David R. Henderson  

Quinones versus Eberstadt

What has Syria ever done for u... Monetary offset in the UK?...
We have demonized government and laughed at government and called it incompetent, not paid taxes to support it. And we have a situation now, in my opinion, where--having done all that, having exalted the private sector, demonized government, what we now have is a story that the private sector has visited upon the United States of America and its people the most devastating threat to personal liberty that we know today, which is opiate addiction. And for a long time the only ones who were fighting that were government officials--coroners, jailers, cops, public health nurses, etc.
This is a statement by Sam Quinones, author of Dreamland: The True Tale of America's Opiate Epidemic. It's at the tail end of the January 23 EconTalk interview of Quinones by Russ Roberts.

Yet elsewhere in the interview, Russ, drawing on Quinones's own book, said:

But you don't have $1000. You do have a Medicaid card. And the co-pay for Medicaid is $3. Which seems like a very nice, thoughtful thing. But what it means is that the taxpayer is going to cover $997 of this. The addict is going to cover $3. And then the punchline--that's interesting by itself and as an economist who has often talked about the value of cash, I can't help but note the irony that we give people Medicaid because we don't want them to have cash as a way to use it on drugs and alcohol. So there's an incredible tragedy here. So, they take the $3 co-pay; they $1000 worth of drugs; and it's worth $10,000 on the street.

I found it interesting--as Russ appeared to also--that after pointing out the huge role of government in creating or exacerbating this opioid problem, Quinones said that we demonize the government and call it incompetent. But surely this absurd policy--having taxpayers pay for people to get addicted--deserves demonization and possibly the "incompetent" label.

I haven't had time to read Quinones's book but elsewhere I did find confirmation of the point he's making. It comes from a chilling article by Nicholas Eberstadt of the American Enterprise Institute (HT2 John Cochrane). The article is titled "Our Miserable 21st Century" Eberstadt quotes the section of Quinones's book that Russ drew on and then adds:

You may now wish to ask: What share of prime-working-age men these days are enrolled in Medicaid? According to the Census Bureau's SIPP survey (Survey of Income and Program Participation), as of 2013, over one-fifth (21 percent) of all civilian men between 25 and 55 years of age were Medicaid beneficiaries. For prime-age people not in the labor force, the share was over half (53 percent). And for un-working Anglos (non-Hispanic white men not in the labor force) of prime working age, the share enrolled in Medicaid was 48 percent. (italics in original)

Eberstadt adds:
By the way: Of the entire un-working prime-age male Anglo population in 2013, nearly three-fifths (57 percent) were reportedly collecting disability benefits from one or more government disability program in 2013. Disability checks and means-tested benefits cannot support a lavish lifestyle. But they can offer a permanent alternative to paid employment, and for growing numbers of American men, they do. The rise of these programs has coincided with the death of work for larger and larger numbers of American men not yet of retirement age. We cannot say that these programs caused the death of work for millions upon millions of younger men: What is incontrovertible, however, is that they have financed it--just as Medicaid inadvertently helped finance America's immense and increasing appetite for opioids in our new century. (italics in original)

So those of us who demonize government and think it's incompetent still have a solid basis for those views. I agree with Quinones on one thing, though: this is not a laughing matter.

Also, unlike Quinones, I don't see how opiate addiction threatens people's liberty or how jailers and cops in the drug war apparently don't.

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CATEGORIES: EconTalk , Incentives , Labor Market

COMMENTS (10 to date)
Matthias Görgens writes:

Americans are such drama queens. In the grand scheme of things, your government is just not very competent at a lot of things, but it's also not the worst thing ever.

By the way, haven't the legalisations of dope in some states already had a decent impact on opioid addictions?

Mike W writes:

Not only are the taxpayers paying to provide the drugs...

"Under the Affordable Care Act, substance use disorder services are essential health benefits that are required to be covered by health plans in the Health Insurance Marketplace. The law also required that covered substance use disorder benefits are comparable to medical and surgical benefits."


AntiSchiff writes:

This is a tremendous failure of many government policies, but also the medical profession. Opiates are prescribed too readily. I just lost my mother to an accidental overdose of opiates, benzodiazepines, and muscle relaxers last month. I had her on Suboxone as a maintenance drug which was keeping her somewhat under control, but Medicare decided they didn't want to pay for it, suddenly. The rationale was medical, though it made no sense. My mom then was prescribed Vicodin instead, and in a 2 year period, she had 2 run-ins with the law, did 3 weeks jail time, and now she's dead. The entire system is badly broken.

