94.6 million patients want treatment… who is going to pay for all these new patients? And, more so who is going to be providing the treatment?
I can envision even more underfunded and underqualified treatment programs popping up on every street corner to get their share of the government funded pie and the top quality care people deserve will still be had by only the affluent.
Substance abuse treatment is a big money business. On top of everything else our tax dollars can only support so many charitable programs/health crises. As a society we don’t have telethons, public outcries, and celebrities gathering around the microphones to sing a song to raise awareness much less donations for the cause.
I don’t have the answers. I don’t think there are any.
I was reading last night that once the ACA is fully implemented, it will expand substance abuse treatment for 62.5 million people and provide first time substance abuse treatment coverage for an additional 32.1 million people. Additionally, under the Act it seems that substance abuse treatment will be moving away from inpatient (reserved only for the most severe cases) and into a "health home" (not an actual home) where all of the patients doctors coordinate their care together.
My thoughts:
I would guess that roughly 90% of rehabs now are unable to afford to have medical doctors, psychiatrists, nutritionists, and life-coaches on staff. And then additionally enough qualified staff to provide tailored treatment for their patients. So even though many of the treatment methods are archaic, what they are doing is the least expensive way to reach the greatest number of patients.
Of course for the other 10% +/- that can and do provide the premier services can afford to do so by charging their patients upwards of $30k a month. And, yes some do accept partial insurance or sliding-scale payment, but not enough to provide top care for the majority. Many families of addiction have already succumbed to having any disposable income (and then some) spent on addiction. Many/most families do not have tens of thousands to hundreds of thousands to pay out-of-pocket for top notch treatment facilities.
On top of that, how/why would anyone, much less the best and brightest in their field want to work for a facility that only receives a partial payment at best (insurance, state-funded) for services provided? This is why most facilities have a majority of staff who either have minimal or no qualifications. IMO, this is why rehab recovery rates are so dismal, and most who do recover will do so on their own.
Now, if only 10% of the newly eligible 94.6 million patients want treatment… who is going to pay for all these new patients? And, more so who is going to be providing the treatment?
I can envision even more underfunded and underqualified treatment programs popping up on every street corner to get their share of the government funded pie and the top quality care people deserve will still be had by only the affluent.
Substance abuse treatment is a big money business. On top of everything else our tax dollars can only support so many charitable programs/health crises. As a society we don’t have telethons, public outcries, and celebrities gathering around the microphones to sing a song to raise awareness much less donations for the cause.
I don’t have the answers. I don’t think there are any.
Member
Join Date: May 2010
Location: USA
Posts: 13,560
Substance abuse is taking over our world. Until something changes in the way treatment is offered it will not change, even then it may not. I wish I had the solution.
One thing I cannot believe they do not do is doctors all coordinate. If so a doctor could see who is doctor shopping, that would take care of that. I also cannot believe all pharmacies are not networked so one could see thay just yesterday that same Rx was filled somewhere else. It's a shame. It would also help the many elderly people who have to see multiple doctors and get confused reporting to them what the other one says.
I am likely to take a flogging for this on here, but I also don't see why insurance should ever pay for more than one go around at rehab. I hear people say they go to detox after detox and have had rehab after rehab. Not only is it not working for many, it is being abused. How many times have you read on here that the person coming out of rehab has relapsed IMMEDIATELY?? Rehab is very expensive and drives up the costs of insurance when it is abused. To me it's the same concept as insurance paying for emergency room care for something that could be treated at a doctors office for 1/3 of the price.
I don't know the answers, I just know our country keeps digging a financial hole that we will never get out of unless costs are controlled and treatments changed.
I mean no offense to anyone on here, these are just my personal thoughts.
One thing I cannot believe they do not do is doctors all coordinate. If so a doctor could see who is doctor shopping, that would take care of that. I also cannot believe all pharmacies are not networked so one could see thay just yesterday that same Rx was filled somewhere else. It's a shame. It would also help the many elderly people who have to see multiple doctors and get confused reporting to them what the other one says.
I am likely to take a flogging for this on here, but I also don't see why insurance should ever pay for more than one go around at rehab. I hear people say they go to detox after detox and have had rehab after rehab. Not only is it not working for many, it is being abused. How many times have you read on here that the person coming out of rehab has relapsed IMMEDIATELY?? Rehab is very expensive and drives up the costs of insurance when it is abused. To me it's the same concept as insurance paying for emergency room care for something that could be treated at a doctors office for 1/3 of the price.
I don't know the answers, I just know our country keeps digging a financial hole that we will never get out of unless costs are controlled and treatments changed.
I mean no offense to anyone on here, these are just my personal thoughts.
