Month: May 2020

Employers, Employees, and Opioids

Employers, Employees, and Opioids

Posted on by jabittan
One of the frustrations I have with modern day America is how frequently employers say that their greatest asset is their employees, but don’t back that statement up with actual action that helps improve the lives of their employees. Many of us work 40 hours when our work could reasonably be completed in fewer hours, alternatively many of us have incredible demands and insufficient help or time to complete our work. On the benefits side, many of us have health plans that don’t make preventative care affordable and have high deductibles and copays which place basic medical care beyond our reach. These frustrations, incursions into our non-work-lives, and a lack of support for living healthy lives are examples where employers are failing to live up to the claim that so many of them make about the care and value they have for their employees.

 

In the end, a failure to take care of employees and a willingness to let workers languish hurts the employers as much as the employees. In his book, The Opioid Crisis Wake-Up Call Dave Chase writes, “Ohio attorney general Mike DeWine estimated that 40 percent of job applicants in the state either failed or refused a drug test. The result: In certain places, solid middle-class jobs can’t be filled.”

 

On a first read, the problem sounds like it is on the job applicants. Why are so many job applicants using drugs, refusing drug tests, and unable to be hired for work? Shouldn’t they stop using drugs, get their lives together, and do the sensible things to be responsible humans and find employment? From the outside, as someone with a job who doesn’t have an opioid addiction, this is easy to say and think, but it’s also shortsighted.

 

Many of us have incredibly lengthy commutes, decimated social lives, no meaningful civic or religious organizations to give us purpose outside of work, and lack access to supportive mental health and general healthcare services. When we fall on hard times and need assistance, we don’t have a social safety net that we can fall back upon with encouragement and understanding. We feel isolated, can barely afford healthcare, don’t have much time outside of work and commutes for social or civic engagement, and if we do need welfare, the system is designed to make us feel like abject failures for turning to public support programs for help.

 

The blame can’t fall entirely on the individual. Businesses have to be held accountable as well, after all, employers count on a strong labor market to stay afloat and be productive. If they truly value their employees, they should prioritize a happy, healthy, and effective workplace by pushing back against institutions and structures in our lives that make us miserable, depressed, unhealthy, and uncommitted to the work we do. Chase’s book shows how employers are beginning to do this, by providing more services (in healthcare) to their employees and actually saving money while doing so. Employers can let their actions speak louder than their HR slogans, and can help their employees actually live healthy lives. In the end, the workforce that they rely upon will indeed be more reliable.
pharmaceutical advertisements

Thoughts on Pharmaceutical Advertisements

Posted on by jabittan
“The reality is that most people hear more from pharmaceutical companies (16 to 18 hours of pharma ads per year) than from their doctor (typically under 2 hours per year).” writes Dave Chase in his book The Opioid Crisis Wake-Up Call. Chase is critical of American’s looking for a quick fix and expecting a pill to solve their problems. He says that short doctors appointments and a bombardment of pharmaceutical advertisements on TV contribute to the mindset that any disorder or illness can be fixed in a matter of minutes with a quick pill. With how much we hear from drug companies, and how little time we spend with someone who is trying to work with us in depth to correct behaviors, change our thoughts, improve muscle imbalances, or make adjustments to help us live a more healthy lifestyle, it isn’t hard to understand why most people think of medical care in the form of a pill.

 

I am wary of pharmaceutical advertisements. I don’t really understand if I am the target audience or if medical professionals are the target audience. I’m not sure if the goal is to just normalize taking pills, or if the goal is to educate patients about a potential solution for a potential problem. I’m not sure if the idea is to get people away from taking generic medication in favor of brand name drugs, or if it is to get people to try a medication and see if it helps them.

