Democrats should go bold on ending the opioid crisis

Greg Sargent of The Washington Post has an interesting interview with former Rep. Patrick Kennedy, a Democrat who sits on President Donald Trump’s commission on the opioid crisis.

Kennedy expressed pessimism about the Trump administration’s commitment to the likely recommendations from the commission, mostly because the policies they are likely to propose will be expensive, and some Trump officials are reluctant to make a large financial commitment to fighting the crisis.

If Trump won’t take the necessary steps to end the opioid crisis, Democrats should explain how they would. And they shouldn’t shy away from a big price tag to fund treatment for anyone who needs it.

Last year, as Congress was debating a bill to fight opioids, Republicans and Democrats fought over whether to attach $US920 million over two years to actually pay for treatment envisioned in the bill. But as we saw during the fight over Obamacare repeal, it’s possible to think a lot bigger.

During the frantic effort to cobble together a coalition to pass a healthcare repeal bill, Republican Senate leaders offered Sens. Rob Portman and Shelley Moore Capito $US45 billion over 10 years to fight opioid addiction.

Republicans meant that as a replacement for opioid spending currently covered by expanded Medicaid, but Democrats should start with that number as an additive goal. What would they do with an additional $US45 billion over a decade, on top of spending through Medicaid and other programs, in an effort to end the crisis?

They shouldn’t be afraid of a high price tag. Opioid addiction is a devastating social crisis. Democrats should explain how they would spend the money, and let Republicans explain why we can’t afford to do it while they try to pass a tax cut for billionaires.

Democrats should look to the response to the HIV/AIDS crisis as a model. HIV/AIDS is a major policy success story that shows what the federal government can do for public health with sufficient dedication of attention and money.

The intense federal response to the HIV/AIDS crisis was a few years late, but it eventually became both large and highly effective. The death rate from HIV/AIDS in the US has fallen by 80% since its peak in 1996, in large part due to medical research and treatment programs funded by the federal government.

This fiscal commitment has been enormous — in 2016, the federal government spent $US26 billion on domestic HIV treatment, support, prevention and research. Another $US7 billion went to fight the global HIV/AIDS epidemic. Through one channel or another, nearly 1% of the federal budget is spent on HIV/AIDS. And state and local governments spend billions more.

Similarly to opioid addiction treatment, most domestic HIV/AIDS spending goes through Medicare or Medicaid, as one aspect of the federal government’s overall commitment to healthcare spending. But about $US2 billion a year is spent under the Ryan White Act, which funds state programs that aim to ensure universal availability of HIV/AIDS treatment, even for the uninsured and underinsured.

These federally-funded, state-run AIDS Drug Assistance Programs operate with the goal of getting free AIDS treatment to anyone who needs it. The opioid crisis is now somewhat deadlier than America’s HIV/AIDS crisis ever was — HIV/AIDS deaths peaked at 39,000, while opioid deaths are above 50,000 and rising.

Why not take a similarly bold approach to opioid addiction and make the financial commitments to back it up? Why not a companion to the Ryan White Act to ensure anyone who needs opioid treatment can get it?

Anti-HIV campaigners aren’t afraid to speak in bold terms. New York’s health department talks not of controlling the AIDS epidemic but ending it — which is to say, they intend to get the rate of new infections so low that the number of people living with HIV in the state goes into decline. The opioid crisis is on a similar scale and deserves similar urgency and ambition.

Democrats should step forward with a plan to do and spend what it takes to end the opioid crisis, especially because it is likely Donald Trump will not do so.

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