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Other Views: Let's not deny Medicaid's role in fueling opioid epidemic

Drug overdose deaths—63,632 in our country in 2016—now outnumber any other cause of accidental death. Fingers of blame point in many directions, with multiple proposals for federal government involvement in fighting the opioid epidemic.

But what if one of the contributing causes of the epidemic is well-intentioned federal spending?

Your federal tax dollars allowed Ramphis Pacheco of Meriden, Conn., to illegally obtain and traffic more than 6,000 oxycodone pills worth $185,400. His 2014 scheme depended on the fact that Medicaid beneficiaries can get large amounts of opioids for free or at little cost.

Pacheco recruited Medicaid beneficiaries, investigators said, by paying them to fill multiple opioid prescriptions. Beneficiaries then sold the drugs to Pacheco, who resold the drugs to illegal users. Pacheco paid beneficiaries approximately $50 to fill a prescription. He could sell a bottle of oxycodone for more than $3,000. Beneficiaries paid nothing for the drugs, and since their prescriptions and Medicaid cards were genuine, most pharmacies weren’t suspicious.

“Medicaid is what allowed (Pacheco) to make so much money with so little risk,” a police detective told my investigators.

Lawmakers never intended this, but I’m guessing there will be many who will not want to acknowledge it.

Why? Because Obamacare included a large-scale expansion of Medicaid. During the 2017 debate on repealing and replacing Obamacare, proponents of expansion cited its role in funding treatment for addiction. This argument became conventional wisdom: “Public appreciation for (Medicaid) has steadily increased as people come to understand … its central role in combating the opioid epidemic,” as the New York Times put it last month.

But that’s not the whole story. Writing in Commentary last February (, demographer Nicholas Eberstadt described the plight of prime working-age male labor-force dropouts, about 7 million men in all. Nearly half take pain medication on a daily basis, according to a study by Alan Krueger, former chairman of President Obama’s Council of Economic Advisers.

How do so many non-working men afford daily pain medication? Eberstadt notes that as of 2013, 53 percent of prime working-age Americans not in the labor force were on Medicaid. “Means-tested benefits cannot support a lavish lifestyle,” Eberstadt writes. “But they can offer a permanent alternative to paid employment, and for growing numbers of American men, they do.”

Eberstadt also explains how. He quotes journalist Sam Quinones’ “Dreamland,” an account of the opioid epidemic’s tragic toll. “For a three-dollar Medicaid co-pay … addicts got pills priced at thousands of dollars, with the difference paid for by U.S. and state taxpayers. A user could turn around and sell those pills, obtained for that three-dollar co-pay, for as much as ten thousand dollars on the street.”

When I read this, I asked my staff to investigate. Within four days, they found 261 examples in six states of individuals convicted of diverting Medicaid-obtained painkillers, which often were sold on the street at enormous profit. This week I am releasing our investigative report that documents more than 1,000 examples of how federal spending intended to help solve the opioid epidemic is being used to fund it.

This should surprise no one. Obtaining employer-provided health insurance is a primary reason for seeking employment. This is why the Congressional Budget Office predicted Americans would do less paid work once Obamacare was implemented, the equivalent of 2 million fewer full-time workers. Give individuals free health care plus the ability to obtain products they can sell for thousands of dollars, and you’ve enabled a new non-working lifestyle.

This is not theory, as our report illustrates, and the dollars involved are not trivial, as Pacheco’s case shows. A one-month prescription of a painkiller might contain 90 pills at 30 mg each. Pacheco was selling such pills for about $30 each, and some drugs can sell as high as $80 a pill. That’s as much as $7,200 per month, or $86,400 per year. The report is replete with examples, from small-time diversions to dishonest prescribers to larger criminal enterprises like Pacheco’s. The common element is that Medicaid spending, which has risen 48 percent since 2013, made the drugs easier to obtain and extremely inexpensive.

Far from being an aberration, the examples in our report represent only the tip of the proverbial iceberg, given that a relatively small percentage of crimes are ever prosecuted. No one knows exactly how prevalent this illicit activity is, or how much it costs American taxpayers.

