Lives We Can Save – The New York Times

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On top of America’s bureaucratic problems are more personal ones.

Some doctors hold stigmatizing views about addiction and the patients afflicted by it, and refuse to provide treatment. Many doctors say they lack the confidence to treat addiction because they don’t have enough training or access to specialists who can help guide them. Drug users can also resist treatment. Some think of medications for addiction as merely replacing one drug with another, though experts reject that framing because the medications replace drugs that do harm with drugs that can help.

All of these problems lead to the underuse of effective addiction treatments in the U.S., and so it is easier to get high than it is to get help.

Some of the problems are specific to addiction. But others are broader. Obesity and mental health conditions are often undertreated, too. Flu seasons are consistently worse than they have to be because not enough people get their annual shots. While Americans’ overuse of health care frequently receives attention, underuse is a problem in many situations as well.

Why is this the case?

Often, people, including doctors, have outsize fears about the downsides of some treatments, especially new ones. With Covid, doctors worry about Paxlovid’s interactions with other drugs — a real problem but largely a manageable one. With opioid addiction, patients make the mistake of thinking of a prescribed medication, like buprenorphine, as just another drug, even though it can save their lives.

The American health care system’s fragmented nature also makes it easier for problems to fall through the cracks. In France, officials can leverage the country’s universal health care system to overcome hesitancy to new treatments by guaranteeing they’re widely available and by strongly pushing for their use. In the U.S. system, there is no centralized authority, so medical authorities struggle to coordinate care even when the best practices seem clear.

As a result, drug overdoses are both a major public health problem in their own right — they are one reason U.S. life expectancy fell in 2020 and 2021 — and representative of the system’s larger struggles. The U.S. spends far more per person on health care than any other country and also has lower life expectancy than Canada, Japan, South Korea, Australia and much of Western Europe.

Related: Opioid overdoses are killing thousands of people in New York each year. The surging death toll is the city’s “new normal.”


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