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.

A recent New York Times highlighted Maine’s attempts at comprehensive healthcare reform. Their experiences serve as a cautionary tale for Congress.   The state established a public health insurance plan, expanded Medicare and Medicaid eligibility, and banned insurers from refusing to cover people with pre-existing conditions, but those actions have done  little to insure more of its residents.  Contrary to the promises of public option supporters, health care costs have only continued to rise in the state.

Reasons for the high health care costs range from the state-specific to the general. Unlike the bill that recently passed the House of Representatives, Maine’s healthcare reform legislation didn’t include a mandate to buy health insurance plans. It’s a vicious cycle: forcing health insurance companies to offer policies to unhealthy people with pre-existing conditions raises the rates for younger people; young adults will be even less likely to buy health insurance if their premiums go up, which results in the insurer’s risk being spread among less people. In the end, the older, unhealthier population remains in the pool and must contend with less affordable health insurance. Therefore, there is a larger uninsured population.

Granted, Maine is a market dominated by just one private health insurance company (which, with its effective monopoly, can increase premiums to their liking); and its population is older, sicker, and poorer than the U.S. in general. Senator Olympia Snowe points to her state as a cautionary tale of what may happen if drastic changes are made too fast. Snowe is a Republican that supports healthcare reform but is against the public option. Budgeting problems have caused Maine to cap enrollment of its own public option health insurance plan at under 9,000. The federal government, unlike most states, is allowed to run a deficit. However, it isn’t exactly rolling in the money right now either.

The reform bill passed in the House has the potential to change what all health insurance plans cover. An amendment proposed by Bart Stupak, which passed in the House of Representatives, prevents federal funding from being used to buy any health insurance plan that offers coverage of elective abortions. In exchange for the votes of pro-life Democrats essential to pass the legislation, the healthcare reform bill was modified. The previous language only prevented government money from being used directly to pay for an abortion.

Obviously, the public option will not include abortion coverage. However, the ban extends to private health insurers participating in the government’s insurance exchange. Low- and medium-income individuals and families will receive subsidies in order to buy a health insurance plan. A compromise proposed by Speaker Nancy Pelosi, which would serve to distinguish private dollars from federal money and allow insurers to cover abortion services with solely the latter, was rejected. Many people with employer-provided or individual health insurance have abortion coverage provided in their policies. In order to enter the potentially lucrative exchange market, insurers might eliminate that coverage entirely.

Those who pay for their entire health insurance policy out-of-pocket will still be allowed to buy plans that provide abortion coverage, although the availability and affordability of these plans will most likely decrease. Pro-choice advocates, such as Planned Parenthood, are crying foul.

Interestingly, the amendment received 240 votes–higher than the actual bill’s margin of victory. Assuming that many pro-choice Democrats voted against it, this result means that a significant portion of Republicans voted for the amendment. Whether they wanted to salvage something they wanted out of a bill that was almost certain to pass or sabotage the bill by creating a schism between Democrats, they decided to amend a bill while rejecting the bill itself.

(Image: mahalie under CC 2.0)

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.

Healthcare reform was finally passed in the the House of Representatives after a long night. The final vote on the healthcare reform bill was very close: 220 for to 215 against. It seems that President Obama’s last minute push for the legislation worked. Despite Obama’s pep talk, nearly 40 Democrats voted against the the bill. As predicted, the vast majority of Republican representatives voted against it. However, one Republican voted for the bill. Supporters are happy that the public option was retained in the bill, and that health insurance plans will no longer be allowed to deny coverage to people with pre-existing conditions.

Now the bill must go to the Senate, where it will be debated and modified further. Some liberal representatives in the House weren’t completely satisfied with the healthcare reform proposals passed, but feel that they have a better chance of getting what they want if they pass the bill and allow their Senate counterparts to work with it. Their other option is letting it fail, possibly endangering the chances of universal health care altogether.

A 242-192 vote allowed the health care reform legislation to reach the House floor to begin with. Several representatives promised to allow the bill to reach the floor for debate, although they opposed the actual proposals to change the health insurance system.

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.

Continuing the use of technology that fueled his successful presidential campaign, President Barack Obama is now using Facebook and other social media sites to push the Democratic healthcare reform bill. By reaching the younger demographics most supportive of the public option where they congregate, Obama hopes to motivate them to call their representatives and express their support of reform. Generations X and Y live on the Internet, and are also the portion of the population most likely to be uninsured. Some of them might think that they’re healthy now and therefore invincible, but others realize the importance of having a health insurance plan at any age.

The House of Representatives will most likely be voting on healthcare reform this weekend, and representatives will no doubt be hearing from their constituents about it. Opponents of the Democrats’ reform are fired up, and the Obama administration’s goal is to light that fire under supporters who believe it’s the best way to provide affordable health insurance to the nation. They must hope that Obama’s millions of Facebook friends and Twitter followers keep up with their news feeds and become inspired to get involved in helping him enact part of the change he promised them. Their presence was sorely lacking for Democrats earlier this week, when Republicans won governor’s races in two states in off-year elections–largely fueled by anger over reform, and fears of people scared of losing their existing health insurance plans. We’ll see if Obama’s final push pays off.

Yes, you read that right. South Carolina Representative Joe “You Lie!” Wilson has proposed an amendment to the healthcare reform bill lumbering through Congress, which would require all congresspersons to enroll in the public option health insurance plan. He hasn’t switched sides and decided to vote for the Democrats’ bill; rather, his amendment is a stunt intended to point out what he sees as the failures of the public option.

Ironically, supporters of healthcare reform have pointed to the government-subsidized insurance enjoyed by senators and representatives as evidence that there should be a public option–if health insurance is good enough for our politicians, shouldn’t it be good enough for the rest of us? (In fact, although the federal government subsidizes their healthcare, it is actually administered by private insurers.) Wilson turns that strategy on its head, by saying that if a public option is suitable for average Americans, it should also be suitable for Washington D.C.

It’s quite unlikely the amendment will be ratified in the House. The current language simply allows Congress to sign up for the public option. Most Democrats probably won’t vote for this ‘poison pill’ provision; as they have admitted, most Americans would prefer to keep their existing health insurance. Republicans might vote for it as a lark, although they might refuse to dignify Nancy Pelosi’s bill with any type of ‘yes’ vote. Joe Wilson has 72 hours to get his own mandate into the bill, before it reaches the House floor.

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.

Although it seems like the Democrats’ healthcare reform bills have been zooming through Congress, Senate Majority Leader Harry Reid predicts that there will soon be roadblocks.  To the chagrin of the Obama administration, Reid believes that a final bill won’t pass before the ball drops on Times Square and 2009 draws to a close. The White House wanted a bill passed prior to Ryan Seacrest’s countdown to the new year. Why is that so important? Well, 2010 is an election year; the entire Congress will be up for re-election. Judging from the few elections held yesterday, things don’t look good for the Democrats. Their prospects will be even worse if the fight to reform the health insurance industry continues to drag on, instead of  allowing the public’s memory to fade.

Unlike the House of Representatives, which is already close to voting on its bill, the Senate may not begin debate until December. There is some speculation that Reid is waiting for the final cost analysis from the Congressional Budget Office. He commented publicly that he doesn’t want to rush such an important bill. However, he is still striving to pass Obama’s top domestic priority by years’ end. They may be worried that waiting too long will make more likely that this administration’s attempt at providing more affordable health insurance will follow the failing path of Clinton’s.

This new development is just another example of why you shouldn’t wait for the public option if you can afford a health insurance plan now.