'Body Brokers' Get Kickbacks to Lure People with Addictions to Bad Rehab
npr.org
npr.org
That is a special kind of evil. I hope they are some harsh penalties involved.
I think it is fair to judge a society by how it treats most vulnerable and marginalized individuals. I don't think we are doing very well there by that metric.
Just like any industry, people accept it because it's just what happens. So busy being a business owner that you cannot afford to be Sheriff.
If there's a zero tolerance policy against drugs there should be a zero tolerance policy against people providing bogus care for drug addicts. Just like you can judge a society by how it treats its weak, you can judge it by which crimes it pursues vigorously and which ones it lets slide.
Unlike the bank robbery case, it gets difficult to tell the difference between incompetence and intentionally crappy care. Nobody accidentally robs a bank because they were poorly trained.
This makes it harder to have a government policy of charging everyone with a felony that provided poor care.
I was watching an old George Carlin video on the death penalty yesterday. He was ranting about how folks want to expand the death penalty for drug dealers. His bit was that you should expand the death penalty for the bankers who launder the money and the drug trade would pretty much stop immediately.
I watched a friend who was suicidal and an addict a couple months ago enter into an iboga treatment and the guy hasn't had a smoke or drink since... he looks like a million bucks.. is hitting the gym and talking about "feeling his emotions" and is happily in therapy.
This is a dude who has neck tats, was routinely getting into bar fights with skin heads in NYC and is a vet who had pretty severe PTSD.
Let's legalize treatments that actually work.
The problem that this article is pointing out is actually that rehabilitation and treatment centers are money making machines and that some owners of those centers are unscrupulous and unethical at best, and acting completely criminally at worst. By legalizing new treatments you actually cause the problem to get worse, not better, especially if those new treatments lack clinical data and scientific backing. This leaves an open door for desperate people in need to be seduced into treatments that might not help and will cost substantial amounts of money.
Many types of treatment do work, and work very well. If someone is in need of treatment, please, do your homework and research and find those people who can really help you.
As far as I know, none of them work ( where working is defined as >50% of people who complete the treatment course being able to move on to lead a normal, drug free life). A lot of them do make a ton of noise though, and several basically lower your expectations from the outset (like AA) - so you treat addiction as a chronic disease: something you'll never be cured of, and have to always deal with.
The parent poster seemed to be arguing that iboga can cure addiction. If he's right, this is a big deal.
A healthy nervous system in a healthy environment (with attuned caregivers and limited traumatic experience) will equipt a person with the neural pathways (and associated beliefs and behaviors) to regulate their nervous system.
In compromised development, either through lack of attunement or childhood / early trauma folks don't have the ability to automatically regulate and they are in a constant state of fight / flight. The dopamine helps to deal with this temporarily.
Psychedelics, some therapy, and sometimes near death / mystical experiences (moments of clarity) can offer a window of opportunity in which the ego loosens its grip enough for the nervous system to relax and for the subconscious material (traumas) to come to the surface and be released with the accompanying rewiring of the fight / flight response.
When one experiences reality from an undefended state it is generally such a pleasurable, rich experience that the desire to use other mechanisms of self-soothing organically fade away and the cognition and behavior reorient to healthier more nourishing alternatives.
These experiences and therapy combined with a healthy environment and relationships that support the honest expression of emotion (ie, not co-dependent) can rapidly support healing.
The basic idea is that traumas are trapped in the somatic system and that altered states of consciousness combined with the right context can allow for an unfolding and healing of the underlying issues.
Depending on the underlying issue and severity of the defense structures folks may find help with various psychedelic substance from MDMA, Iboga, LSD, Mushroom or Ayahuasca.
We also have seen great result using Holotropic Breathwork which was developed as a legal alternative to LSD Psychotherapy.
This is essentially the same process I used to heal from bipolar, as I began to see bipolar as an "addiction" to states of depression and mania as a protective, adaptive response.
It's also the process I now use with my clients and the underlying philosophy that I bring to the communities that support.
If anyone is interested, there is a new book out (published anonymously) that documents accounts of a number of people who have been helped by an underground MDMA therapy practice. (Not specific to substance addiction, but includes some accounts.)
https://smile.amazon.com/Trust-Surrender-Receive-Release-Tra...
I'm a supporter / member of MAPS.org and we have funded research with Iboga.
I would wager this sort of thing is beyond unheard of in a country that has both centralized, state-run healthcare and a progressive attitude towards addiction.
This happens just as flagrantly in other branches of the healthcare system as well, from fraudulent diagnoses in personal injury and accident situations to routine overbilling, to recission.
You are correct in noting this isn't a story about drugs at all, it's a story about health insurance.
It was mentioned that after being "admitted" they were held there against their will.
The treatment method was to "break the patient down" and then "build it back up".
