The Washington Post reports on a punitive policy idea out of Wisconsin:
Wisconsin Gov. Scott Walker, a Republican who not only supports work requirements and premium payments but also a new additional condition: to make applicants undergo a drug test if they’re suspected of substance abuse.
If Walker gets his way, Wisconsin would be the first state in the country with mandatory drug screening for Medicaid enrollees. The governor plans to release his proposal in mid-April and submit it to the Department of Health and Human Services by the end of May.
The approach — which also would mandate treatment for those testing positive
At least there is treatment involved instead of denial of services. But the creation of another layer of hassle will discourage people from signing up especially if there is fear, uncertainty and doubt about the consequences of a positive test. This will drive more people back into the wood work instead of seeking enrollment in a program that they are eligible for.
I am also curious as to how people will be suspected of abuse. There are certain claims based algorithms that can detect highly probable abuse patterns but beyond that, how is this determined? Is it a tool of harassment or treatment? Given what we know of Governor Walker, I’m placing my bets on one side of the equation.
There is a line that gives away the game:
Republicans have long wanted to overhaul the Medicaid program, frustrated by its growing costs to states and provider shortages.
Providers don’t participate in Medicaid because they don’t get paid as much for their time and services compared to both Medicare and commercial rates. The frustration of “growing costs” and “provider shortages” are in direct opposition to each other. This is an attempt to cut some of the costs by erecting another barrier to enrollment.
sherparick
Its a tool of harassment and poor shaming that feeds Waker’s base. Walker in his statement asking for this basically implies folks are Medicaid are all drug abusers and that poor health is basically a character flaw. He is such a little asshole.
JPL
Health care should be left between you and your doctor, unless you are an addict seeking help. Then the state has a right to know.
Steeplejack (phone)
@Mayhew:
“Punitive policy idea
ofout of Wisconsin.”Percysowner
@JPL:
Or you’re a woman trying to control your reproductive life.
Enhanced Voting Techniques
What exactly is the reasoning here – they want the poor working, getting tagged as a drug abuser stops that and forces them back on public support.
Chyron HR
Great idea! There’s a guy living on Pennsylvania Avenue who gets $400,000 a year from the government AND free housing. Go test him to make sure he deserves it.
JPL
@Enhanced Voting Techniques: They are vindictive assholes, so they don’t need to use logic.
Lurking Canadian
@Enhanced Voting Techniques: More and more I think they literally want the poor to die. It’s still considered gauche for them to say it in public, but I think “die and decrease the surplus population” really is their vision.
That “the poor” is synonymous for many of them with “dark of skin” is probably not a coincidence.
liberal
I think we should make piss testing mandatory for taking the preferential capital gains marginal rates.
OzarkHillbilly
I think all those on Republicaid should be drug tested before receiving their govt handouts as well. All their family members too.
NYCMT
It’s still a Fourth Amendment violation.
sherparick
Walker basically has written the formula for plutocratic governance. Wisconsin’s blue collar working class (white and non-white has seen a 40 year decline and de-unionization. In 1970 American Motors was still headquarters in Kenosha and had their big plant there, Janesville had big GM plant, and Milwaukee and LaCrosse had several major breweries. Paper mills lined the Fox river (although their pollution was big problem for the Fox and Lake Michigan. At least 50% of the work force was unionized. All that is gone and the top 10 employers in the 10 or Government or retail. In the white suburbs surrounding Milwaukee, the blame and resentment for this decline centered on the Black population and professionals who still do well in universities, law, and medicine. Walker’s true base of support are Wisconsin’s ultra-rich, Hendricks, Menard, the Johnson family, and outside Koch money, who fund the conservative campaigns and support the conservative media message. This type of thing is what makes the just scraping by folks suburbs in the suburbs happy while Walker carries out the real agenda of cutting the taxes of Diane Hendricks and John Menard, and allowing them to become feudal potentates in the state.
rikyrah
Call me a cynic, but I suspect it’s as clear as SKIN COLOR.