Member
Join Date: Oct 2013
Posts: 98
I ran across this study today and found it interesting.
Opposite types of love stimulate brain differently, Yale researchers say
From the article:
And:
This study also makes me wonder if the continual stimulation of the reward centers by drugs may increase selfishness in the addict.
Science may be nearing a point where addictions can be better treated. Any money directed toward research is money well spent, IMO.
In the meantime, those of us who are codependent may benefit from engaging in charitable activities and/or meditating on selfless love.
Opposite types of love stimulate brain differently, Yale researchers say
From the article:
Romantic love tends to activate the same reward areas of the brain as cocaine, but selfless love actually turns off those same reward areas, say Yale School of Medicine researchers.
The neurological boundaries between these two types of love become clear in fMRI scans of experienced meditators. The reward centers of the brain that are strongly activated by a lover’s face (or a picture of cocaine) are almost completely turned off when a meditator is instructed to silently repeat sayings such as “May all beings be happy.”
Science may be nearing a point where addictions can be better treated. Any money directed toward research is money well spent, IMO.
In the meantime, those of us who are codependent may benefit from engaging in charitable activities and/or meditating on selfless love.
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Thread Starter
Join Date: Apr 2013
Posts: 1,405
LMN,
I agree that money does not buy recovery. But, I am a grateful member of one of the few programs of recovery that believe that addiction is a disease.
To me diseases are treated by medical doctors and a program of recovery and support is followed as an adjunct treatment. My personal experience is limited to only about a dozen or so rehabs. The state funded ones had a roaming psychiatrist that patients had access to every other week or so, and medical doctors in the local area that they would recommend. And, while I personally felt the charity based facilities offered more structure and tending to the spirit than any others, they offered nothing in the way of medical or psychiatric care. Only the self-pay (think Lindsey’s first rehab) had both a psychiatrist and a medical doctor on staff…oh, and prison.
I agree that money does not buy recovery. But, I am a grateful member of one of the few programs of recovery that believe that addiction is a disease.
To me diseases are treated by medical doctors and a program of recovery and support is followed as an adjunct treatment. My personal experience is limited to only about a dozen or so rehabs. The state funded ones had a roaming psychiatrist that patients had access to every other week or so, and medical doctors in the local area that they would recommend. And, while I personally felt the charity based facilities offered more structure and tending to the spirit than any others, they offered nothing in the way of medical or psychiatric care. Only the self-pay (think Lindsey’s first rehab) had both a psychiatrist and a medical doctor on staff…oh, and prison.
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Thread Starter
Join Date: Apr 2013
Posts: 1,405
hopeful,
First, never apologize for your thoughts.
A National Controlled Substance Database is almost here, they have been working on that for years. However, I'm not sure how that's going to work with the pill mills though when they dispense meds right from their clinics. Insurance companies do not allow you to refill controlled substances early, but that only works if scripts are ran thru insurance and not self-pay. I'm also not sure how much government regulation we want in order to save us from ourselves.
I don't see how doctors could logistically coordinate in a cost-effective manner. If a PCP has 300 patients, who each have 3 specialists, that's 900 doctors that would have to have access to each patients history, charts, and recommended care. Each doctor would need to employ a team to cross-check all files. I know when I have had to see a specialist I always ask to have a copy of my chart and any treatment or test results sent to my PCP. I’d rather be a bit proactive than to rely on them to do so.
I also agree that the revolving door of detox and treatment drives up healthcare costs for everyone. But, that could also be said for other diseases like diabetes or asthma and mental health issues when one doesn’t follow the recommended protocol and repeated treatment is recommended.
What we’re doing isn’t working, time for a Plan B, a different approach. The “war” on drugs is a very expensive fail, research is expensive and time consuming, the little research money available is spread thin, and for now the data has to support the continuation of this “war”. Hopefully, in generations to come, they will find a different way and our grandchildren and their children will hopefully either be immune to this disease, or better treatment will be available.
First, never apologize for your thoughts.
A National Controlled Substance Database is almost here, they have been working on that for years. However, I'm not sure how that's going to work with the pill mills though when they dispense meds right from their clinics. Insurance companies do not allow you to refill controlled substances early, but that only works if scripts are ran thru insurance and not self-pay. I'm also not sure how much government regulation we want in order to save us from ourselves.
I don't see how doctors could logistically coordinate in a cost-effective manner. If a PCP has 300 patients, who each have 3 specialists, that's 900 doctors that would have to have access to each patients history, charts, and recommended care. Each doctor would need to employ a team to cross-check all files. I know when I have had to see a specialist I always ask to have a copy of my chart and any treatment or test results sent to my PCP. I’d rather be a bit proactive than to rely on them to do so.
