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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.

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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.

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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)

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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.

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