Certified Mutant Enemy
@Chyron HR:
But he’s white!
laura
I’m guessing that the drug testing costs are passed on to the applicant/recipient of the benefit and that the testing company expects to profit from this and possibly has some mandatory minimum services agreement that forces the bar for suspicion ever downward.
Didn’t Florida Bat Boy/Governor profit from that testing grift?
Thoroughly Pizzled
My poor state of Michigan has much to be ashamed of, but we did not elect Scott Walker three times.
danielx
Where there are poors to be punished (one way or another), you will find Scott Walker leading the charge.
ArchTeryx
@Lurking Canadian: They absolutely do.
Major Major Major Major
Didn’t they try something like this somewhere else, and end up finding like literally three people on drugs, saving the state $100?
Chyron HR
@Certified Mutant Enemy:
Since when?????
Also: His unemployed daughter and son-in-law live with him in government housing. I think they need to be tested as well and made to go to the unemployment office once a week.
MomSense
I have a counter proposal. Let’s do it for everyone who claims the mortgage interest deduction.
MomSense
@Major Major Major Major:
You mean costing the state millions of dollars in testing fees.
Major Major Major Major
@MomSense: And I should have put ‘saving’ in scare quotes, yes.
Was it Florida? Because in FL all that food stamp(?) drug testing money went to Rick Scott’s testing company.
JCJ
Does this substance abuse include ethanol? Our beloved blog host noted fewer accidents after he stopped drinking.
NorthLeft12
I’ll take harassment and shaming for $200, Alex.
This is another in a long line of conservative attempts to deny basic rights and services to anyone that they think is undeserving. And this is not a new or “Made in America” idea, these slimy right wingers have been trying [and sometimes succeeding] to implement these ideas for centuries.
Chris
Why do I have a funny feeling that this will be yet another one of these things that just happens to target black people out of all proportion to the way the population as a whole is treated, but that conservatives will emphatically assure us is not racist?
The Moar You Know
Test positive and then the state holds those results for the rest of your life. Good luck getting a job. Any job.
This is why I’ve always been against drug testing for anyone in any profession…because this is where society WILL end up. Testing for everyone and the results hung around the necks of the victims for the rest of their lives.
MomSense
@Major Major Major Major:
Yeah it was Florida but I don’t remember if Scott still owned the company or not. Really gross. It’s like they are crafting policy to justify their biases.
The Moar You Know
@NYCMT: I agree. The courts don’t. There’s now one generation of lawyers and judges, and two generations of law students who’ve been bought up from day one believing that drug testing is totally A-OK 100% constitutional. I don’t know if we’re ever going to get those rights back.
Thoroughly Pizzled
@Major Major Major Major:
Michigan found zero people.
Major Major Major Major
@Thoroughly Pizzled: I think that’s the one I had in mind, thanks.
TriassicSands
Yeah, treatment. For those addicted to opioids, Walker will provide a padded cell for cold turkey withdrawal.
Mnemosyne
Whenever stupid requirements like this come up, I think about the (now sadly late) son of a former commenter here (I think she mostly lurks now). He was born with severe disabilities that meant he could not walk or talk, and every few years they had to have a doctor certify that a miracle had not occurred and he was still severely disabled.
And now if they lived in Wisconsin, his health care would have been taken away because his disabilities were too severe for him to work?
There’s also my co-worker’s sister, whose epilepsy is too severe and erratic for her to be able to hold down a job. No, she can’t work in fast food, because putting someone with grand mal seizures in charge of the deep fryer or the grill would be a really bad idea. But, hey, if her disability is too severe for her to work, then the state can just cut her off her medication, amirite?
Yarrow
I’m unclear on this mandate. They can require treatment, but as we know treatment is very difficult to get and expensive when you can get it. Who’s paying for that? What happens when the person who tests positive doesn’t get the treatment, possibly because they can’t afford it? Do they get thrown off Medicaid? Is this just a slightly longer route to denying people Medicaid with a false veneer of helping them?