 

However, I also remember seeing a study which suggested that drug advertisements did help improve people’s health literacy, and did lead to patients being more likely to ask about medications which would help them, without finding an increase in patients asking about medications that wouldn’t be helpful for them. `When primary care providers are stressed, have limited time with patients, and are likely to miss important details, having patients with goals and specific questions about beneficial medication is important for overall health gains and an improved doctor-patient relationship. Additionally, advertisements approved by the FDA and at least somewhat regulated are better places for people to gain medical information about a drug than a Reddit or Facebook post from a random person.

 

Ultimately, I think I fall on the side of banning direct pharmaceutical advertisements. I find they are overly broad, dangerously support the idea that all one needs is a pill to solve all health problems, and ultimately are more about pharmaceutical companies than about improving health in general. I’m not 100% sure this is the best course, but I’d put my confidence around 75% sure this is the best path to pursue. I don’t think it would hurt America to be a little less focused on pills as cures rather than focused on lifestyle changes, especially if we start to favor policy changes that would support more healthy lives.
Opioids and Mental Health Disorders

Opioids and Mental Health Disorders

Posted on by jabittan
Opioids and mental health disorders probably do not seem like a good mix in anyone’s mind. I’m sure most of the general public would find it problematic to prescribe opioids to someone with a mental health disorder, but every day, physicians across the country prescribe large numbers of opioid prescriptions to these patients.

 

Dave Chase, in his book The Opioid Crisis Wake-Up Call, writes, “According to a recent study, more than half of all opioid prescriptions in the United States annually go to adults with a mental illness, who represent just 16 percent of the U.S. population.”

 

Why do we over-prescribe so many opioids to people with mental health illnesses? I can think of three potential causal models that lead to our over prescription of opioids for people with mental health disorders. 1: our system was never set up to treat health broadly speaking, 2: mental health has always been stigmatized and hidden in America, and 3: we have sabotaged ideas of community in the United States as we pursue our own self-interests and spend unreasonable amounts of time working and commuting.

 

1: The history of the American medical system was focused on interventions and solving health problems after the problem had popped up. Insurance companies were created to help people access different parts of the medical system, and over time private insurance has become more or less the only way to reasonably access affordable medical care in the United States. Our reliance on third party payers allowed prices to profligate, and it feels as though we are at a point where we can’t turn the ship around. If you have a mental health disorder, you are less likely to have stable employment, which means you are less likely to have quality health insurance provided through your job, and less likely to establish the mental health care that you need. As a result, you probably see your primary care provider and end up with an opioid prescription during your 10 minute appointment because your doctor doesn’t have time to really work with you on addressing your mental health challenges.

 

2: There are many examples throughout history of people hiding children with intellectual disabilities. Generations before us warehoused children in mental health institutions that did little to help improve health. We are mostly beyond that today, but nevertheless, we hide anxiety, depression, learning disabilities, and other mental health challenges from our friends, families, and coworkers. We still don’t do a good job of accepting that mental health disorders are not something that people should be ashamed of, and many people do not seek appropriate care but instead life lives that are less than healthy, where ending up with an opioid prescription, or self-medicating with something worse, is a less public alternative to dealing with mental health challenges.

 

3: Tying both points one and  two together, our lack of community makes mental health management almost impossible. We don’t have a lot of friends and family members that we can truly rely on for help with physical, mental, and emotional challenges. It may take a village to raise a kid, but we have run away from our villages to hide in our suburbs. We have dis-invested in the communities where we live and as a result, people with mental health disorders lack the social support systems necessary to truly address their needs. Even if people with mental health issues have some family and friends close by, those who they rely on probably lack the support they need to care for someone with mental health challenges. We spend too much time at work, spend too much time commuting to work, and don’t have time to help those who are more vulnerable. As a result, we simply shut people with mental health disorders out of our lives and out of society, and numb their lives with opioids.

 

Our country has not set up a system that truly takes care of our health, from before we are sick or have significant health challenges through to a successful recovery. We have overloaded the system that we built which was designed for people with the means to afford care after they were ill. We have ignored mental health and pretended we didn’t know it was an issue, until now, when it is too late and we don’t have the supports we need. Our communities are non-existent, and taking the steps to care for our community feels impossible.

