Health department officials in Miami have a bitter pill to swallow after uncovering more than 40 licensed physicians who legally operate clinics that treat patients with chronic pain using narcotic-based prescriptions, while marketing non-narcotics for those struggling with others for pain killer addictions.

Narcotics officers in a number of states from Kentucky to Texas and throughout the Northeastern United States blame Florida for their own states’ influx of prescription drug abusers and fatal drug overdoses since federal regulation of such clinics in Florida is non-existent, thanks to a provision in state law that makes it impossible to prosecute physicians who prescribe such narcotics without a court order.

The issue that health officials face isn’t the pain clinics themselves, but the turn-style marketing tactics some use when they knowingly treat patients who suffer from legitimate chronic pain conditions with excessive amounts of narcotics and attempt to wean them off the drugs with non-narcotic replacements after they become addicts.

Dr. Bernd Wollschlaeger, an addiction specialist and past president of the Dade County Medical Association tells the Miami Herald that “offering such services is like a slap in the face.”  He says some pain clinics are seeking not to help addicts but to profit from selling drugs used to curb dependency — in addition to selling large amounts of painkillers to patients who don’t necessarily need them.

Wollschlaeger calls pain clinics “pill mills,” because of their well-known reputation among drug traffickers in other states who regularly travel to South Florida with the sole intent of shopping these clinics for easy access to narcotics. The recipients then sell the drugs on streets in their home states. The Herald reports that neighboring Broward county / Ft. Lauderdale is home to two-thirds of all physicians identified by the DEA as prescribing the most Oxycodone anywhere in the United States.

The irony is that Federal officials essentially built the market for such clinics in 2002 by allowing physicians who operate pain management clinics to prescribe a drug called Suboxone, a medication commonly used to treat heroine and narcotic addiction. Its better-known alternative, Methadone, is strictly dispensed through licensed and regulated hospital-based clinical settings.

Suboxone was introduced by the Feds at a time when prescription drug abuse was increasing to almost epidemic proportions in the United Stated. The idea was to encourage more addicts to seek treatment for abuse without having to visit hospitals or traditional medical clinics for care.

The problem in Florida is lax regulation and training requirements, according to pain management experts. Unlike in other states, Florida does not require a physician to be board certified in pain management to dispense Suboxone. All it takes to open up shop is an 8-hour training session before any physician with a clean medical license and the desire can start a clinic. On the Federal level, the requirements are the same in any state, but most states have more rigorous standards for Suboxone prescribers.

“If the physician has a license to practice medicine, we don’t have the right to prevent them from prescribing Suboxone,” said Nick Reuter, a senior policy analyst with the Substance Abuse and Mental Health Services Administration, a branch of the U.S. Department of Health and Human Services that oversees the Suboxone certification program.

The presumptive leader in the 2010 race for governor of the Sunshine State has launched a controversial public campaign to persuade Attorneys Generals in other states to join him in “launching a full review of the constitutionality of the individual mandate and potential legal options for States to pursue on behalf of their citizens should this mandate become law,” Florida Attorney General Bill McCollum writes in a letter to his AG peers.

The Senate recently approved a draft of the healthcare reform bill that provides for a mandatory tax of $700 to $4,000 against individuals who do not obtain health insurance coverage, either individually or through their employers, before 2013. The provision was added when lobbyists for the nation’s top health insurance companies successfully negotiated it in exchange for dropping an additional proposal that bans insurance companies from declining to provide coverage for people with pre-existing health conditions.

McCollum maintains that the tax would violate the provision of individual freedoms contained in both the United States Constitution and that of the State of Florida.

“I have grave concerns about the constitutionality of this mandate,” said McCullom. “Such a ‘living tax’ is worrisome because it would be levied on a person who does nothing, a person who simply wishes not to be forced to buy health insurance coverage…The mandate is especially troubling to Floridians who are guaranteed through the Florida Constitution to have ‘the right to be let alone and free from governmental intrusion into [their] private life.’”

In another public statement to the media, McCullom explained his stance against the proposed tax and threatens legal action if it becomes law.

“I am committed to pursuing any legal action necessary to defend (the rights)…of the more than 18 million individuals who call Florida home,” writes McCollum.

Earlier this year, McCollum announced his intent to seek the Republican nomination for Governor of Florida in 2010. He intends to replace Governor Charlie Crist, a fellow Florida Republican, after serving one term as Attorney General. McCollum is considered the frontrunner in the race for the nomination because Crist also served as AG for Florida before he took over the state’s highest office.

