Much of the country is not that rich at all, especially once you get to central parts of the country where industry has fled leaving people with odd jobs and insufficient healthcare. The opoid crisis centers around parts of America which are the hardest hit financially: http://edition.cnn.com/2016/09/23/health/heroin-opioid-drug-...
Finally, there is also something about expectations. For my generation, we grew up hearing "work hard, study hard, and you will live a good life, own a home, enjoy the life your father and grandfather lived." Except that formula does not work anymore -- industries which worked for our parents got offshored and we're now competing internationally. An entire generation still holds the expectations of an American lifestyle, buying a home with our 8-5 factory job, having barbecues in our backyard, playing "Where the Boys Are" but that expectation is no longer valid for all, leading to unmet psychological contract an entire generation expected to live.
With the change in pay structure, holding back a weeks pay, and the fact that I changed jobs because I wasn't making enough money; I've been unable to buy a temporary policy. Cobra is out of the question at over $2.5k for the month.
Last week we suspected my daughter had an ear infection, which thankfully seems to have cleared up, but it was and is worrying to think that I really have no options if one of my kids gets sick. If I go to the ER, I'm looking at a minimum bill of around $400, any clinic wants payment up front of around $100. My budget is really tight until I get a couple paydays under my belt.
I was admitted to the hospital recently at 2am with a stomach (I think) issue. It hurt like hell. This was in a big hospital in the middle of a huge city. It was extremely clear what the issue was, but without a doctor, policy is, no diagnosis will be made, and of course that means, you can't get so much as a drink of water, never mind medicine.
Of course, there was no doctor anywhere near me until well past 11am (effectively the day after). He did a blood test, which showed mild inflammation, and otherwise nothing. He gave the industrial strength version of an anti-inflammation med and some stomach drugs. An hour later, everything had disappeared.
Analyzing the situation, I can only conclude that the doctor only had a few negatives to go on, and that's why he took this action. It wasn't appendicitis. It (probably) wasn't acidosis (a leak in the stomach). It wasn't an actual wound, either visible or internal bleeding. It wasn't ... But zero positive diagnoses. So he gave something against stomach cramps and a milder painkiller, and patient (me) happily goes home, not because the pain stops but because I was unable to detect the pain any longer. I don't know how they work, but I am sure he gets to add 1 to his "patients cured" tab for the quarter and the government and my insurance (and me, of course) will get billed for that.
Needless to say, issue restarted the very next day. I still have no idea what the problem is, but why go back to the hospital or GP (GP is worse than hospital).
So you might wonder, what is done to someone who is admitted to the hospital with painful, but trivial complaints, to avoid having to allocate a doctor to them ? Well, large doses of morfine (enough that I couldn't walk without toppling) combined with other painkillers (not sure which). Because that's the only thing they have permission to do.
But this allowed me to put the pieces together of things I already knew : Unfortunately there are a ton of painful ailments (just wait until you're 45 and you pull your back. It will happen, I guarantee it. But there's stomach problems, there's hairline fractures (ouch), there's heart issues, there's blood vessel obstructions (ie. the dr. house problem), there's unfixed "mild" allergic reactions, ...). They won't entirely prevent you from moving or even working, but they hurt like hell, all the time 24x7x365. You'll find out that the pain easily exceeds what you can reasonably work with, even at a desk. But there is no obvious problem.
Pray tell, what is a patient supposed to do who fails to get a decent diagnosis, but has an unidentified long term painful ailment ? Other than getting strong painkillers on a regular basis ?
Of course, these people will fight for their painkillers.
But we, as a society, have decided that saving costs by sabotaging the training of physicians, resulting in far too few available physicians (and too incompetent), and even when you have a physician, they don't have easy access to diagnosis equipment, or labs. Everything has to be shared, accounted for, and nothing can be done by the doctor. It must all instead be done by people who, in the worst cases, have no knowledge of what they're doing beyond the safety instruction video (but even in the best cases never have a physician's knowledge). I am not against specialization, but having blood tests done by people who would not be able to recognize a heart attack from a test result is strictly not an efficient use of resources. It's killing people to save 5$.
The consequence of this is a LOT of older people undiagnosed, and utterly dependent on very strong painkillers.
I am also convinced we won't fix it.
They are also very, very reluctant to prescribe opioid-based painkillers, and even the over the counter ones like ibuprofen or paracetamol (acetaminophen) are sold in 10-packs and truly from behind the pharmacist's counter, not economy-sized jars of 500 on grocery store shelves.
ok. it's the doctors and big pharma. so, let's get doctors to prescribe fewer painkillers? is that the policy proposal?
the next thing you see is a news story about the huge amount of unnecessary suffering because our evil, immature government has unjustly demonized painkillers, which are, after all, just good medicine and common sense.
these stories go around and around.
A Tale of Two Surgeries:
A good friend and I had exactly the same type of benign tumors removed, within a year of each other, around 2006-7.
Her surgery was outpatient, and she was sent home an hour after the procedure with 30 doses of Vicodin, which even back then she shied away from taking more than a few doses of. The whole thing cost over $6,000, most of which her insurance picked up, but she was still on the hook for about $1,000. She joked that she could have covered a lot of that by selling off the unused Vicodin. She didn't.
My surgery was outpatient, but my surgeon told me that she might decide to have me stay overnight for observation. I passed out when I saw the normal amount of blood, so she had me stay. I received paracetamol (Tylenol) and Tramadol (weak prescription opioid), given to me by the nurse. I went home the next day, fearing the bill for an emergency overnight. I took home a week's worth of Tramadol and instructions to write down when I took it to show my doctor who I had a follow-up with in a few days.
I shouldn't have worried: the whole thing was 1400 EUR, which my US-based insurance company paid with surprising alacrity.
My friend was a grad student at UW Seattle, treated in their system, and I was a US Army IT contractor, working in Germany, treated at a small city's hospital.
However, this same medicine produces a sort of a buzz or feeling of euphoria desired by persons who are not truly suffering from chronic pain. Since in the USA (and many countries) opioids are restricted to prescription only and are not legally usable for the 'buzz', persons who seek this effect of opioids have 2 choices: (1) see a medical doctor and pretend to have pain that requires treatment with opioids, or (2) purchase an opioid through non-legal pathways, and assume all the legal and medical risks of doing so (arrest, incarceration, violence, inadvertent overdose via unknown content of purchased supply).
Also, in the good old USA, treatment for addiction is expensive and not available for those w/o medical insurance or other source of funding -- it is not a right or benefit of citizenship, but a private matter for negotiation with the service provider. So many persons who might benefit from addiction treatment are never treated.
So the 'blame' for the opioid crisis goes beyond drug manufacturers, and includes addicts themselves, the medico-legal system that drives addicts into doctor's offices to pretend to have pain to get an opioid prescription, the lack of treatment for many addicted persons, and the legal (public health) decision to treat use of opioids in the context of addiction as a crime and not a disease.
So don't just blame drug manufacturers. there is plenty of blame to spread around to other actors! JMHO.