 

The path forward involves a shift in how we provide, pay for, and think about healthcare. The systems we turn to for health need to move up-stream, where we focus on health before people are sick. To do that, we have to be honest about things like mental health, we have to be willing to provide spaces and community so that people can engage with healthy lifestyles and behaviors. We have to break out of our 40 hour work-weeks, and find ways to work closer to where we live, to end the soul sucking commutes that so many of us have. We have to give people time, and develop communities of support so that we can take care of our health and the health of those most vulnerable people in our communities. Without making these transformational changes, we will be stuck in our default of opioid prescriptions, unable to give people what they need to live healthy and meaningful lives.
Jobs and Addiction

More Than The Chemical: Jobs and Addiction

Posted on by jabittan
A simple view of addiction is that people become hooked on a powerful chemical and their entire life becomes focused on nothing but the drug. The chemical sinks into the brain of the addicted person, and their desire for the neurological high from the chemical drives them beyond everything else. If only we could stop the person from ever being exposed to the chemical, even once, we would prevent them from ever developing their drug addiction and chemical dependence.

 

This view, however, is incomplete. A lot of what I try to do with this blog is show that the world is more complex than we often realize. It is easy to sit at home, listen to a news story on TV, and call everyone an idiot while offering an obvious solution from the couch. In reality however, our first impressions of the world and its problems are woefully inadequate, and drug addiction is a good example.

 

I recognize that chemical hooks, neurotransmitters, and brain chemistry are major parts of addiction, whether to a chemical substance, to a behavior like gambling, or other forms of addiction, but research that Dave Chase’s book The Opioid Crisis Wake-Up Call presents is a good indication that there is more going on than just a drive to fill the brain with a chemical. Chase writes, “For every one percent rise in unemployment, there’s a four percent rise in addiction and a seven percent increase in emergency department visits.“

 

Our economy, it appears, is deeply connected with addiction. It is not hard to think of a causal model between economic performance and addiction. Having a meaningful job gives people a chance to feel valued, gives people a chance to contribute to society, and gives people an increase in their social status (in political science we might think of Social Construction Theory: working people are Advantaged or at least Dependents whereas the unemployed are simply Deviants).

 

When people lose their job, they feel a loss of social status, they may feel helpless if they cannot find another job of equal status, and they lose their feeling of importance. They become more vulnerable, and it appears are more likely to turn to substances to blunt the pain they feel, either physically, mentally, or emotionally. This sets people up for addiction.

 

In this model, addiction is not just a moral failure. It is a failure at more levels than just the individual and their ability to work and resist chemicals. Our society has isolated people and made it hard to maintain strong family connections. When jobs disappear and people don’t have close people and community connections and organizations to turn to for meaning, purpose, and participation, they will struggle, and in their empty void potentially turn to drug use. Economic data makes this clear, and the solution is not just to provide someone with a bleak call-center job, but to really develop community connections, meaningful work, and opportunities to improve social status while deepening relationships and opportunities to contribute to society. Drug use is not a simple issue, it is tied to larger economic and social forces, and we have to recognize that reality to solve our nation’s problems.
Businesses and Healthcare Solutions

Businesses and Solving Healthcare Problems

Posted on by jabittan
We often overlook businesses when we think about the problems in American healthcare and how we can fix the issues that plague our system. But about half of all American’s receive their health insurance as a benefit provided by their employer. Businesses purchase and provide health insurance for millions of Americans, and must think about employers and the plans they offer when we think about the problems in the American healthcare system.

 

Everyone will tell you that healthcare is complicated. We know that insurance is hard, getting to a doctor can be hard, understanding what you have to pay is hard, and trying to guess what kind of plan you need for the next year is hard. All of this makes the solutions to our healthcare problems hard, but for a majority of Americans, the person who is shaping the structure in which they will make these decisions and figure out what is available to them is someone at their job. And for a lot of those Americans, the person at their job is probably in HR, and their main goal is not to find a great healthcare solution for the employees, but to just not get yelled at by the CEO for raising health insurance coverage costs and to avoid being yelled at by unhappy employees. Nevertheless, businesses can step up and play a role in making changes for the positive in the American healthcare system.