Democratic Senator Dan Gelber of Miami, who is running to replace McCullom as Attorney General, quickly criticized McCullom in a statement shortly after McCllom announced his intent to review the constitutionality of the healthcare tax.

“General McCollum’s decision to use his office to investigate ways to block health insurance reform is exactly why we need new leadership in the Attorney General’s office,” said Gelber. “There are four million Floridians without health care including 800,000 children. Only one state has a higher percentage of uninsured. I wish McCollum was as concerned about solving Florida’s health care crisis as he was about stopping the solving of the health care crisis.”

I look at healthcare reform as a football field. It’s separated by a virtual, high-res 50-yard line controlled by the commentators at ESPN.

On one side of the yard line, there are politicians shouting at their quarterback about a health plan run by the U.S. government; one that would force private health insurance companies to compete with a presumably cheaper public plan (“GO PUBLIC PLAN!”). On the other side of the 50-yard line, there are politicians shouting at their quarterback about a health plan run by the U.S. government; one that would choke  private insurance company CEOs until they raised their premiums or be forced out of business (“GO PRIVATE ENTERPRISE!”).

Outside the stadium, insurance companies are having an awesome tailgate party in the parking lot.

The smell of hot dogs and hamburgers are filling the air, beer is flowing as fast as the crude jokes about the game going on behind them. If you look at recent public statements from some of these companies, it’s clear they couldn’t care less who wins this one. Because they know they’re going to be the ultimate winners, no matter who makes the last field goal.

After President Obama established healthcare reform as a top priority almost immediately after saying “I Will” on January 20, most major insurance carriers went into the locker room. Their public silence  was about as deafening as the Super Bowl at half-time.

But insurance industry analysts knew it was only a matter of time before the position papers, talking points and customer Q&A scripts started to trickle down, ready for public consumption. Company leaders just needed to huddle up and come up with a contingency plan. After the House won their own marathon Pro-Public Option showdown in overtime on Saturday night, it’s as if the coach for the insurance plans threw a cooler of Gatorade on themselves in victory.

Here’s a look at some of the not-so-partisan statements that have come across the newswires about the vote:

“…(we are) deeply disappointed with the legislation progressing in Congress. Both the bill proposed by the House of Representatives and the bill passed by the Senate HELP Committee miss the opportunity to address the underlying cost drivers in our health care system.” – WellPoint, nation’s largest health benefit company, with approximately 35 million policy holders.

“A government-run program would threaten employer-based coverage…An independent analysis by the Lewin Group found that millions of employees would lose their private coverage and be forced to join a new government-run health plan. People will reject proposals that could put at risk their employer-sponsored coverage.” – CIGNA Corporation, one of the largest investor-owned health care providers in the U.S., the bulk of which is employer-based.

“We support reforms that make the market work for everyone, by bringing more people in rather than creating a new government-run health plan that would cause millions of Americans to lose their private coverage.” – BlueCross and BlueShield Association, covers 1-in-3 Americans, approximately 100 million policy holders.

It’s no shock that none of the commercial insurers are behind the public option. But what’s a little surprising to me is  they’re not hanging out in the parking lot waiting for the post-game traffic to die down.

By making these dire threats about how people will lose their coverage; pay more for what they’ve got; or even lose access to insurance altogether (as in the odd assessments of CIGNA and BlueCross), it’s insulting to the American public.

If Uncle Sam were to open up shop down the street, private insurers only make their industry look like a bunch of spoiled sports  in a game where the ones who are crying foul are the ones the Fed will be counting on to administer their plan. It’s not like the U.S. Government has some kind of top-secret, underground insurance company waiting to jump out after the Senate vote and take over like King Kong in Times Square.

Bottom line: The insurance companies are going to be just fine no matter what happens in D.C. Public option or not. You know it, I know it and they most certainly know it. For the sake of public perception at least, insurance companies need to throw their full support behind health insurance reform (or at least pretend to, in an intelligent way) because the game’s  in overtime and nobody is injured on the field.

Reform is going to happen. They may not have wanted to be in the game, but  it’s now time to be gentlemen at the end and shake the winning coach’s hand on the way off the field.

Marilyn Wann never bought into professional modeling marketing-speak proclaiming that “Thin is In.” It’s not because her physique doesn’t fit the phrase. For her, it’s a widely-held bullying tactic for the current authors of health insurance reform. Marilyn tells New York Times reporter Susan Saulny that an increasing number of slender Americans blame fat people — not Medicare, nor pharmaceutical company profits — for the most historic overhaul of our healthcare delivery system since the U.S. Government started Medicare itself.