Barbara
States that have tried to do this have given up when they realize how much money they are spending on drug testing with negative results. They usually announce the policy to great fanfare and then a few months later when (as always) they are looking to save money, this one is quietly withdrawn. As with segregation policies in the South, like building twice as many bathrooms, you really have to want to shame someone to go out of your way to throw away money like this.
Major Major Major Major
@Barbara:
Very well put.
Le Comte de Monte Cristo, fka Edmund Dantes
It IS harassment and shaming.
That said, as far as I’m concerned, though, a record if chronic opioid or benzo prescription over a three year period (call it more than 4X annually) should result in some sort of review and potential mandatory treatment if levels are inconsistent with the prescription amount (or screens show “extras”).
It is bad out there, across all demos. Too much abuse, lack of personal accountability to family to get treatment abounds. They literally refuse until they’re brought low enough to be homeless and puking in the gutter. Lives are being lost, opportunity wasted, families ruined, and it is all because of cheap heroin facilitated by our contractors and military, flying the shit out of Afghanistan.
PhoenixRising
What happens when the ‘treatment’ fails?
Le Comte de Monte Cristo, fka Edmund Dantes
@Yarrow:
You hit a nail on the head – free beds are short, and have a very long waitlist (in KY, figure 6 months to a year). Outpatient space abounds, but frankly, that rarely works by the time an opiate user graduates to smack. Even inpatient treatment has an appalling recidivism rate – the number I hear is that less than 1 in 10 succeeds in sobriety.
And don’t get me started on the money printing machines that are fronted as suboxone/methadone clinics.
Shantanu Saha
If the idea is not to waste government money, I fully support drug testing — for Wisconsin legislators, the governor, and all his lackeys. And all results should be made public.
Jim Kakalios
We should demand drug testing for all of the Wall Street brokers and bankers that received their bail out monies, paid for by the tax payers. And of course, demand that they return any monies they received should anyone fail said drug test. Fair’s fair, after all.
Enhanced Voting Techniques
@laura: Ok Walker is looking to run a drug screening scam and vindictive poor bashing part of it is just so the bitter old men go along with it make sense.
And what’s the deal with Deadman Walker? He gets reelected three times yet dies like a dog in the GOP primary for being both bland and vile. This more of in a blue hair heavy state even Osama Ben Ladin can get elected if he is the one with a “R” next to his name on the ballot?
hilts
OT
Trump Can Pull Money From His Businesses Whenever He Wants — Without Ever Telling Us
Previously unreported changes to President Trump’s trust stipulate that it “shall distribute net income or principal to Donald J. Trump at his request.”
h/t https://www.propublica.org/article/trump-pull-money-his-businesses-whenever-he-wants-without-telling-us
https://projects.propublica.org/graphics/trump-trust
J R in WV
deleted
trollhattan
My Iowa granny received Medicaid when she moved into a care facility in her 90s. Sure, Scotty would have uncovered her pesky heroin habit but what then?
Enhanced Voting Techniques
@The Moar You Know:
There was an article last week that was pointing out a lot places have to hire immigrants because immigrants are the only ones who can pass drug testing. Basically stoners are the only white Americans willing to work a lot of these low end jobs. Again, an actual conservative would be pushing to change things so these stoner twits wouldn’t become permanently wards of the state because they failed a test in their 20s but then the “conservative” party in this country is a mix of confidence men, vicious old twats who should be put down and god botheres living out their Christian themed LARP so this what we get.
Major Major Major Major
@Enhanced Voting Techniques:
Didn’t used to be. Possibly he was an early harbinger of the revolt of the rust belt whites.
J R in WV
@JPL:
Why does an addict seeking help from a doctor give the state any right to know about one’s medical issues? That seems so odd and perverted to me. The war on some drugs is making people thing twisted thoughts about medical care, and putting people in jail for victimless crimes.