Our report does not argue that federal spending is the primary cause of overdose deaths, nor do we deny that it benefits millions of Americans. But our report does provide solid evidence that federal spending is also funding the opioid epidemic that is killing thousands. That is a reality we should not deny.

Harsanyi: Donald Trump's greatest gift is his enemies

Every morning, it seems, President Donald Trump’s most determined opponents awake to find out what sort of obnoxious, fact-challenged, puerile, norm breaking thing he has offered that day and say to themselves: “Oh, that’s nothing. We can do something dumber than that!”

So the nation wades from one bizarre and nonsensical controversy to another. As I write this, I can’t even recall what topic we were debating last week, but I’m certain it was idiotic. Part of the problem is that those who drive coverage of Trump are obsessed with the president in unhealthy ways, ways that have absolutely nothing to do with policy or governance.

For a couple of weeks now, our self-styled guardians of democracy have engaged in a concocted controversy about the president’s mental state. It wasn’t only liberal columnists plying their readers with this wishful thinking; the entire city of Washington, according to Politico, was consumed with using the 25th Amendment to remove the president. It was a major topic of conversation on the Sunday shows. Former Trump booster Joe Scarborough squeezed a week of coverage out of it.

When the president’s physician, Dr. Ronny Jackson—a man who has been the White House doctor since 2006—explained that Trump is, in fact, “very healthy” and has “incredible genes” and excellent cognitive health, the White House press corps was in disbelief. I mean, Michael Wolff told us the opposite was true.

One reporter asked why Trump “appeared to slur his words” at a recent press conference. Another reporter asked why Trump had the “sniffles.” Everyone was worried about his insalubrious meal plans. “Is he limited to one scoop of ice cream now?” a real reporter asked the presidential doctor. Jonathan Karl of ABC asked, and I kid you not, “Can you explain to me how a guy that eats McDonald’s and Kentucky Fried Chicken and all those Diet Cokes, and who never exercises, is in as good of shape as you say he’s in?” Confirming what everyone in the world who eats right and exercises daily yet still struggles to keep their weight down already knows, Jackson answered, “It’s called genetics.

More importantly, the doctor also said Trump passed an extensive cognitive exam that tests for “all those things” and repeated the conclusion that the president doesn’t suffer from mental issues. So the conspiracy theories began on social media, not by random tweeters but by White House correspondents of the nation’s leading newspapers and leading reporters of the nation’s biggest networks.

CNN chief medical correspondent and former Hillary Clinton adviser Dr. Sanjay Gupta asked Jackson, the doctor who actually examined the president, whether Trump has heart disease. Jackson said no. On Wednesday, Gupta claimed on television that Trump does have heart disease. (It took a little more than one year to go from “Russia stole the election!” to “Trump is too fat to be president.” Those 15 to 20 pounds are a killer.)

There is simply no way we would have gone through a similar round of frenetic mental-health coverage if the president had a D next to his or her name. Yes, a person can be cognitively sharp yet unfit for office. But here’s the problem: Many journalists, including CNN’s Brian Stelter, spent the past week baselessly speculating about the mental health, not the overall fitness, of the president. They did so based on their intuition and hopes, rather than any genuine evidence. “We’re just asking questions” is the sort of thing birthers tend to say. Be better than the birthers.

Just because the president speaks in a manner alien to the D.C. press doesn’t mean his mental facilities are in trouble. The fact that a neophyte president doesn’t understand the intricacies of policy is troubling, but it doesn’t mean he’s intellectually incapable of doing his job. Just because Trump’s comments are often coarse or ugly doesn’t mean he’s cognitively impaired.

More significantly, the truth is there are a bunch of people in this country who don’t really care about Trump’s mental health, the future of democracy, the decorum of the office, the Constitution, collusion or the truth. They’re personally insulted by the outcome of the last presidential election and happy to embrace any story that helps them try to overturn it. Some of them, I’m positive, are hopeful that Russian interference changed votes so they could continue to spin their tale of a stolen election.

These folks are often Trump’s greatest gift. The day-to-day drama is often brought on by the president’s words, which are sometimes ugly and often self-destructive. Much of it, though, is exacerbated by his adversaries, who are ridiculous in their own special ways.

Anyway, on to the next nonsensical controversy.