Rx for reform: Spend on addiction treatment now, save later.

This was originally posted on takepart.com:

StatisticsThe debate about healthcare reform is raging with democrats and republicans seemingly entrenched in their positions on different sides. The overall question is simple: How do we reduce the cost of healthcare in this country without negatively affecting the quality of it?

US healthcare can be some of the most advanced and innovative in the world. Unfortunately, it can also leave nearly 46 million Americans with too little, or even no, coverage. With insurance companies caring more about the bottom line than about people’s health and well being (that is, along with safety, after all the stated job of the government, isn’t it?) individuals lose, or are not granted, coverage when they become unprofitable.

If you’ve seen Sicko, or a number of other productions dedicated to this problem, you know where this story leads: Bankruptcies, homelessness, and the destruction of families, due to cancers, genetically acquired maladies, and other chronic illnesses. This might be okay with some Americans, but it’s not okay with many of us.

Those who oppose reform are using the same scare tactics and generalities they normally resort too, warning us of the loss of our health coverage by this government takeover. If you’re told that regular checkups at the doctor will save you thousands in overall medical costs (and we all are), it would be silly to consider the co pay for the regular doctor visits an additional cost burden. In fact, those smaller payments are allowing you to avoid more expensive, and painful, procedures down the line.

The constant barrage of republican scare messages seems to ignore that simple fact. Spend more now to save money later has worked with thermostats, energy efficient appliances, consumer conveniences like AAA, and will work with a healthcare reform overhaul.

In the same way, treating drug addicts will reduce their burden on our healthcare system. Spending even tens of thousands of dollars on an individual that costs that much yearly in emergency room visits will reduce their total financial burden on society as long as it significantly reduces the number, and severity, of the healthcare visits they seek. And if we add to this and give coverage to the same group, many of whom are uninsured, and you’ve hit the jackpot.

Let’s clarify what costs we’re talking about:

  • With the average cost of an ER visit ranging from $200 to $2000, and an average of 13.3 ER visits per year for untreated addicts, we end up with costs ranging between $2600 and $26000 per year per addict in additional costs. Given the estimates of about 23 million addicts in the US, that takes us, even at the low end, to $60 billion more just for ER visits (the high end would leave us close to half a trillion).

Fortunately, addicts who enrolled in treatment had ER costs that were reduced by 20% and those who completed treatment reduced those costs by 50%!!!

All of this doesn’t take into account health costs associated with chronic illnesses and other indirect effects of addictions. Since these include heart disease (hypertension, stroke) cancers (lung cancer especially), and more (liver disease, kidneys, etc.) even the most conservative estimates would add additional billions of dollars in costs to our healthcare system annually.

As of right now, tax payers are left holding the tab for many of these services. California businesses and families alone shoulder a hidden health tax of roughly $1,400 per year on premiums as a direct result of subsidizing the costs of the uninsured**.  Similar numbers are available for other states, and our federal dollars subsidize even more of the overall healthcare system burden left behind by those who can’t pay for it.

Some suggest that we simply stop providing services to those who can’t afford them. The reality is that all we’ll end up with in that case are millions of people who will become hospitalized through our correctional system. If you need serious healthcare, you’ll do anything to get it. The US already holds the proud distinction of having more than 50% of the world’s prison population while only making up 5% of the overall population. I don’t know about you, but I’d rather lose that number 1 spot.

Addiction treatment may be expensive, but it’s far less expensive than the ER services I mentioned earlier. By allowing individuals to have coverage for those services, we’ll take away some of the burden those same individuals are currently placing on our system AND improve lives at the same time.

My last point has to do with the “pre-existing conditions” clause so many insurance companies love so much. As our understanding of many diseases, including addiction, improves, we’re finding genetic, environmental, and developmental effects on almost all conditions. If we don’t do something to eliminate such restrictions, we may all soon end up paying more that we could possibly be expected to afford because our genes show we have a slightly elevated risk for things like hypertension, arthritis, or yes, even addiction.

It’s time to change the conversation about this and take away the notion that any of us will lose anything in this reform effort. If you have money, you will always be able to get better treatment – this conversation isn’t about you. This entire debate should focus squarely on those who aren’t getting the medical services they deserve by their mere existence as human beings. Every other civilized society on earth recognizes this by now. It’s time for us to make our way out of the dark ages.

**Furnas, B., Harbage, P. (2009). “The Cost Shift from the Uninsured.” Center for American Progress.

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