This clinic is the one which was mentioned. http://novavidarecovery.com
Ah, here it was: https://www.buzzfeed.com/rosalindadams/intake
> A button behind the receptionist’s desk controlled the lock to the front door of the facility, and, she said, “If someone came in voluntarily, I wasn’t allowed to let them out of the door.”
> Two dozen current and former employees from 14 UHS facilities across the country told BuzzFeed News that the rule was to keep patients until their insurance ran out in order to get the maximum payment.
A criminal probe is ongoing.
A local news article claims they also treat airline pilots, which should be harder to mistreat, but that was two years ago.
Unfortunately there aren't many leads. It's hard to denounce these places without an inside witness.
They do share information via state regulators (insurance commissioner or state department of insurance) regarding actual fraud once it is proven. Proving fraud requires significant investigation. You have to have more going on than a high rate of recidivism for patients wrestling with addiction for them to accuse you of fraud.
Furthermore: Healthcare providers operating in sectors with low barriers to entry should be constantly subject to random audit/inspection regardless of their stats. Do we wait for a customer to report glass in their food before we inspect a restaurant?
So if you're United Health, you can't really improve your profit margins. And if you cut costs, you can't pass the extra value to shareholders.
If you want to give more money to your shareholders, you need more revenue and then more costs and you need to maintain your margin - the extra costs defray the extra money you return to your shareholders.
If you spend an extra $65 million on 'rehab' - you get to give more money to your shareholders.
Here's what's really bad about it, there's no real expectation that the health care improves. The insurance company doesn't care whether the expensive care is better, it cares that expensive care = more money for shareholders.
That's such a perverse incentive it's incredible. Healthcare has become a noose around the neck of America - it's 16% of our GDP and it accounts for about half of all the inflation since 1990.
Here's a blog post explaining the mechanism in the ACA: http://thehealthcareblog.com/blog/2012/02/04/does-obamacare-...
Here's Martin Shkreli saying that insurance companies make more money off expensive epipens than cheap epipens: http://www.businessinsider.com/martin-shkreli-on-epipen-and-...
Change the game, not the players.
Why would the outcome change until the players that get to change the rules change themselves?
I think this is more of a political and ethical corruption problem than a healthcare problem. There is no desire within the industry for competition or a market. See the cable industry for another example.
An (almost) insurmountable problem with the regulatory climate today is if you look at who (generally) set it up, its the same interests that would would lose the most of the playing field were changed. Counter-lobby groups aren't as well funded so they just can't compete using the same tactics.
Can monetary incentives be removed while still motivating people and businesses to work towards the public good (e.g., availability of broad mental health treatments, treating addiction as the disease it is)? In my heart of hearts I hope so, but I'm doubtful that I'll see it in my lifetime.
But I remain hopeful and will do what I can within my capacity as a citizen to forward the idea.
https://csis-prod.s3.amazonaws.com/s3fs-public/legacy_files/...
you'll be darkly amused to note that the F-22 wasn't very cost-plus intensive and the F-35 is completely cost-plus.
Also note that the F-22 seems to be a more effective weapons platform and at the end of the program, many people thought that we could just kill the F-35 program, fill up our airforce with F-22s and save money.
Honestly, addiction is a difficult problem. A lot if the time it's good for people with similar problems to get together and work towards a solution. It's not always easy to tell who's a good actor. For example, some rehabs take mostly indigent low-bottom drinks from off the street. I'd imagine that they have a much higher rate of relapse just from the population.
Ultimately I think it's tied in to a lot of similar social problems, like poverty, mental health, homelessness and prison issues. In general, the US just doesn't value improving those things very much. Which is sad.
In the UK we have the NHS and the only way to get into rehab on the NHS is if you are a single mum or are homeless. Otherwise you pay for some private facility. We also don't have the prescription opiates that American's take for breakfast, elevenses, lunch, tea and dinner so the problem is not a full on crisis here.
From the anecdata I have I believe that coming from a broken home, not knowing whom your father was and childhood trauma is a large part of it. Drugs are 'always there for you' and work predictably, therefore a relationship with a drug is kind of preferable to maintaining real relationships, with a partner, with friends, colleagues or family. I believe that addicts that go through rehab to then work with the addicted, vulnerable members of society stand a much better chance of living a worthwhile life, even if their 'family' becomes the intake of addicts at the place where they work that 'family' is pretty good compared to the empty and pointless life that is addiction.
Everything you think you know about addiction is wrong | Johann Hari
It's the same today. We still cooperate and share with about a few hundred closest people, and for everyone else, we have capitalism. Whenever the two meet, we shock-horror a bit about the callousness of others, and then we go back to treating everyone outside our Dunbar number as an object to extract resources from.
