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Review: "Medicaid May Soon Pay for Some Inpatient Addiction Treatment" – NPR

This story was written by Ben Allen for NPR yesterday. Substance abuse treatment is sometimes a difficult subject to discuss because it is strongly influenced by both biology and psychology. People often wonder why they don't "just stop."

That question has implications across the board and treatment is often a mix of biological and psychological approaches that oftentimes are misunderstood by those holding the opposite philosophy. With that said, the best way to make the situation even worse is to let the government's "bull" into the "china shop" that is substance abuse treatment.

This article drives that point home. Medicaid, a federal health care program, is "proposing to cover 15 days of inpatient rehab per month for anyone enrolled in a Medicaid managed care plan."

On the surface, this sounds great. After all, 15 days is better than none, right?

Unfortunately, that's not how treatment for addiction works. Having worked at a halfway house during my residency in Kentucky, I saw first hand the destruction that chemicals can have on your mind, you body, and your family. Luckily, the journalist found the right person to chat with:

"Where they came up with the 15 days, I don't know, but it's not based on research" says Mike Harle, head of the nonprofit treatment program Gaudenzia, which serves about 20,000 patients a year in Pennsylvania, Maryland, and Delaware. In just 15 days, he says, you can't expect to acheive a positive outcome.


The article also quotes the National Institute on Drug Abuse's guide: "Individuals progress through drug addiction treatment at various rates, so there is no predetermined length of treatment. However, research has shown unequivocally that good outcomes are contingent on adequate treatment length."

In other words, the right treatment length is the length at which it takes to achieve the right treatment. Yeah, welcome to the world of psychiatry and substance abuse treatment.

Allen also interviews Cindy Mann, "a former top administrator at the federal Centers for Medicare and Medicaid Services, which governs Medicaid," and she endorses the idea that beggars can't be choosers and that every little bit helps. My words, not hers.

This is why any federal health care program, again, is doomed to fail. People require individual treatment that is created and overseen by a treatment team. Federal programs are about grouping people together to get better financial results from the economies of scale. These two goals are, in this case, mutually exclusive and increase the chances of failure for that individual patient.

What would substance abuse treatment look like under the P.S.Y.C.H. plan? Since individuals would have the funds to pay for their own treatment, and there will be a slew of choices across the nation (all connected through a universal medical record), I can easily see opiate users in Kentucky paying for an interactive individualized spiritual program in Sedona. Or cocaine users in New York coming to do an affordable ranch program hosted by a nonprofit in West Texas. Affordable versions of the Betty Ford clinic would pop up everywhere.

The opportunities are endless because the costs will be affordable and the mobility nationwide. That's the type of treatment planning variety a federal program would never be able to do.


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