HEALTH CARE/Joan Retsinas

Willie Sutton for A New Age

When a reporter asked Willie Sutton why he robbed banks, he allegedly replied, “that is where the money is.”

Today banks are targets only in movies that feature inept thieves (think Woody Allen), dye packs, and getaway cars that don’t get away.

Today Willie Sutton would target the poor, because that is where the money – the easily snatched money – is. In the Depression, poor people were certifiably poor, clinging to the bottom rung of the subsistence ladder, with no boosts (other than the inner spunkiness that readers of Horatio Alger tales expected from that era’s lumpenproletariat.) Willie would have found slim pickings there.

But today Uncle Sam prods up the poor, a bit; and Uncle Sam’s pockets are deep. Why not rob Uncle Sam, via the poor? Skimming from programs aimed at poor people doesn’t unduly upset anybody’s balance sheet: the poor still get their subsidies, if at a greater cost; the government still operates its programs; taxpayers foot the bill.

In the developing world, business mavens recognize the profits to be made from the poor. Consider the lessons in “Fortune at the Bottom of the Pyramid” by C.K. Prhahald, a 21st century imprimatur for profiting from the impoverished. In the modern-day United States, savvy entrepreneurs can get rich too, by targeting the poor.

The tale of opioids is a case study.

Pharmaceutical companies recognized the huge – the lingo of our President – market for anything that dulls the pain, physical and psychic, of the people working jobs that entail physical labor, at low pay, with few benefits, few chances for advancement — the waitresses, truck drivers and construction workers.. At the same time, the companies seized on the efficacy of opioids, long recognized for their role in alleviating pain from cancer, at dulling non-malignant pain. Small-scale controlled studies of patients had demonstrated the efficacy – hardly enough to justify wide-scale distribution from a medical vantage, but enough from a fiscal vantage.

So the frenzy of opioid prescriptions started, as some physicians seized on this tool to help their patients and other physicians seized on this tool to bolster their incomes. After all, Medicaid, Medicare, or a private insurer would pay. (For patients without insurance, a robust black market emerged.)

Opioids are, financially, the gift that keeps giving. Users soon become dependent.

Today the nation confronts an epidemic of addicts, driven to stronger, illegal drugs to maintain their highs. For Americans under age 50, overdoses are the leading cause of death. Police departments are starting to carry naloxone to administer to the addicts who have overdosed. State legislatures are relaxing laws to let Good Samaritans carry naloxone. The fatalities include the young-to-middle aged truck drivers, waitresses, and construction workers; they leave behind families who suffer from this epidemic much as families in the Middle Ages suffered from the plague.

At last the pharmaceutical companies are feeling states’ rancor: some states (e.g., California, Missouri, and Ohio), some counties, some cities (Chicago) have launched difficult-to-win lawsuits against the pharmaceutical companies: opioids, unlike cigarettes, are approved by the FDA. Most states have “pain policies” to staunch the easy prescriptions.

Furthermore, states, along with private insurers, are funding detox and rehabilitation treatment centers for the thousands of addicts – many on waiting lists. Here too, a New Age Willie Sutton has emerged: the treatment con artist.

The scam centers recruit addicts, offer few services, file bogus claims. Ironically, the Affordable Care Act, which covered “mental health services,” proved a boon: fraudsters could manipulate insured poor people into being unwitting dupes.

Uncle Sam is playing catch-up. The Department of Justice is prosecuting fraud from the pharmaceutical companies and the bogus treatment centers. Recently, two “sales reps” from Insys Therapeutics pleaded guilty to violating anti-kickback laws as they “encouraged” physicians to prescribe Subys.

Willie Sutton, the FBI’s robber-celebre of the Depression, was poor, with an eighth grade education. He carried a gun. These New Age Willie Suttons don’t flaunt guns; they flaunt marketing projections. Willie Sutton never killed anybody; the new ones are killing their victims. And these new age whizzes are unlikely to do the prison time that Willie Sutton did.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, September 1, 2017

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