 

Dave Chase in his book The Opioid Crisis Wake-UP Call writes, “The opioid crisis is a complicated issue over 30 years in the making. But companies have played a major role in creating and sustaining the crisis. And a vanguard of employers are realizing that they have a major role to play in solving it, and that the solutions fall well beyond what the government alone can do.”

 

Companies, since they control the healthcare of half of Americans, can start making real changes to the care available to people. Employers who set up their own plans can make primary care access, physical therapy, and nutrition services virtually free to their employees. By providing a greater selection of preventative services, they can improve employee well-being and reduce the likelihood that an employee will deal with chronic pain and develop an opioid addiction. This is an over-simplified example of what companies can do, but it is important that we realize that the employer is a major player in the fight to improve the American healthcare system, and if we don’t step up to demand better from our employers, we won’t see the changes we want.
The Costs of High Healthcare Costs

The Costs of High Healthcare Costs

Posted on by jabittan
Dave Chase believes that healthcare costs have stolen the American Dream. Beyond that, Chase believes that our high healthcare costs have cost us more than just money. People stay in jobs they don’t like so that they can afford healthcare, people feel a wage stagnation as employers have to spend more on healthcare, and up to 70% of people who file bankruptcies due to healthcare costs have insurance. The high costs of healthcare come at a substantial emotional, psychological, and aspirational cost to Americans.

 

In his book The Opioid Crisis Wake-Up Call, Chase writes, “Had health care costs paralleled the Consumer Price Index, rather than outpacing it, an average American family would have had an additional $450 per month – more than $5,000 per year – to spend on other priorities.”

 

The money that families are spending on increased healthcare is not the only money that could be redirected toward other priorities. Employers are spending more on healthcare, which means they have less to use for business investment, less to use for retaining great talent, and less money for expanding into new areas.

 

The stagnation for individuals and companies is real, and it has serious costs beyond just the money going toward healthcare. Individuals who don’t see their take-home pay increase will feel discontent. If inflation picks up, and the amount of goods that can be bought diminishes, people will channel their frustration into social unrest. If businesses cannot invest in R&D because too much money is going to the healthcare costs of their employees, then the United States will not see new innovations inside our boarders, and the dynamic companies that we depend on for our jobs will not be able to compete on a global scale. The costs of our high costs of healthcare go beyond a loss of spending money for some people. The costs are real, and threaten our economy, our global standing, and our social contracts with each other and our institutions.
Revealed Preference

Revealed Preference – Insights from Government, Healthcare, and Sports

Posted on by jabittan
I have written in the past about government budgets as seen through the eyes of people who have studied government and political science. The budget serves as a written calculation that enumerates the government’s priorities. In economics terms, we might call this revealed preference, where the government puts a dollar figure down next to the things that candidates and political leaders said was important. The dollar figure they put next to an educational program, a defense program, or towards a new Veteran’s Administration Hospital reveals just how much they actually care about that thing. If we elect a whole set of candidates who promised to improve our local school buildings, but then budget only a tiny new amount of money toward school maintenance while offering a big tax break to financial institutions, their real preferences have been revealed, and they didn’t match what was in their campaign message.

 

I wanted to present a detailed example of government budgeting and revealed preference to set up an observation that comes from Dave Chase in his book The Opioid Crisis Wake-Up Call: Health Care is Stealing the American Dream. Here’s How We Take it Back. Chase was working in the healthcare industry as a revenue cycle consultant, what he describes as someone who helps hospitals with, “generating as a big a bill possible, getting it out as fast as possible, and getting paid as quickly as possible.” After the loss of a close friend, whose encounter with the healthcare system at a young age was incredibly financially costly, Chase saw behind the hospital curtain, and was shaken by the revealed preferences that he uncovered.

