Re: If the incentives are wrong, you need to change them
The opioid issue isn't just something that can be blamed on capitalist medicine. That was only the very beginning of the problem - and while capitalism certainly IS a massive problem in healthcare, it's not really the thing that turned some overprescribing into a complete nightmare.
No, the real problem was created by the crackdown.
See, after several years of doctors finally adequately treating pain and a few people going overboard with what are powerful drugs, a few problems popped up. One of them being that drugs are VERY expensive in the US, and controlled drugs far more so, because for most Americans the required monthly trip to the doctor was even more expensive than the drugs. So someone who needed opiates either for pain control or addiction maintenance is going to be spending a LOT of money, frequently in the hundreds of dollars a month. There's a black market, of course, there always is. But the vast majority of that market is still the same relatively low strength opiates. Yes, some people OD, yes, there are some deaths. But it's the moral panic that followed that really started killing people.
The government sees the few ODs happening, and starts really putting the screws on doctors. Most doctors stop prescribing opiates at all, they hand it off to pain specialists. The DEA starts cracking down on those too. And lots of people stop being able to get pain treated.
they're still in pain, though. And with the medical route to treatment unavailable, well, there's already a black market. Crackdown intensifies.
Then it becomes nearly impossible to get pills on the black market. The supply has dried up, doctors are going to jail for adequately treating patients, manufacturers have cut production, the pills just aren't there or are prohibitively expensive.
But guess what's cheap? Yup, that would be heroin. So now you've got lots of people who should have been treated for pain and lots of people who just need addiction maintenance who become novice heroin users. Problem is now worse. Crackdown intensifies.
So now it's a bit harder to get heroin into the country, it's harder to transport it. And then a solution to the black market's problem appears. Yup, that would be fentanyl. Much more powerful, much easier to conceal, much easier to transport.
And now a problem that started from a bit of overadvertising of fairly powerful drugs has turned into a major crisis because of a puritanical moral crisis induced enforcement crackdown is killing a lot of people with incredibly powerful drugs.