People suffering from chronic severe pain, caused by any number of medical conditions, deserve compassionate treatment for their pain. Whether opioids or other medication to alleviate their pain, as well as treat the underlying conditions causing it, if at all possible. Sometimes there is really no treatment for the causes, and the best medical science can offer is treatment of the ensuing pain.
But cannibis is a Schedule 1 drug, no known medical uses. Right. And Attorney General Sessions is a medical doctor and scientist who forms his opinions on the best science available. And the moon is a big pizza pie in the sky, too.
I call bullshit on this. The state never has a right to know about your medical condition unless you may harm other people. And but for the war on some drugs, there wouldn’t be junkies or addicts, there would be people who would get their drugs from a drug store for a small co-pay.
Major Major Major Major
@J R in WV:
Er… ever met an alcoholic?
germy
I’m late to the thread; haven’t read every comment. Has it been mentioned that this is often the result of intense lobbying by folks who will make $$ from testing kits? These folks donate to people like walker.
Tissue Thin Pseudonym
In statistics, there is the concept of Type 1 vs. Type 2 errors. A Type 1 error means that you reject a null hypothesis is true, generating a false positive in support of your alternative hypothesis. A Type 2 error means accepting a null hypothesis that is false, generating a false negative against your alternative.
There are two important things to keep in mind about Type 1 and Type 2 errors. The first is that it’s impossible to tell whether you have either of them, or which one, just from looking at your data set. The second is that the chances of generating a Type 1 or Type 2 error is on a sliding scale, and that any steps you take specifically to reduce the chances of a Type 1 error increases the chances of a Type 2 error, and vice versa. The main method for altering these chances is the confidence interval. In most statistical analysis, there is a strong bias in favor of minimizing Type 1 errors at the expense of increased Type 2 errors. The standard for most work is a 95% CI, which means that, if the null hypothesis is in fact true, you will only get a Type 1 error one time in twenty, assuming the rest of your methodology is sound. The probability of generating a Type 2 error, assuming that the null hypothesis is false (if the null hypothesis is true, there is a zero probability of a Type 2 error, as is the case with a Type 1 error if the null is false) is more complicated, but is inversely related to the probability of a Type 1 error.
Where I’m going with this is an observation about people with different political ideologies. If we assign as the null the hypothesis that an individual receiving government assistance is not deserving of them, we get an alternative hypothesis that the individual does deserve them. Within this framework, liberals in general are willing to tolerate a lot of Type 1 errors in order to minimize the Type 2. Conservatives, on the other hand, are determined to reduce Type 1 errors to zero, and show no concern whatsoever as to how many Type 2 errors this process produces.
Me, I’m a liberal, and find the consevative mindset appalling and lacking in anything resembling empathy, but your mileage may vary.
Enhanced Voting Techniques
@germy: Yep, Sounds like Walker’s major donars are drug testing companies and rehab clinics.
schrodingers_cat
@Tissue Thin Pseudonym: From the perspective of game theory Rs believe in zero sum games, for them to be win others have to lose. They don’t believe in the existence of win-win or lose-lose scenarios.
pseudonymous in nc
Drug testing companies are a kind of para-healthcare, not that far aware from the barely-regulated vitamin and supplement industry that attracts grifters and shitheads like the orange menace. They’re providing medical services, but they’re not providing healthcare: they serve a mandated need, not a health-driven purpose.
(A lot of those drug-testing facilities also do the mandatory immigration medicals — cash only, thank you very much — which is another way they stay afloat.)
Major Major Major Major
@Tissue Thin Pseudonym: @schrodingers_cat: Both are true.
John M. Burt
Someone I know was once suspected of substance abuse because she was found to have taken 40% of her sick days on a Friday or a Monday.
Please consider what percentage of a five-day work week is Mondays and Fridays.
Just because you call it an algorithm doesn’t make it reliable.
[email protected] Damn, you’re right: not only do they not believe in win-win outcomes, they also don’t believe in lose-lose: if they can tell you’re losing, they’re sure they MUST be winning. That explains so much.
