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.

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.

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)

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.

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.

I recognize that healthcare reform is a serious issue that has the potential to change the lives of millions of Americans. I also acknowledge that many people are worried that such a bill will endanger their existing health insurance plans; their fears shouldn’t be downplayed. However, when healthcare reform proposals are compared to “domestic terrorism”, isn’t that going a bit too far? North Carolina Republican Virginia Foxx recently took to the House of Representatives floor to express her vehement opposition to the Democrat-written bill. The representative was quoted in the Associated Press as saying that the nation has more to fear from the bill’s potential passage than it does from terrorists. While hyperbole is a standard feature of modern politics, Foxx has reached a new level.

One of the identifying features of terrorism is the intent to cause a feeling of terror in a population.  Many may disagree with Nancy Pelosi’s plans of healthcare reform that include a public option, but keep in mind that congresspersons of both parties genuinely believe that what they are doing will help America. They may be wrong–and their policies might have disastrous results–but neither Democrats nor Republicans are purposely trying to destroy the United States. Therefore, comparisons to the likes of Osama bin Laden are off-base.  The worst thing about her comments is that they serve to cheapen the legitimate concerns people have. Foxx doesn’t like the bill because she believes it will allow the government to force people to buy health insurance, raise taxes, and and give bureaucrats more power. These are all valid arguments that deserve to be debated, but some people may tune them out due to her inflammatory statements.

Our infamously long-winded Vice President once said that he tried to never question a person’s motives, no matter how much he disagrees with their policies. All of our politicians would do well to take that advice. Both parties are striving to achieve what they think is best for America. Their varied opinions on healthcare reform deserve to be discussed civilly, without resorting to the modern equivalent of Godwin’s Law. In my opinion, that would be best for us all.

(Image: U.S. Army under CC 2.0)

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.

The House’s healthcare reform bill looks like it’ll cross the $1 trillion mark, according to the nonpartisan Congressional Budget Office. Many Democrats have promised a bill that would cost less, and initial CBO estimates agreed with them. However, they have since added billions more in funding health insurance for the retired, as well as more spending on public health and increased reimbursements for preventative care services. Some of these provisions are intended to garner more support from important populations, such as senior citizens. These modifications bring the estimated total of the bill to at least $1.2 trillion over ten years.

Breaking the trillion dollar threshold makes reform of the health insurance industry more difficult to achieve. Nancy Pelosi has previously claimed that the bill would cost about $900 billion; still a massive sum, but short of the trillion mark.  It seems to be a sort of psychological block, even among Democrats whom are otherwise supportive of the bill. The new CBO estimate is closer to Republicans’ claims of $1.3 trillion. The big question is whether it’s worth the price. Supporters would argue that the eventual savings from health insurance plans would allow the nation to pay off that debt in time (after all, America managed to pay off its decades-long national debt by the end of Bill Clinton’s second term), but others feel that it’s a pointless gamble.

Last year, a representative from Texas was the true Republican maverick in the presidential race. Ron Paul may not have won the nomination, but he is still bringing his unique libertarian perspective to Congress’ table. His proposals for healthcare reform are no different. He recognizes that the current health insurance situation is untenable, but is against governmental involvement. Recently, he presented several intriguing bills to the House of Representatives.

1. The Comprehensive Health Care Reform Act of 2009 would give Americans a 100% tax credit on their health care costs (e.g. prescriptions, hospital stays, doctor visits). Health Savings Accounts (HSAs) with high-deductible health insurance plans would also be tax-free. Low-wage employees who don’t file tax returns can have the credit refunded against their payroll taxes, so the bill would help those who need it most afford healthcare. Currently, only medical expenses that reach over 7.5% of an individual’s income can be deducted.
2. Dr. Paul’s Coercion Is Not Health Care Act of 2009 would forbid the government from enacting a health insurance mandate. There has been some speculation as to the legality of such a mandate. Congressional Democrats, along with the Obama administration, believe that it has to be part of healthcare reform legislation. Their view is that universal coverage must include the young and healthy in order for the insurance pool to afford covering those with pre-existing conditions. This interference in the free market is anathema to Paul. Incidentally, if there is no public option, such a mandate might not be necessary.
3. Finally, his Freedom From Unnecessary Litigation Act of 2009 would save money through indirect tort reform. This act would establish so-called “negative outcomes insurance”, which would pay off if a patient’s medical treatment goes wrong; it would also offer a tax credit to make the purchase more affordable. The goal is to decrease some of the unnecessary (and costly) testing done in order to avoid malpractice liability, as well as lessen the need for hospitals and physicians to carry billions of dollars in insurance.

As Paul is himself a doctor, his views on the healthcare industry are worth listening to. His opinions tend to be shortchanged in the House because he doesn’t walk in lockstep with either party’s platform, giving his bills little chance of passing.  However, many Americans–who fear socialized medicine, yet acknowledge that we need more affordable health insurance as soon as possible–could find something to applaud in his plans.