I don't want to suggest that it's biologically inevitable, but that we aren't going to overcome it until we start recognizing the blind spots in our cognition and empathy.
That and, as far as I understand, when they went hunting, only a few get lucky, and those couldn't eat all the meat themselves before it spoiled.
Take cigarettes. Even if you argue that people ought to be able to make and buy and smoke cigarettes, which I can agree with, I believe certain kinds of promoting cigarettes would be taking advantage of addicts? I have read that cigarette companies also add many additional compounds into cigarettes that make them more addictive.
The firefighters did more for my friend with their Naloxone than any of the mental health professionals. Her drinking was under control for about two weeks. Then the naloxone wore off...
I think the fundamental problem with current approaches to addiction/rehabilitation is that they mostly view addicts as having had a 'moral failure' in choosing to use 'recreational drugs'. ~80% of rehab facilities use some version of the 12-step program, which is helpful for ~10-15% of people who are addicted to something.
I've observed some cases of alcoholism too. It's not very different from street drugs, except every corner store has their vice.
About five years ago someone figured out that the brains of alcoholics switch to running on acetate, one of the breakdown products of ethanol. Alcoholism is basically a metabolic problem, as far as I can tell. I found an article by an alternative medicine heretic ~3 years ago that said nerve tissue can run on coconut oil too. I've heard a tablespoon really does help with alcohol cravings.
IMHO, it's much more productive to view addiction as self-medicating physical and mental anguish. People who are emotionally stable tend to not get hooked.
I was just transcribing the videos my friend made of us frying donuts (in coconut oil), taken two weeks before her first hospitalization. She was doing very well, then she ran out of alcohol & the professionals got hold of her...
A very smart woman I know once said, "When a person feels safe, the false ego goes away." Helping people to feel safe is the most important part of all effective drug rehabilitations. Sometimes people need access to their drug of choice to feel safe. It's much better to give them pharmaceutical-grade drugs [1], and wait for them to age out of their addiction, than to train them to be helpless in jail, or help them to feel like failures in a 12-step-based "drug rehab".
[1] https://news.ycombinator.com/item?id=14782416 - Switzerland gives their most hopeless heroin addicts access to pharmaceutical-grade heroin.
I'd say 12-step is closer to "takes credit for the ~10-15% of people who'd beat their addictions anyways".
The things that concern me the most, however, is, well, it's weird, but I've seen this happen a few times... Friends who had moderate problems with alcohol and/or drugs go into 12-step programs. They seem to over-identify with the social side and really want to belong, but feel that they haven't had a bad enough bottom, so they go out again but really go overboard in an effort to prove that they belong. I've seen some otherwise sane people go on some crazy, nearly life-ending binges.
Also, AA seems to stunt people in a weird way... They seems that they think AA is a total solution to all their life's problems, and so they often go on for years with some difficult psychological problems. Depression, anger issues, ADHD, etc... stuff that would be much better addressed by modern medicine. Maybe it's the similar to many religions, in that once you've got God, all your problems will be fixed by prayer and devotion.
Even after all that, I think 12-step programs can be a great thing for a lot of people. It depends a lot on the person, and the groups around them.
So... chiropractic?
Uh,I felt terrible about the whole thing, it seems like a cut and dried case of insurance fraud to me. My MD said she was sending me to physical therapy so I thought I'd be getting real treatment and didn't think about it further. I never heard of craniosacral therapy before that but it was clear that the physical therapist was practicing woo once I was actually there.
The worst thing is, since craniosacral therapy claims to treat almost every symptom and every disease she may refer 90% of her patients. :(
...so why am I so cynical about being optimistic for an actual consumer-beneficial outcome in cases like these?
Insurance companies like scans from MRI tests, not reports written from mental health consultants.
These are some of our most vulnerable people. We need to take care of them. It's less competitive as a business to do so.
[edit - like much of mental health issues, 'success' is difficult to define, so outcome based measurement is difficult.]
In your opinion, in the facilities such as those discussed in the article and ones like them, would physical inspections address the more egregious cases? Are run down facilities, lack of sanitation, etc., enough to add a location (and operators) to an interstate "do not process insurance claims" blacklist? More regulation isn't the answer for everything, certainly, but as you stated, we are talking about exceptionally vulnerable people.
Or is the stigma of addiction and mental health issues the root cause? Would this type of regulatory pressure be DOA because regulators, as people themselves, often believe addiction is a moral failing and not a health consideration?
Insurance is for independent, random risks.
It doesn't take a genius to see this coming: Here is a law that says "you get to a lot of money if you 'treat' people. Don't worry, there are really no criteria of success you have to achieve, all you have to do is get addicts through the door. Oh, you have repeat customers? Even better. Here take as much as you want."
Most insurance revenue comes from non-ACA employer plans, which don't have this requirement.