Best to, ironically, totally legalize all prescription drugs. Take out doctors as the middlemen(women), but insurance would be wise to only cover drugs that doctors prescribe. At least then victims of terrible insurance company policies or idiot doctors can still get the drugs they want, and we non-addicts aren't hugely shaken down and inconvenienced just to get our next dose of Lipitor, for example.

To give some idea of how ridiculous the current system is, my mother had to see a doctor regularly just to be able to buy nsaid eye drops to prevent rejection of her corneal transplants. Everyone knows she would need those drops for the rest of her life, and how are such drops dangerous such that they should require a prescription? Nsaid pills, such as aspirin and Alleve are available OTC. Yet, doctors keep getting fed fees for office visits and eyedrop manufacturers get to charge huge premiums due to restricted competition.

Make pharmaceutical companies compete in the OTC marketplace for all the drugs they produce, and I won't be surprised if many drugs fall in price, and some radically. Notice that OTC drugs tend to get cheaper over time.

For those who insist certain addictive drugs be controlled, there is middle ground. Perhaps drugs known to be addictive can be controlled when a doctor diagnoses a patient with a substance abuse disorder, but comprehensive treatment should follow and there should be a deadline on such restrictions, so that there's less incentive to develop black markets and so that victims of ineffective treatment approaches can at least just go back to having access to their drugs of choice without being forced into awful compromises. Freedom is the better answer here, but no one's talking about it, as far as I know.

Imagine, not standing in line at the pharmacy anymore, waiting for two separate people to count and physically fill your prescription bottles. Imagine prepackaged blood pressure medication that costs far less in the context of so much more choice.

Dumb people will take drugs they shouldn't, sometimes with disastrous consequences, but the rest of us will be better off. And let's never forget that this current opiod epidemic was largely the creation of the system we have now. I suggest there is little superior about the status quo.

David R. Henderson writes:

I’m sorry about your loss. How old was your mom?
I agree with much of what you wrote above. I recently wrote a piece in which my co-author and I advocated taking out doctors as middlemen.

AntiSchiff writes:

Dr. Henderson,

Thanks. She did not quite make it to her 58th birthday.

Mark Bahner writes:

AntiSchiff, I'm so sorry about your mom.

AlanG writes:

Mark Maron did a really nice interview with Sam Quinones a while back on the wtfpod.com podcast (it might be behind the Howl paywall now as his interviews are only free for three months). He did a really good investigative job looking into the opiate addiction issue. These are a class of drugs that do have a medical use but their prescription has gotten out of hand. Ironically, I can remember taking elixir of codeine as a kid when I had a sore throat and in those days it was available OTC.

I wish that I could be on AntiSchif's side (and sorry to hear about your mom, wouldn't it have been Medicaid regarding paying for the drug since you mother was only 57?) regarding liberalization of drug prescribing. I spent my working career in drug regulatory affairs as well as drug safety. Even drugs such as lipitor are not without problems. All the NSAIDS are also problematic in terms of stomach bleeds and there are some other not so nice side effects as well. Certainly there have to be some easier ways to get necessary Rx meds without paying big $$$s for a doctor visit. More nurse practitioners should have the ability to prescribe needed drugs.

There is a whole cottage industry of lawyers who work on getting people onto the disability gravy train when they probably should not be eligible. I'm probably one of the few bleeding heart liberals who regularly comments here but I think this is one area that really needs to be policed a lot more carefully. The 'fraud' that my Republican friends always talk about is pretty rampant here.

[minor edit to use full domain name--Econlib Ed.]

TMC writes:

I can't comment on the article overall, but an opiate prescription does not cost anywhere close to $1000, nor has a street value anywhere near 10k.

I have issues about the way doctors handle opiates. I had back surgery 2 years ago and needed opiates towards the end. I was offered them throughout the process, but did not need them too much until the last month before surgery. Then I really needed them, and the doctors were suddenly concerned with my need. This is after they had real concern about the amount of another non opiate nerve medicine I took took to relieve nerve pain. I was a victim of the government cracking down on doctors for giving pain relievers when they were medically justified.
I've heard many stories of terminally ill people not getting pain meds because doctors _ the government- worried they'd get addicted, in their last 3 months of life. Idiots run the asylum.

From what I've read, it's this crack down that has created the boom in heroin addicts. These are people cut off from legal pain med who genuinely need them.

mm writes:

the whole problem started with a 2001 government proclamation that MDs were under treating pain & they were going to monitor & grade MDs on pain therapy using a totally subjective system. The results were absolutely predictable

David R. Henderson writes:

@TMC and mm,
Thanks for your insights.
So I gather that the push that mm describes starting in 2001 was completely reversed so that TMC had the opposite experience?
Kind of like a pendulum?

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