“We’re kind of a popular punching bag,” says Wann, author of the book, “Fat! So?”

Physicians, dieticians and the scientific community have proven that there is a common link between obesity and a slew of chronic and terminal illnesses, from diabetes to heart disease. Healthcare bean counters claim that fat people increase the entire cost of healthcare for everyone, since they are more often diagnosed with long-term disease.

We’re all aware of the doomsday, sky-is-falling stats that apparently prove we’re all eating funnel cakes, Twinkies and potato chips all while sitting in front of the couch watching The Biggest Loser every night. It’s the stuff that sensational television and reality series’ feed off of. To be sure, the Robert Wood Foundation (a think-tank on healthcare issues) just published a study showing that two-thirds of us are fat. In four states alone, Tennessee, Alabama, Mississippi and West Virginia, more than 30 percent of its residents are statistically obese.

But Wann thinks it is somewhat discriminatory that corporate America is suddenly offering sums of money, free stays at fat camps and other incentives to overweight Americans in a thinly-disguised campaign to cut group insurance coverage costs while marketing the move as a gesture toward caring about the wellness of their employees.

On the flip-side, Wann and other obesity fairness champions say the efforts for reform are energizing opportunities to cultivate what she calls, Fat Pride. “Basically, we want to be treated with respect the same as everyone else.”

Who knows. Wann and her followers might start a movement toward true health insurance portability and help prove that individual health insurance is still affordable.

On the eve of the historic House Congressional vote on the wobbly healthcare reform bill, President Obama managed one last pull at the AARP, but may not have saved its members from falling into the verbal mud pit in the long tug-of-war over the Affordable Healthcare for Americans Act. By his own admission, AARP CEO Barry Rand knows his 40 million members are still very much split down the middle in their support. This leaves the President wiping his brow while leaving Rand in the awkward position of posing for the photo-op while crossing his fingers behind his back. The near-finalized bill will hit the House floor on Saturday night for a vote.

“As members of the House gear up for this historic vote, they will hear from older Americans,” said Rand, in a prepared statement announcing the endorsement. Although Rand said this marks the first time the AARP has put its “full weight behind a comprehensive health care reform package,” he’s likely to find more raucous town hall style debates swarming around retirement homes after the vote and regardless of the outcome. That’s because by all accounts on Capitol Hill, the Senate and the House are miles apart on the road to reform. Somehow, some way, there’s got to be another lane built on the highway to accommodate both parties’ differences.

“It is not enough in our eyes just to say we endorse a particular piece of legislation and expect that all the dominos will fall into place as a result,” Sam Wilson, the chief AARP rep in South Dakota tells the Daily Republic today.

Right now, the ropes in this tug-of-war are wearing thin. Parties on both sides are gonna need gloves to avoid further rope burns. Whether or not the holy grail of health reform — the so-called Public Option — remains in the final bill is sitting squarely in the mud pit.

It’s not that they don’t want you covered. They just don’t want one “option” shoved down their collective post office boxes.

Senator Tom Harkin (D-Iowa), the venerable leader of the powerful Health, Education, Labor and Pensions Committee, gave small business owners their chance at the mic. Apparently, they had a lot to say at the Harkin-hosted “Increasing Healthcare Costs Facing Small Business” forum. As you might imagine, all the usual debaters for low-cost insurance advocacy were there. Those lobbying for the — dare I write it, Republicans — “Public Option” — were also on the soap box.

Since small businesses have been among the most vulnerable victims of this long, cold economic downturn, health insurance (by virtue of its current cost-model that favors group rates) has gotten really expensive for these folks. The less people you have on payroll, the more you pay for coverage. The more people you have on payroll, the less you pay for coverage, but the more you pay in salaries and overhead. Roll the dice. Either way, small business owners are taking it on the chin.

“Get it off our backs,” small Iowa newspaper editor and publisher Art Cullen, told Senators, “If that means a public option, fine. If that means an insurance exchange of some sort, fine. But give us a way to get out from underneath this albatross. It’s become expected that small businesses will provide insurance, even if they can’t afford it. And we cannot afford it.” I gotta hand it to the Congressman. The audience was appropriate. Since everyone has a stake in affordable healthcare, ears were burning everywhere. But we’re still waiting for something — anything — to change the bleak outlook.