 

“Despite breakthrough technologies that could improve patient outcomes, that’s not what hospital wanted to buy. All they wanted were systems tuned to game every reimbursement opportunity the industry had to offer.”

 

I don’t want to say that all hospitals are evil and that hospital management only wants to maximize the money they get out of their patients at every encounter. However, Chase’s quote reveals that the goals of being a financially solvent hospital or healthcare system serving the needs of patients can be displaced by the goal of profit or increased margins. The financial side of a hospital is important – you don’t want your hospital to go under and leave people without medical care – but if the hospital is advertising itself as an organization that puts patient’s first, then its actions should support that messaging. Revealed preference shouldn’t show us that patient care and outcomes fall far behind maximizing profit.

 

Chase was so shaken by the observation in his quote that he left the healthcare field altogether. When revealed preference shows us something hypocritical about the space we are in, whether it is government, healthcare, or even sports, it creates cynicism and drives away the talented innovators who are needed for making the world and field a better place. Chase argues that the revealed preference that he uncovered, increasing hospital margins/profits, was actually damaging to the health and well-being of Americans, and not just in a financial way. If we are in a leadership position, if we are part of the team that makes decisions between the public goal and the internal goal of the organizations we are a part of, we should be asking what our actions and decisions reveal about our preferences. In healthcare, are we really just chasing the dollar, or are we trying to help people live longer and better lives? In government, are we really trying to serve people well, or are we just trying to get really good at following the rules so that we don’t get called in front of a legislative committee? In sports, are we really focused on the game and improving the experiences of athletes and fans, or are we again just maximizing the dollars we get from butts in seats and eyeballs on tvs? The bet I’m willing to make, one that I think Chase would make as well, is that our real preferences will be revealed to the people who interact with our organizations, and in the long-run, if the revealed preference is not what we advertise, people will know, and our organization will lose trust, lose customers, lose talent, and will ultimately fail.
Addiction and Community

A Final Thought on Addiction and Community

Posted on by jabittan
In the afterword of his book Dreamland, author Sam Quinones includes a quote from an obituary written for a 24-year-old man who lived in Avon Lake, a town of about 24,000 people just west of Cleveland. The parents of the young man who died from addiction wrote in their son’s obituary, “They say it takes a community to raise a child. It takes a community to battle addiction.”

 

Everyone, including those of us who are not parents, know that it is true when we say it takes a community to raise a child. Historically, new parents have been in their early to mid twenties (this is changing now – possibly for these communal reasons), and with lower incomes in early stages of their careers and fewer immediate resources, new parents have relied on family members and friends to help with child rearing. As kids get older, they enter public schools, where everyone, parents and non-parents, contribute financially, typically through local property taxes. We know that it is hard to raise a kid on your own, and that it makes a big difference to live near family, to have close friends who are raising kids at the same time, and to have supports from work for the times when our kids are sick and need extra love and attention.

 

The quote from the parents in their son’s obituary, and all of Dreamland demonstrate that the same is true for how we should approach addiction. Asking someone to overcome addiction on their own is like asking a child to raise themselves. It can happen, but it doesn’t often turn out well. People battling addiction need supportive relationships in their lives. The family members and friends of people with addiction need help, because it can be challenging and taxing to help someone else stay sober and find meaning in life beyond addiction. We need communities where we can help each other, watch out for one-another, and provide support in times of need. Many of us have lost this along our way, as our culture has pushed us toward staying inside, watching TV in our own homes, and filling our lives with stuff rather than with the people we love and care about.

