Tuesday, August 25, 2009

On Healthcare

...in which a bleeding-heart liberal attempts economic theory.

So, here’s the deal with me and economics.

I actually took both micro- and macro- in college. As electives. I thought they would compliment my sociological studies. My macroeconomics professorr was eerily reminiscent of Ben Stein in Ferris Bueller’s Day Off (down to the “anyone?... anyone?...” drivel). My microeconomics professor was married with children, and yet all of his illustrations centered around the diminishing returns of frozen burritos when he was a bachelor.

My good intentions were poorly rewarded.

Despite my disinterest in numbers, I have managed to work for both an investment and a commercial bank (though on the administrative rather than financial side of the business). Even during my non-profit stints, I eventually found myself overseeing a million dollar grant and coordinating multiple income streams. I may not like number crunching, but I’m not entirely inept.

In my prior position, I worked as the Director of Continuing Care for a family treatment center. We brought in women in need of treatment for substance abuse, most co-presenting with mental health issues, and allowed them to bring their children with them. For many of our clients, our center was their last opportunity to regain their health before losing their children to the foster care system. These were not the women with supportive families who could care for their children while they focused on their recovery. These were the women who never had much support or resources to begin with, many of them had been introduced to alcohol and drugs by their family, they had burned any bridges they once had, and there was no one left to assist with the children. So we brought them in for family-based treatment. In the 6-months per client we were given, we worked to begin the bio-psycho-social healing process necessary to get the families back on their feet and on the road of recovery. When they graduated, my staff’s job was to coordinate five variables we saw as essential to continued success: housing, transportation, employment, childcare and healthcare. We had learned, any one of these social supports falling out of place could undo the months of work the family put into their treatment.

I could write a million essays on family treatment, but this one is about the economics of healthcare.

When your job involves identifying and coordinating family resources, you get a pretty good grasp of the cost of various services. One of the things we tried to do with this knowledge, was to promote legislation that would make not only good sense for individuals and society, but that would also make good economic sense.

Case in point: Garrett’s Law.

The old dogs they got a new trick,
It's called criminalize the symptoms
While you spread the disease…

~ Ani DiFranco (‘Tis of Thee)

Garrett’s Law had really good intentions (kinda like my electing to take two semesters of economics). The overarching idea was to protect children born to substance abusing mothers. I won’t get into all of the pros and cons of various aspects of the bill at this time.

As supporters of the family-treatment model, we set out to have the bill amended to provide a provision for a family-treatment option for the mother and her child(ren) before the children are automatically removed from her custody. Family treatment with wholistically coordinated services has been shown effective at teaching the health management skills necessary to deal with the chronic disease of substance abuse. While healthcare professionals view addiction as a chronic disease, it bears a greater stigma than most chronic diseases due to its overt social implications.

There are generally two broad objections to promoting treatment vs. criminalization:
1. These women deserve to suffer for what they are doing to their children.
2. I shouldn’t have to pay for their treatment.

And that was where we entered into the process. Again, I will focus on the second objection, because I’m supposed to be talking about the economics of healthcare.

It really was a pretty short and simple spreadsheet.

We laid out the immediate cost of incarceration of the mother and foster care for the children, versus the cost of six-months of family treatment.

The cost was significantly lower.

But in case that isn’t enough, the long term savings for a mother who successfully completes treatment and receives assistance in coordinating employment, housing, etc. to contribute to the care and welfare of her family in the long run is incomparable to the inevitable multiple and/or long-term incarceration that could occur with prolonged drug use.

This is simply the economic impact on society, not even addressing the social impact.

What does this have to do with the greater healthcare debate?

I can sit here and tell you that I think healthcare should be a basic societal right until I’m blue in the face, but that will really only speak to those who agree with me.

But what I can also say is healthcare costs are rising.

As Representative Vic Snyder shared during a local town hall meeting, healthcare premiums continue to rise at the rate of 2-3 times faster than wages (and in addition to premiums, copays and deductibles are also rising).

Part of the reason they are rising is inflated executive salaries and perks, but that isn’t the whole story. After all, most of you don’t want to hear my rants on greed and Adam Smith’s idyllic belief that our “ethics” would keep capitalism’s free market in check...

The truth is the system is broken. The sheer existence of uninsured people with limited to no access to healthcare is putting a strain on the entire healthcare system.

Emergency and intensive care is more expensive than primary care.

Consistent and accessible primary care significantly reduces the need for emergency and intensive care.

People who do not have access to primary healthcare rely on emergency hospital services (where treatment can not be refused) to treat symptoms when they are at their worst, rather than receiving preventative care that could have avoided the symptoms all together.

As more uninsured people utilize emergency care services, costs rise and are spread to those who are insured.

Healthy people can work and make a greater financial contribution to their families and their society.

Sick people and/or dead people tend to make and contribute less.

We can choose to do nothing to reform the healthcare system. In the meantime, our cost of care will continue to rise and almost 50 million Americans will continue with limited access to basic healthcare.

Or, we can choose to recognize that reform is necessary, and that the “cost” of insuring healthcare for all of our citizens can have potential “savings” for the overall system of healthcare.

Whether you want to see poor families gain access to primary healthcare services, or you simply want to stabilize the percentage of your income that goes toward health insurance, reform makes sense. Reform is necessary. Reform is unavoidable.

Image Attribution.

1 comment:

Rachel P. said...

Hey friend,

Some healthcare professionals view substance abuse as a chronic disease, as well as some mental health professionals. However, the research doesn't seem to support this in the majority of cases. Patients seem to respond well to cognitive therapy (identifying and changing false beliefs), which seems to discount the biological proclivity argument in most cases. There are always exceptions, yada yada.

And interestingly, there are other mental disorders that are termed chronic - Bipolar Disorder and Schizophrenia are two examples - that respond very well to medication therapy, and not so well to non-medication therapies. This would suggest that these diseases are in fact biologically based, and deserve the term "chronic" (meaning, the disorder cannot be behaviorally or cognitively mitigated, only biologically). But that's a very heavy word that can be crippling to someone who would perhaps otherwise struggle willingly to find an end to a life of addiction, and I think we should use it sparingly.

However, I would agree that it is a disease. Using this terminology with the patient can help him/her to release any (often counterproductive) stigma-induced guilt or shame, AND places responsibility for dealing with the disease squarely on the patient's shoulders.

I'm not sure how this relates to your experiences with substance-addicted folks, but I did want to share the other side of the "chronic disease" argument. Thanks.