The latest report from the Census Bureau has produced some worrying figures. It seems almost 17% of us are living below the federal poverty line. You have to go back to 1993 to find a higher percentage of Americans living in poverty. To add to the interest, the Super Committee in Washington has just begun its discussions on what to do about the federal deficit. Its choices are between increasing revenue to maintain more of our services or simply cutting spending. Given the terrible state of our economy, it’s hard to see what the federal government can do to help the poor. In this, there’s a secondary consequence looming into view. No matter what happens to Obamacare in its journey to implementation in 2014, there are an increasing number unable to afford health insurance. It’s currently estimated some 52.5 million adults are without any form of support from Medicare, Medicaid or VA benefits. This reflects the dramatic and sustained increases in the costs of treatment and care. We now have the highest retail prices for drugs, medical devices and hospital treatment in the world.
The European approach to pain management is evidence-based. In other words, the regulators have invested time and money to research which treatments are the best value-for-money. These treatments are then made available either free or at subsidized rates. All other treatments are left available but the patient must pay the full price, whether through private insurance or out of savings. The evidence consistently shows counseling in general and cognitive behavioral therapy in particular, are the best long-term strategies for pain management. In labor terms, this one-to-one approach is relatively more expensive than drug therapy in the short-term. But, if you look at the continuing costs of drugs and the added costs of dealing with problems of dependence and addiction, paying more at the initial stages of treatment gives a better outcome.
Unfortunately, this is not going to be rolled out in the US. First, it’s against the interests of the drug manufacturers. At the current high retail prices, their losses would be spectacular if doctors and therapists referred their patients to cognitive behaviour therapists. So the lobbying to doctors is firmly in place to keep the flow of prescriptions running smoothly. Second, the doctors would lose a share of the revenue to therapists. As things stand, it’s easy money to see multiple clients an hour and write prescriptions. Unless there’s a culture change, doctors are unlikely to cooperate. The only hope for forcing change comes from the health insurance industry. As more people are unable to pay their premiums, the profitability of insurers is being squeezed as health costs rise. They may decide to prefer paying for preventative medicine and cognitive behaviour therapy as the pain management strategy. Such is the insurers’ buying power, they may force some change. Except we need thousands of therapists and they are not in training. Someone in federal health planning forgot to order more people trained.