Commodifying Addicts

Knowing I would not be able to talk him out of pulling his own rotten tooth out with pliers, I asked Brad to wait to do so until after I went home for the night. Michael’s insurance lapsed, resulting in him not having his psych meds for over a week; he started barbequing his pants in the back yard. Travis’ insurance ran out 3 weeks into his stay and had to return to living on the street; he was found dead 3 days later. Jason’s insurance would not cover a stay at the only rehab around with an open bed; he died while waiting for another one to open. During my time working in treatment, I saw these same stories repeating themselves over and over. The names changed but the underlying cause stayed the same: the health insurance industry treating people as commodities rather than as human beings.

While not unique to those suffering from substance abuse disorders, this phenomenon is especially profound in these instances given the young age at which people are becoming addicted to substances, particularly opiates. Indeed, in 2016 the average life expectancy dropped as a result of all the opioid crisis (https://www.pbs.org/newshour/health/the-opioid-crisis-is-driving-down-u-s-life-expectancy-new-data-shows). And while overdose rates briefly started to decline from 2017 to 2019, data shows that during 2020 rates skyrocketed above their previous peak. (https://nida.nih.gov/drug-topics/trends-statistics/overdose-death-rates). Though we don’t hear about the opioid crisis nearly as much as we used to—with the Covid-19 pandemic taking center stage—there is still a real need for reform in this area.

One possible solution, albeit a partial one, is to prohibit health insurance providers from denying or cutting off coverage for substance abuse treatment. This would reduce instability in treatment progress and would likely improve outcomes as a whole. There are, however, several limitations preventing this from fully solving the problem. First, entering rehabilitation is not a guarantee of success. Indeed, some 40-60% of patients who enter rehabilitation end up relapsing

(https://nida.nih.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-effective-drug-addiction-treatment). Second, it seems likely that if insurance providers were not allowed to provide only partial funding, there is an increased risk of patients being fully funded for lower quality treatment centers. Insurance providers might not be willing to pay for certain treatment centers all together, and if there was a shortage of beds those suffering from addiction would be left with long wait times before they could get treatment.

Third, and relatedly, the lack of oversight over treatment centers and halfway house programs means that there is no guarantee that substance abuse sufferers will receive effective treatment. Indeed, there have been numerous horror stories the last couple years of people seeking treatment only to end up being sold into human trafficking. (https://www.fbi.gov/news/stories/florida-sober-home-owner-sentenced)

The proposal limiting the ability of insurance companies to deny or cut off coverage for substance abuse treatment would, therefore, have to be coupled with efforts to improve the quality of treatment across the board. There will always be higher and lower quality treatment centers, but there needs to be some sort of baseline below which a facility is not allowed to operate as a treatment center.

As a whole limiting this behavior by providers of health insurance combined with regulatory reforms would seem to improve the likelihood of addicts getting the help they need and would hopefully improve treatment outcomes.

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