I also agree that the revolving door of detox and treatment drives up healthcare costs for everyone. But, that could also be said for other diseases like diabetes or asthma and mental health issues when one doesn’t follow the recommended protocol and repeated treatment is recommended.
What we’re doing isn’t working, time for a Plan B, a different approach. The “war” on drugs is a very expensive fail, research is expensive and time consuming, the little research money available is spread thin, and for now the data has to support the continuation of this “war”. Hopefully, in generations to come, they will find a different way and our grandchildren and their children will hopefully either be immune to this disease, or better treatment will be available.
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Thread Starter
Join Date: Apr 2013
Posts: 1,405
Originally Posted by Stucco 
This study also makes me wonder if the continual stimulation of the reward centers by drugs may increase selfishness in the addict.
It's all just so fascinating to me, thanks so much for the link. I'm going to try to find the full study, hopefully I can access it through my college.
Member
Join Date: May 2010
Location: USA
Posts: 13,560
I totally agree cynical. I truly hope that we are close in being able to figure out how the brain all works with addiction. For myself, as the spouse of an addict, I just feel worn out. I wish his rehab had offered better follow up care and that he had done that in the months following rehab. That did not happen.
I also agree on the front of the medical costs of other diseases. The lists could go on and on. Alzheimers is a big big big one right now, with very very little funding going into research. It's an evil cycle for all disease.
I do believe those with substance abuse should be given the opportunity to go to rehab if they truly want to recover. I just don't think it is up to the government to pay for it if they relapse. The financial crisis of it is one the of the consequences. Unfortunately, it is a consequence for the family often times too.
Now...where is my magic wand I can waive over all of this mess? O well, guess I will just pray instead...and EVERYONE PLEASE RESEARCH AND VOTE!!!!
I also agree on the front of the medical costs of other diseases. The lists could go on and on. Alzheimers is a big big big one right now, with very very little funding going into research. It's an evil cycle for all disease.
I do believe those with substance abuse should be given the opportunity to go to rehab if they truly want to recover. I just don't think it is up to the government to pay for it if they relapse. The financial crisis of it is one the of the consequences. Unfortunately, it is a consequence for the family often times too.
Now...where is my magic wand I can waive over all of this mess? O well, guess I will just pray instead...and EVERYONE PLEASE RESEARCH AND VOTE!!!!
Member
Join Date: Oct 2013
Posts: 98
I just don't think it is up to the government to pay for it if they relapse.
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Thread Starter
Join Date: Apr 2013
Posts: 1,405
When I wrote my thesis paper in 2009, at the time the average incarceration was $23k per year, and the average rehab was $7500. That was the point of my paper, much less expensive to treat than incarcerate.
Member
Join Date: Mar 2012
Posts: 111
we have two family health insurance plans. neither one paid for anything when it came to treatment for addiction. employers are so concerned about physical health, that addiction/mental health/depression and what ever else just is not covered.
b.
but, i and my employer, keep paying for this "insurance"
b.
but, i and my employer, keep paying for this "insurance"
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Join Date: Dec 2011
Location: Dallas TX
Posts: 2,282
Cynical wrote:
I don’t have the answers. I don’t think there are any.
================================================== =============
Refreshing honesty. I for one tire of complicated problems being boiled down
to binary (black/white, up/down, right wrong) bull crap.
Bottom line: If a substantial proportion of your population is unable to process
sophisticated subject matter----the rest of your problems are moot.
I (Vale) can solve the deficit problem right now (I AM that good!!!)
Cancel all government retirement payouts. No more retirement for anyone, be it
Social Security, Military,Medicare.....NOTHING!!!!
What a smart guy! And SOOOOOOOOO tough! That's what we need right now---
a STRONG leader!
Except it's bullcrap. The solution is like wiping out New York City to save on street
cleaning costs. It DOES work.......but at what cost????
Beware stupidity. It is the most dangerous thing on Earth.
I don’t have the answers. I don’t think there are any.
================================================== =============
Refreshing honesty. I for one tire of complicated problems being boiled down
to binary (black/white, up/down, right wrong) bull crap.
Bottom line: If a substantial proportion of your population is unable to process
sophisticated subject matter----the rest of your problems are moot.
I (Vale) can solve the deficit problem right now (I AM that good!!!)
Cancel all government retirement payouts. No more retirement for anyone, be it
Social Security, Military,Medicare.....NOTHING!!!!
What a smart guy! And SOOOOOOOOO tough! That's what we need right now---
a STRONG leader!
Except it's bullcrap. The solution is like wiping out New York City to save on street
cleaning costs. It DOES work.......but at what cost????
Beware stupidity. It is the most dangerous thing on Earth.
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