J R in WV
@Major Major Major Major:
“Er… ever met an alcoholic?”
Oh, yes. My F-I-L was a sweet guy, an engineer who loved his work, but when he got drunk, he was mean, and couldn’t stop. He died pretty young, 69, of liver failure. His parents both made it into the mid-90s.
But liquor is cheap, even panhandlers and bums can buy some legally without robbing people. It is a shame when you see parents who scored some smack, shot up in a parking lot, passed out with kids in the back seat.
But that irresponsibility shouldn’t interfere with other people’s medical treatment, and if they were getting their drugs from a pharma company, it wouldn’t be spiked with unexpected drugs. We don’t sell alcoholics methyl alcohol, either, which was a problem during prohibition, with the poisoning of people drinking bootlegged booze.
I’m not saying that ending prohibition of drugs would be all sweetness and light. We would still have driving under the influence, and parents not caring for their kids.
But people’s careers wouldn’t be ruined by felony convictions for possession, would they?
I gotta go run errands, see you all later. Figuratively, you know?
JaneE
Any bets that someone prescribed opioids for pain will be forced into “treatment”.
Brachiator
@MomSense:
The Republican tax plan would effectively eliminate the mortgage interest deduction for many people. The middle class get shafted along with poor people.
Walker’s proposal to make applicants undergo a drug test if they’re suspected of substance abuse is crappy. But if good drug treatment programs are available, this might not be intolerable.
Ruckus
@sherparick:
No. No he is not. He is a tiny little man. He is a huge fucking asshole.
Miss Bianca
@Brachiator: “Walker’s proposal to make applicants undergo a drug test if they’re suspected of substance abuse is crappy. But if good drug treatment programs are available, this might not be intolerable.”
They’re not, and yes..this IS intolerable. The whole war-on-drugs, poor-shaming scam that is drug-testing is out of control. The whole “pee in a cup” culture is seriously out of control. It is an unwarrantable invasion of privacy unless there is is some demonstrable reason for it – and more and more, the reason just seems to be, “because we can and because we feel like it.”
amygdala
Late to the thread here, but the answer to your second question, which I’m assuming is rhetorical, is yes, on both counts. Being expensively and pointlessly punitive is what these vicious clowns do.
As for highly probable abuse patterns, there are probably some claims-based algorithms that could be developed. Repeated episodes of trauma in young men, for example, is supposedly specific (but not sensitive, unfortunately) for alcohol abuse/dependence. Other substances too, I suspect.
Having said that, I think the suspicion for substance use problems is often more at a individual practitioner gut level and thus harder to pick up in an algorithm. In patients you know well, for example, it can be easier (recognizing someone’s off because you know them) and harder (also being in denial, because you don’t want it to be true). And more because it’s a combination of several things–symptoms, exam findings, lab results–not infrequently over time, that set the alarm bells ringing. When those things are individually nonspecific, as they often are, I don’t know how that can be programmed.
It is said that the most common causes of peripheral neuropathy in the US are diabetes and alcoholism. Diagnosis of the former is fairly straightforward and it’s pretty uncommon to make that diagnosis in a patient referred for evaluation of neuropathy; the PCP’s already done it. But it’s not unusual to pick up on serious alcohol problems that a patient who is still otherwise compensated has managed to hide from family, coworkers, PCP, and maybe even him- or herself.
But you look at the labs over time and see the fluctuating and otherwise unexplained elevations in liver enzymes over years, the ED visit for a fall down a flight of stairs, the elevated MCV on the blood count… Any one of those things doesn’t mean much, but together they paint a picture. Sometimes you ask about how much they’re drinking and the patient will clam up; other times there’s a sense of relief that someone is on the right track and oh, God, Doc, please… help me. Sometimes the spouse is in the room and calls or emails you later to tell you they’re worried, too.