 

This is a tough time to find new connections and community as we work to prevent the rapid spread of a new virus, but we should be thinking forward nonetheless to a time where we can better connect with those around us and find new ways to live in community with those who matter. It might just save the life of someone we know whose struggle with addiction has been hidden from us.
More on Isolation and Addiction

More on Isolation and Addiction

Posted on by jabittan
I previously wrote about pain medicine ideas that Sam Quinones presents in his book Dreamland. He is critical of the idea that we can take a pill to alleviate chronic pain without making substantial changes in our lives to address the root cause of our pain. Even if we can’t completely stop chronic pain by changing our habits, our environment, and our lifestyles, Quinones shares information which suggests that our experience of pain is connected to many parts of our lives, and that we can change how we think about and relate to pain, even if we cannot eliminate it completely. This is a holistic approach to pain and pain management that Quinones thinks is a crucial piece for understanding our nation’s current opioid epidemic.

 

Chronic pain and its mismanagement is a common route to opioid addiction. Quinones views opioid addictions similarly to how he views chronic pain. In his book he writes, “Chronic pain was probably best treated not by one pill but holistically. In the same way, the antidote to heroin wasn’t so much Naloxone; it was community.”

 

Naloxone is a drug that helps prevent opioid overdoses by binding to opioid receptors in the body to block the effect of opioids like heroin. This drug has helped save thousands of lives, but on its own it won’t stop addiction. Quinones argues that a big problem with addiction is the way in which we hide it from others, whether it is addiction to drugs, gambling, or something else, we don’t allow anyone to know about our addiction. Without talking about addiction, without acknowledging that it has had impacts on our families and lives, and without having meaningful connections with others, we languish in our isolation and addiction.

 

The argument that Quinones makes in his book is that we need more community. We need more things in our lives where we interact meaningfully with others. We need to find more ways to be in service to other people, to work together for meaningful causes, and to have greater social connections with the people around us. By developing meaningful relationships with others, we provide community for everyone, and that helps push back against the forces that drive toward isolation and drive many of us toward substance addiction. Community provides us the space to discuss our challenges, our addictions, and our discontents, and hopefully gives us the chance to build constructive spaces in which we can connect and find solutions to problems that we cannot find in isolation.
Making People Feel Valuable

Making People Feel Valuable

Posted on by jabittan
Toward the end of his book Dreamland, Sam Quinones quotes a the VP of sales from a shoelace factory in Portsmouth Ohio named Bryan Davis. Speaking of the company that Davis helps run, and discussing how Davis and a few others took over a failing shoelace company and reinvented it, Davis says, “It’s all been about money, the mighty dollar. The true entrepreneurial spirit of  the U.S. has to be about more than that. It has to be about people, relationships, about building communities.”

 

Quinones writes about how the decline of manufacturing has harmed cities across the United States. He understands why companies have relocated oversees, and in some ways accepts that businesses move and that economies change, but he sees the abandonment of American workers and the lack of supports for those workers when opportunities disappear as a major contributing factor to the Nation’s current opioid epidemic. When people suddenly lose the job they have held for years, when there is no clear alternative for them to turn to in order to feel useful, valuable, and like a contributing member of society, an alternative to ease the pain of their new reality is often pain killing opioid medications. It is an easy recipe for widespread addiction.

 

I don’t understand economics well enough to place criticism on businesses and factories that move operations to different cities, different states, or different countries altogether. I won’t criticize or praise these companies, but what is clear to me, is that we need to find ways to be more respectful of the people who work for and with us. We need to find real ways to make people feel valuable in their jobs, whether they are call center staff, healthcare workers, or a VP of a successful company. We can’t set out with a goal to make money and then withdraw ourselves from the lives of our fellow Americans and communities. We have to develop real relationships with people across the political, economic, and cultural spectrum of the communities where we live, otherwise we turn toward isolation, which isn’t helpful or healthy for ourselves or others in the long run.

 

This is the idea that Bryan Davis expressed. We can be inventive, creative, and push for economic success, but we should do so in a way that supports our community and values relationships with those around us and in our lives. If we only drive toward our own wealth and bottom line, we risk exploiting people, and that ultimately leaves them in a vulnerable position where isolation, depression, and isolation are all the more possible.