One of the things I really like about HBO is their documentaries. They had a great one this morning called “Addiction.” Several directors each did a segment, and I especially liked the one about Steamfitters Local Union 638 and their employee assistance program. (It was directed by Barbara Kopple, who has such a gift for making films about the working class. You can watch it here.)
In a segment called “Insurance Woes,” prosecutor Gary Tennis speaks to the representatives of the managed care industry who attended a Pennsylvania legislative hearing on patients who died after being denied appropriate addiction care. He reads the statute on manslaughter, and warns insurance companies they are “dancing right up to the edge” of it and it’s only a matter of time before they’re charged in a death. A very powerful moment.
Anyway, it’s all available online. Everyone should see it, because sooner or later, everyone is touched by addiction.
Susie,
I’m really glad you posted this HBO item. Addiction is everywhere in our society - no one is clear.
Case in point:
We were at a party yesterday and were told of two fine young men both college graduates, and both in rehab for herion addiction. One of them relapsed - this is his second round of rehab. These young men are lucky that their families can afford to pay for private rehab.
Another brilliant young man and family friend relapsed several times with alcohol and cocaine addiction over the years. He’s lucky - his rehab was finally successful which is rare for his problem. But his family is now in a serious financial hole due to the treatment cost.
I’m not one to defend insurers, but this is a bigger problem than just addiction treatment, and it goes to the healthcare debate: our biggest coverage issues are around the things that have intangible time issues - things like mental health generally, rehabilitation, and others. Costs are hard to quanitify, time limits are hard to establish - when is one recovered from addiction? when do you get over depression? when do you have enough speech therapy? - and thus costs are hard to control.
The point, as my mom always reminds me, is that the problem here ultimately comes down to viewing healthcare as a for profit business. Yes, that’s an obvious indictment of insurers… but it also colors how we think about hospitals, treatment centers, rehab facilities… and even practitioners, like Doctors. It’s why insurance reform, of any sort, is only a partial solution: until we figure out how to control costs, insurers will say, sometimes rightly, that they can’t simply pay forever for everything.
Yes, it’s abominable what insurers don’t cover in addiction treatment… but that’s true across issues in mental health (ask yourself why the main facilities treating schizophrenics at this point are prisons). And it can’t get better simply by forcing insurers into some sort of “coverage mandate”. At the state level mandates will cause insurers to exit the state. At the federal level, if they passed, they’d be hard to implement, and likely never be enough.
And believe me, this is a very personal issue for me. I say none of this lightly. But the problem here is extremely complicated… and there is no easy fix.
Re: “the problem here is extremely complicated… and there is no easy fix.
In concept the problem is easily fixed: We tax the wealthy and the corporations to pay for health services and all other human services our nation’s citizens deserve.
The existing health care insurance system is not workable nor functional. We have to ditch it for a nationalized health care system. Other First World nations make it work.
This won’t happen unless we win both the White House and the Congress, of course.
The existing health care insurance system is not workable nor functional. We have to ditch it for a nationalized health care system. Other First World nations make it work.
This a lovely abstraction… but that’s just all it is - abstract, and vague. In theory, I agree with the notion of a national managed care system. In practice, I think the hurdles have be realized and faced - and Congress, really, is the least of it. We have multiple systems now that are not well understood by many and a notion of how healthcare works that many Americans have that needs to be challenged. Too often, I think, progressives right now assume that what they see when they look at healthcare - a broken system in need of drastic reform - is what everyone sees. That’s just not the case.
We have to keep in mind that getting seniors to accept changes in Medicare, Veterans to accept changes in the VA, not to mention workers in professions who currently still have perfectly good employer provided insurance, are all tall orders. And this isn’t just about insurance - it’s about cost controls, and changing the way health care providers do their work, changes that are systemic and hard. So yes, it is complicated, and even in concept, it’s desperately in need of hard thinking and more specifics. And finally, as I mentioned above, little of this actually solves the questions raised in this post about mental health treatments, addiction services, and other forms of rehab.