As for confidentiality, it gets violated, with protection of the law generally, when patients are a significant threat to others–certain communicable diseases, for example, or actively homicidal (or suicidal). It can get a little dodgy beyond that. California, for example, requires that practitioners report loss of consciousness. Even though, for epilepsy, there’s no evidence this lowers accident rates and mostly encourages patients not to be forthcoming with their level of seizure control, them’s the rules. And I’ve absolutely had patients storm out of clinic in a rage when I’ve recommended they not drive until the DMV reviews their privileges. They often threaten to sue, not realizing that neurologists who have failed to notify have been held liable if a patient with poorly controlled seizures drives and harms someone else.
I absolutely do not think routinely reporting substance abuse to the authorities is a good idea, outside the setting of an actual DUI or something similar. In any other context I’d think it’s mostly stupid. In this one, my assumption is that it’s vindictive, too.
laura
@Enhanced Voting Techniques: part of his continued upward failing is that the demo have repeatedly failedto coalesce around a single candidate and splits the opposition. Repeatedly.
Ruckus
@J R in WV:
I like the cut of your jib.
We have criminalized almost any substance that changes one’s moods and perceptions in this country. Alcohol, pot, heroin, prescription drugs, etc, etc. Yes all of them are dangerous when abused. Dangerous to the user and frequently to others. But what is the result of all of this criminalization? Mostly to make criminals of users, which clogs the courts and prisons, makes the people vastly less employable even if they clean up….. And really hasn’t done crap for the idea of drug abuse. And what amazes me is that humans have been looking for ways of altering the moment(s) for almost all of it’s recorded history through the use of substances. We’ve just gotten better at it currently. Most if not all of us at one time or another has taken some substance that alters the present. A good percentage have abused one or more substances at one time or another. That doesn’t mean we will continue to, liked it, or won’t stop completely. None of this means we are less than human, it means we are exactly human. I wonder why so very few have ever looked into why we all search for something/anything to alter the present? And why so many think that we have to, not control the abuse, but stop this very human trait completely? Trying to stop it is always going to fail. Always. For any group or any reason.
Ruckus
@amygdala:
Vindictiveness seems to be at the root of a lot of conservative ideals. But I wonder if it is actually always vindictiveness or could it sometimes be something else? Because a lot of the things they seem to be against are things that they themselves are guilty of. Are they asking for some more control on their own actions so that they don’t have to make a hard decision, society has done it for them? Or are they trying to make things more titillating for themselves? Are they ashamed of who they are?
Brachiator
@Miss Bianca: RE: “Walker’s proposal to make applicants undergo a drug test if they’re suspected of substance abuse is crappy. But if good drug treatment programs are available, this might not be intolerable.”
If the choices were between denial or health care and drug testing, I would take drug testing in a heartbeat.
If there is a way to fight back against what he wants to do, I’m all for it. Otherwise, you pick the battles you can win.
TenguPhule
I’m sure nothing can go wrong by drug testing people who are applying to get coverage…in order to take medically necessary drugs.
Miss Bianca
@Brachiator: How about if the choices are “get a drug test AND be denied coverage”? Because they’re not going to use this to provide health care. “Pick the battles you can win” sometimes means you have to FIGHT the battles.
amygdala
@Ruckus: Those are all great questions. The reverse authoritarian thing is real–“hey, I don’t make the rules… I’m just doing my job.” I’ve never understood castigating someone struggling with a problem one used to have. To me, that carries a responsibility for greater compassion. We get out of the holes into which we dig ourselves with help, invariably, and that carries a duty to help others.
Michelle O’s comment about not pulling up the ladder behind us may be what distinguishes today’s Republican party from the rest of us.
boatboy_srq
Late entry here, but I suspect the metrics will be: Poor? Yes. Blah/Brown/Otherwise-Other? Oh HELL yes.
boatboy_srq
@Ruckus: Respectively: frequently; true; no, because if they’re caught it’s no fun (see next question); absolutely yes; it does, which makes the titillation more exquisite.