Yes you must!

There’s been a lot of uproar over Michelle Obama’s recent remarks about mandatory contraception coverage. Here’s what she said:

“Because we passed health reform–health insurance–people need to understand that insurance companies will have to cover preventative care, things like contraception and cancer screenings, things like prenatal care, and they have to do it at no extra cost,” Mrs. Obama said.

That is true. Unfortunately, the contraception debate is allowing this issue to be framed in such a way that people are sidelined into a debate over contraception coverage and thus missing the bigger (and IMO more ominous) picture:

…the Affordable Care Act establishes ten categories of “essential health benefits” which must be included in the individual and small group market policies, including ambulatory patient services; emergency care; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care. According to the Department of Health and Human Services, these provisions will mean that 8.7 million Americans will gain maternity coverage; 4.8 million will gain substance abuse coverage; 2.3 million will gain mental health coverage; and 1.3 million prescription drug coverage.

What I’d like to know is, what if you’re one of those self-employed people who only wants to pay for a major medical policy, and you have been able to save money by buying a policy which excludes such things as ordinary office visits, mental health and substance abuse treatment, and of course “preventive” treatment? Will your company no longer be allowed to offer such a plan? And if not, what will they do? Raise your rates astronomically? Go out of business?

I honestly don’t know, and it’s hard to tell. I admit, I have still not read all 2000-plus pages of the dreaded ACA/Obamacare monstrosity, and perhaps I should have. What I do know is that the mandatory coverage provisions aren’t to kick in until January 1, 2014. Then the shit will hit the fan.

How utterly convenient to have written into the new law a deadline which would not occur until well after the coming election.

Things like mental health, alcohol and substance use treatment, and preventive care are expensive, and they used to be something you’d get only in a so-called “Cadillac” plan or else have to pay for privately. What I would like to know is what’s wrong with me being allowed to choose what kind of insurance I want to pay for in order to save money as I have previously? Who are these people who banded together and got the Democrats to fulfill their wildest dreams of making everyone pay so that there is a government-mandated virtual blank check for the so-called “treatment community”?

Needless to say (especially in light of the Supreme Court’s recent decision), they are rejoicing:

The Supreme Court has upheld the Patient Protection and Affordable Care Act (aka “Obamacare”), the greatest expansion of medical coverage since the passage of the new Social Security Act in 1965. The new law, and this ruling, have understandably been greeted with jubilation by the recovery community—from top-flight, top-dollar rehabs like Hazeldon to inner-city community care clinics. “This is a triumph for recovering Americans, many of whom were directly involved in advocating for the new law,” said Stanford University psychology professor Keith Humphreys, a leading expert on addiction who was also a senior adviser at the White House Office of National Drug Control Policy in 2009 and 2010. “Both the quantity and the quality of care for addiction are set for unprecedented—and long-overdue—growth.”

I’ll just bet. Humphreys calls Obamacare “the most sweeping expansion in the quality and quantity of drug treatment in at least 40 years.” While he likes to shy away from the drug war metaphor, he is a highly prominent doctor who not only opposes marijuana decriminalization (and medical marijuana), but who has been waging a campaign to make it harder to get pain meds (now largely a done deal), and who proposes that prescriptions should be required in order to buy Sudafed. In addition to marijuana, he also sees alcohol and tobacco as “gateway drugs” leading to opiates. Ignoring this country’s experience before 1914, he asserts that legal drugs mean more addiction. He also speculates that Rick Perry needs drug and mental health treatment.

Rick Perry’s former communications chief disputes the claim that painkillers caused the former presidential candidate’s poor debate performances and occasionally strange demeanor on the campaign trail. Technically, the claim isn’t even in the public square yet, but is said to appear in a soon-to-be-released book by veteran political reporters Mike Allen and Evan Thomas.

If the claim is true, there is certainly no shame in Perry’s use of the medications themselves. Back surgery can produce intense and lasting pain. And if his use of pain medications has led to a debilitating addiction, again, nothing for which to apologize, and he should receive the best medical treatment available. There are pharmacological, psychological and behavioral interventions that can help people overcome iatrogenic addiction, and in general the sooner they seek treatment the greater the chances of recovery.

All that said, if the Governor was experiencing fuzzy-headedness, memory problems, and mood disturbance from his pain medication, then the decision he and his campaign staff made to run for the right to put his finger on the nuclear button was reckless in the extreme. Furthermore, as he is still a sitting Governor with powers of consequence (e.g., consenting to capital punishments) it’s a legitimate question now whether he is experiencing continuing medication-related mental and emotional impairment.

Whether the above theories about Perry are true or not, I think it’s entirely Rick Perry’s business. Not according to the treatment mindset. They promote endless crackdowns, because more the government cracks down, the more people are coerced into “treatments” that all of us must pay for. Addictionologists (and mental health treatment advocates) love to talk about “parity” between substance abuse and other illnesses, but with the exception of dangerously transmissible diseases, can anyone name one physical illness in which a person may be coerced into treatment? Without the draconian criminal penalties behind them, these people would be stuck having a much smaller client base consisting only of those patients who decided to enter treatment voluntarily.

A philosophical question the treatment community might want to consider is whether illness should be made a crime so that it would be easier to force patients into treatment. Many people neglect their health, and we all pay, right?

Already, some people are asking why not compulsory treatment?

If under ObamaCare medical insurance, like automobile insurance, is compulsory, shouldn’t medical examinations, like car inspections, be also? What would happen if we tested positive for nicotine or excessive alcohol intake? If our body mass index exceeded the limit? If we showed signs of oppositional disorder? Any of these conditions could demonstrate a risk of higher medical costs, and when the government pays the bill, it can claim an interest.

And if there is parity between drug treatment and diseases like obesity, and if we screen people for drugs, then shouldn’t we be doing something about all these fat Americans (many of whom have food addictions) running around untreated?

Am I serious? Or am I writing satire? Considering the politics of medicine, it’s hard to tell.

Orwell would probably be amused.


Posted

in

by

Tags:

Comments

5 responses to “Yes you must!”

  1. Jennifer Krieger Avatar

    IF Perry is debilitated and unwilling to give up the governorship and unable to administer effectively, (IF), well, then, what are the poor Texans to do? Continue to send the hordes of unaborted babies to schools which teach Creationism until they do something wrong and Perry executes them?

  2. Sigivald Avatar
    Sigivald

    contraception and cancer screenings, things like prenatal care, and they have to do it at no extra cost

    “You must provide more and eat the cost” is a recipe for disaster – and an indicator of gross ignorance of economic reality.

  3. TMI Avatar

    I’m afraid I’ll have to defer to Dr. Pangloss.
    .

  4. Mannie Avatar
    Mannie

    If there was one reform I’d make to health insurance, I would decouple it from employment. Let people shop and buy the coverage they want.

    I would choose a catastrophic policy, say 5,000 deductible. YMMV. Right now, none of us have the choice.

  5. Kathy Kinsley Avatar
    Kathy Kinsley

    @TMI. Ouch.

    “”Excellently observed,” answered Candide; “but let us cultivate our garden.””

    And indeed we should – it may be our only source of food if the economy keeps tanking.