In spite of all the back-and-forth between hecklers and proponents of more affordable healthcare (and I’ll admit, after Wal-Mart kind of took over the small business niche’ years ago) a plethora of insurance plans are still around, alive, well and thriving. Small Businesss can get it done. Care at less cost can happen. It just takes some entrepreneurial spirit to change the debate. Unfortunately, Congress has never been known for their independent streak.

States have struggled with it. Hospitals pray their patients won’t fall over it. Software makers are grinning over it, like the Cheshire Cat.

The massive rock paperweight that keeps our medical records in an ever-growing stack is fossilizing. Fast. As a result, congress, President Obama and insurance providers are shaking hands, creating partnerships and evaluating vendors to send our medical records into the cloud. Poof! Just like that…Up, up and away goes the latest results of your cholesterol test to that great big server in the sky. Paperless healthcare is supposed to create lower healthcare quotes for consumers. But will it?

“We’ve proven that paperless documentation can save costs for one of the most documented segments in the healthcare industry,” says Gerry Stone, founder of Redoc, an electronic medical records software company that specializes in documentation for physical and occupational therapists. “Believe me, if it works for Physical and Occupational rehab, it will work for the rest of healthcare.”

Stone has a point. He built his software platform from scratch 14 years ago, when electronic medical records were but just a glint in Bill Gates’ eye. Since physical and occupational rehabilitation is usually prescribed by health insurance plans to those who injure themselves on the job, Workers Compensation claims (and in the case of post-65-year-olds, repeated Medicare reimbursements) require an average of one hour of a therapists’ time filling out forms after each session. Stone has managed to reduce the hand-driven process of jotting down billing codes and treatment notes down to mere minutes by designing a simple interface of drop-down and text boxes, key shortcuts and the like. That was w-a-y before big Goliaths like Siemens, SAS and open-source companies jumped into the tepid waters of paperless healthcare.

Now that the President has essentially mandated paperless medical practices, the Cloud is gonna get a lot more crowded now. But how soon is now? Depends on who you ask. Software companies are courting their respective Congress persons and the President is waiting for the sky to open up and accept the first pile of medical paperwork. So far, there doesn’t seem to be any protocols drafted to guide how the information is documented, where and how it’s shared and who backs it up and how often. By the time the paperweight gets lifted, the ACLU and other privacy advocates will have their say on how private medical information is managed.

And what about HIPPA (Healthcare Insurance Portability and Accountability Act)?  When the medical records pile shifts to the servers, we’ll probably have an even L-O-N-G-E-R paper form to read and sign at the pharmacy counter. Figures.

And just a few years ago, we were blaming traffic cameras, public surveillance systems and mall cops for our lack of privacy. Pretty soon, if Microsoft has its way, we’ll all be watching ourselves anyway.

I’m self-conscious enough without CNN reporting this morning that the empire in Redmond is working on a personal surveillance system called “SenseCam,” which will serve as your own personal voyeur — essentially recording everything that you see and do, every minute, of every hour, all day long. Imagine a huge media card inserted in your neck.

Do you remember when Google started developing Google Maps and people starting calling local police departments to tell them about strange cars from the future with UFO-like pods (which we all later found out, was the actual GPS mapping thing) on their roofs? Well, keep that iPhone in its holster on your way to work this morning…Microsoft Beta testers are actually walking around cities across America today with audio and video equipment strapped to their heads. Human droids.

Of course, today’s technology creates opportunities for moment-by-moment documentation. But does that mean we really should document the mundane? More importantly, what does that mean for the future of affordable healthcare when, say, your electronic diary goes viral in the cloud and your insurance carrier watches you smoking a cigarette? Do our health insurance quotes go up?

Mircosoft claims the benefits of the system outweigh the inherent risks to personal privacy. Archives of your blog, Facebook or Twitter feed — both in text and in pictures – would help you remember exactly what you ate on important occasions, the papers you were proud of and the outfits you wore. For sure, such a tool would be a helpful aid for people suffering the horrors of Alzheimer’s Disease or other memory-related ailments.

Come to think of it (pardon the obvious subject pun), I could use a device like this to help me remember my countless log-ins, my parking spot and on those extra crazy days, my name. Not sure my own personal risk (i.e. – I am very clumsy) or the embarrassment of snickering pedestrians is worth me  strapping on a bulbous helmet-cam and wiring harness, a-la Ghost Busters.

So how many Gigs does your brain have, anyway?

