I have a dirty little secret to share, at least that’s the impression one might have in response to the crusading zeal of the Opioid Prescribing Work Group. I take narcotic analgesics (hydrocodone) on a daily basis. Along with this medication, I receive four corticosteroid injections annually to alleviate almost a decade of chronic pain caused by several bulging discs in my lumbar spine. Of course, over the years I’ve tried almost every realistic alternative, from nonnarcotic prescription and over-the-counter drugs to chiropractic treatments, in addition to a broad variety of balms, tinctures and medicated patches. None of these has been nearly as effective as my present therapeutic plan, which is administered under the close supervision of my doctor. Back surgery is the only other feasible solution, and it may well come to that, but two sets of consulting specialists have urged me to consider that as a last-resort option.

In the meantime, I can’t help but feel stigmatized by an all-too-generalized conclusion that implies my present treatment plan is medically unsound at best, or at worst, almost a vice. Despite their obvious dangers and pitfalls, these narcotic medications have been a godsend in preserving my quality of life. Although of retirement age, I still run a successful small business, have a happy and fulfilling marriage of 33 years, and remain a good citizen with active ties within the community. Thanks to this opioid medication, I can remain physically active, from embracing the rigors of international travel (Christmas in Paris this year!) to the simple joy of splitting firewood every summer at my lake cabin Up North. I shudder to think about having these things diminished or taken away altogether by severe pressure placed on my physician and me, however well-intended it may be.

According to my pharmacist, hydrocodone is one of the most-prescribed of all medications in any category. There must be millions of people like me who can use them responsibly and therapeutically on a long-term basis without adverse consequences personally or to society. One need not discount their misuse or addiction liability to extol the vast benefits they can bring to a majority of us who suffer from chronic pain. Already pharmacies and insurance companies rely on computerized tracking that make it easier to spot abusers and, yes, the medical community might take some further steps to minimize the downside of opioid medications. However, I don’t wish to feel ostracized by a movement that might wish to burn down the forest to remove a diseased patch of trees, or force my doctor to feel unduly influenced and pressured in determining my treatment plan. As the expression goes: Let’s not throw out the baby with the bath water. Opioid medications have been around for thousands of years, and with good reason — they’re very effective, and used properly, can be employed with a great deal of safety.

Charles Cleland, Brooklyn Park


The clash between insurance, drug costs and the bottom line

In the Nov. 23 paper we learn that “Rising drug costs have overtaken a long stretch of stable premiums” (“Experts foresee big premium hike for Medicare Part D”). On the adjacent page, a story discusses the likely (and since-announced) Pfizer-Allergan merger. While the analysis focuses on the deal as a slick piece of tax dodging, other analysts have pointed out that the merged company will have more power in negotiating prices with insurance companies. Look for drug prices to keep going up.

John Sherman, Moorhead, Minn.

• • •

Lost in all of the hand-wringing about increases in Medicare premiums is the treasonous refusal by Congress to allow Medicare to negotiate drug prices. Sen. Al Franken has submitted a proposed law to allow Medicare to do that, but it is languishing in committee with virtually no hope of even being voted on before the next presidential election. Congress has allowed the Department of Veterans Affairs to negotiate prices and apparently also Medicaid, because they pay far less than Medicare for the same drugs. I imagine that Congress has done that because they don’t want to pay a penny more than they have to for the poor, disabled or veterans. If you think this is outrageous, as I do, please contact the other members of Minnesota’s congressional delegation and see if they are true Americans or puppets for Big Pharma.

R.J. “Tate” Halvorson, Minneapolis

• • •

UnitedHealth Care (UHC) reports income losses in its first year of participating in Affordable Care Act health exchanges (“Insurer sours on exchange markets,” Nov. 20). Newly insured individuals will discover undiagnosed medical conditions or will seek treatment for conditions they long neglected. Delayed diagnosis and care also lead to more costly tests and treatment. I discovered this in research I conducted with a sample of dual-diagnosed mentally and chemically dependent individuals, who once treated for these conditions experienced a significant spike in other medical care costs for a period of 90 days for the reasons described above. However, once their neglected conditions and illnesses were diagnosed and treated, their subsequent medical-care costs declined and plateaued to a level more typical of a general patient population. Other researchers in longitudinal studies of newly insured populations had similar findings.

Health care is a long-term investment. The benefits are not always apparent in the short term. Rather than watching the annual bottom line, UHC should stay the course and invest in its subscribers for the long haul. Despite a short-term loss from new ACA subscribers, UHC is doing very well. The bottom line will recover and our nation, including all UHC subscribers, will be better off.

Barry B. Cohen, St. Paul

• • •

In her otherwise detailed and edifying discussion of the problems with American health care markets, Megan McArdle failed in two important respects (“Troubling symptoms for Obamacare,” Nov. 23). First, she failed to convincingly link the problems of health care markets generally with the changes made by Obamacare specifically. And secondly, as persuasive as she was in setting out the problem, she made no attempt at all to solve the important and critical problems she identified.

Although the working out can be incredibly complex, the problem she is discussing is remarkably simple: Americans have preexisting health care conditions, the treatment of which needs to be paid for. Obamacare didn’t invent the conditions, the care of such conditions or the need to pay for them. That such conditions should be treated and paid for is a goal of pretty much all health care reformers across the political spectrum; they simply differ in their methods. Obamacare proposes creating large insurance pools, capable of diluting the costs of covering preexisting conditions. It’s a common model in the insurance industry, indeed, going to the very nature of insurance itself. McArdle’s problem isn’t with the nature of insurance. It’s that the pool isn’t getting large enough, fast enough to be immediately profitable to insurance companies like UnitedHealth, the subject of McArdle’s column.

The solution she omitted? First, get through the start-up period so companies find their bearings in these hard-to-predict markets. Then, find ways to encourage and sustain the participation in these markets, which are, after all, amazingly advantageous to those who find their way into them.

Jon Miners, Crystal