A newly-released survey of human resources professionals suggests that HSAs (or Healthcare Savings Accounts / Flexible Spending Accounts) need a strong legislative antibiotic to ward off a growing epidemic of consumers who are enrolling in higher deductible health care plans in a flat, uncertain economy.

Originally signed into law as a cornerstone of the Medicare Prescription Drug Improvement and Modernization Act of 2003, HSAs were endorsed by then-President George Bush as a compromise between healthcare industry advocates who insisted at the time that higher co-payments for medical coverage are necessary to make a profit and please their shareholders and the American Association of Retired Persons (AARP), who lobbied hard for retirees on fixed incomes to obtain public assistance for medications. When the dust settled, the HSA was supposed to be the panacea for skyrocketing healthcare costs.

Shortly after last year’s health insurance open enrollment season, consulting firm Celent released dismal numbers citing the HSA market’s “disappointing early showing”, and projected 12.5 million accounts by 2012. That’s down about four million people than were originally estimated. Even with the additional tax and so-called “catch up” savings incentives for enrollees over age 55 added in, employees who are eligible for health insurance coverage through their workplaces are coming off of a wave of economic uncertainly and every penny counts. Even leading economists with the Government Accountability Office (GAO, the agency in charge of crunching these kinds of numbers) openly admit that given the slow recovery of the current economic climate, HSA enrollment this year will suffer.

“When you tell a worker in this economy that you’re going to take some money out of their pay check each month and then further squeeze them by earmarking the funds for healthcare expenses with a guaranteed loss at the end of 12 months’ time, it’s healthcare suicide,” says James Lloyd, an analyst for the Southeast region of the GAO. “This year will be especially volatile.”

Budget-Friendly HSA Alternatives:

Employers are streamlining their health insurance plans to cut costs. Whereas just a few years ago, according to the GAO, the average U.S. company with more than 100 employees offered three different health insurance plans; you could pretty much count on a high-deductible PPO, a low-deductible PPO and an HMO to choose from when signing up for benefits. Now, more and more employers are promoting the HSA option and/or eliminating any low-deductible, affordable health insurance plan they may have previously offered. Not only do FSAs cost companies less, but they get to share in tax credits too. The trend, according to the Human Resources Association of America and the U.S. Department of Labor Statistics, will only continue toward workers converting to individual medical policies. At least until open enrollment time rolls around again in 2012.

New Rules for Old Healthcare: Many of us are ‘Going it Alone’

After nine months of back-and-forth public debate, big corporate bail-outs and strained political ties amongst members of Congress, the shock of the new economy and all its moving pieces has officially worn off. But healthcare reform still dominates our national agenda at a time when few of us can afford to be without. Whether or not the so-called “Public Option” becomes part of any finalized healthcare bill signed into law, the average American will have some vital decisions to make about when, where and how they seek coverage. The old rules of group coverage no longer apply in the new economy.

No Safety in Numbers

Just as fast as the U.S. housing meltdown completely redefined what it means to live within our means, so too are the days when finding a good job guaranteed you’d find affordable health coverage where you work. Companies of all sizes are cutting back benefits now that they’ve cut back their workforces. As a result, the old-school “pool” insurance model is proving less and less sustainable. The good news is while debate still rages on Capitol Hill, health insurance providers are restructuring their product portfolios to make coverage more affordable for millions of individuals — no matter if they’re employed or not.

“Next to salary, health insurance is the largest expense any company has,” says Larry Johnson, a human resources officer with Nashville, Tenn.-based Hospital Corporation of America (HCA), the nation’s largest for-profit hospital company. “The reality is that individuals can go online and out in the open market now and get low cost, low deductible coverage on their own.  Lots of times it’s cheaper than what we can provide our own employees.”

Inside Out

In the same way telephone companies broke themselves up into smaller, regional providers in the 1980s (to address government concerns that telecommunications had become a monopoly of a few big providers), health insurance companies are breaking themselves up from the inside out. It was clear several years ago, says one industry health insurance executive, many healthcare companies saw the governmental reform train coming down the tracks.

“Changing an entire product set, expanding a marketing strategy and creating a new pricing model for an industry that’s been pretty much self-regulated up until now doesn’t happen overnight,” says Miami-based independent health insurance agent Jerry Sommers. “Public option or not, this has been in the corporate pipeline for years before it ever got into the media or Congress. It’s only going to get more confusing before it gets better. I’m quoting a lot of policies for people who are scared of what we might end up with when the government gets done.”