PDMPs: the Progressives’ “Common Core of Health Care”

A “Mechanism of Socialized Medicine”

Mary Byrne, Ed.D. Co-founder, Missouri Coalition Against Common Core

March 2020

Prescription Drug Monitoring Programs have been used by different states for law enforcement purposes since the

beginning of the 20th century

Since the Obama administration, the purpose of PDMPs has been expanded

The real purpose of PDMPs is not

what you’ve been told

Since FDR’s administration, national health care has been promoted by Democrat presidents with various degrees of success. Truman was the first president to seriously endorse a “universal” national health insurance program in 1945. Since then, Progressives have nudged the U.S. toward democratic socialism by way of socialized medicine , i.e., universal health coverage. Truman denied his plan was socialized medicine because doctors would not be employees of the government (though they were in the Veteran Administration’s Department of Medicine and Surgery established in 1946). The defining feature of socialized medicine , however, is not who employs doctors, but the goal of medical care they provide. The goal of socialized medicine is a “healthy society” achieved within cost controls and policies developed by consensus. This goal contrasts starkly with the American understanding of their government’s purpose – to protect the rights, liberties, and pursuit of happiness of individual citizens. Progressive Democrat presidents since Truman have incrementally nudged the United States toward socialized medicine. The Johnson administration established government health care programs for certain populations (low income and senior citizens). The Clinton and Obama administrations sponsored legislation to expand government health care programs to universal health coverage. (UHC). Democrat 2020 presidential candidate Joe Biden’s Affordable Care Act (ACA) 2.0 builds on Obama’s ACA and works toward achieving universal coverage as soon as possible Dr. Ezekiel Emanuel, advisor to the Clinton’s health care task force and architect of Obama’s ACA, is now a public health advisor to the Biden campaign. At the same time, he is special advisor to the director general of the World Health Organization (and is a vocal critic of the Republican administration’s handling of the COVID-19 crisis). The Progressives’ education agenda of workforce development is a complement of their universal health coverage agenda. Progressive education is marked by the transformation of the purpose of publicly funded education from the preparation of individuals to assume the responsibilities of self-governance, to preparation of workers for jobs to ensure national economic security. The most recent and transformative iteration of the Progressives’ school-to-work agenda is the Common Core State Standards Initiative (CCSSI) funded with grants from the Obama U.S. Department of Education. CCSSI receives public attention each year as declining or stagnant statewide and national assessment results expose American youths’ lost opportunity to learn. Less well known are the effects of the Obama administration’s incremental expansion of socialized medicine through the transformation of Prescription Drug Monitoring Programs (PDMPs) from a law enforcement tool to a medical services surveillance tool. The Obama administration was not transparent about the role of a nationwide expansion of PDMPs for implementing socialized medicine in the U.S or its alignment with a World Health Organization agenda for surveillance of prescription drugs. This PowerPoint and accompanying handout explain how the federal government’s efforts to re-purpose and expand PDMPs make PDMPs the “Common Core of Health Care” -- promising service delivery for the people’s “general welfare” (societal needs) at the expense of the individual person’s constitutional rights of self-governance and privacy.

Executive Summary

In a socialist system the people [i.e., the collective or government] own and control the means of production and distribution through democratically controlled public agencies, cooperatives, or other collective groups. The primary goal of economic activity is to provide the necessities of life, including food, shelter, health care, education, child care, cultural opportunities, and social services. These social services include care for the chronically ill, persons with mental disabilities, the infirm and the aging. Planning takes place at the community, regional, and national levels [not the individual level], and is determined democratically with the input of workers, consumers, and the public [i.e., groups] to be served.

Socialist Party USA’s Definition of a Socialist Society

https://www.socialistpartyusa.net/principles-points-of-agreement

PDMP Plays Into Democratic Socialist Agenda for Health Care

Obama’s Affordable Care Act included funds to reform health care with Health Information Technology. In 2011, the Obama administration’s Office of National Drug Control Policy instigated an aggressive plan to establish PDMPs in every state despite the lack of conclusive evidence that PDMPs had any positive effect on reducing opioid deaths from prescription medication or positive effect on society. Every Democrat running for president in 2020 embraced a health care system that uses the power of the federal government to structure and finance universal health coverage. They differ on the degree of control the federal government would exert. Dr. Ezekiel Emanuel, special advisor to the director general of the World Health Organization (WH0) was advisor to the Clinton task force on health care that developed Hillary Care, and was the chief architect of Obama’s Affordable Care Act. (Emanuel is the WHO official frequently quoted by the media as criticizing the Trump administration’s management of the COVID-19 crisis. Emanuel is also a public health advisor to Joe Biden’s presidential campaign.) Since 1948, the WHO agenda for member states has been to provide universal health coverage (under Sustainable Development Goal 3) and a national Health Implementation Technology system “to support data collection for surveillance and reporting of risks” (WHA 72.6). The ultimate goal of socialized medicine is NOT compassionate care for the individual. The goal is cost control for national economic viability, that is, a healthy workforce for “making society flourish.” PDMP data, as a component of medical information , will be merged with school –collected data in the statewide longitudinal data system, and workforce data at the individual level.

Phase I: The First Step of Progressive Socialized Medicine in the U.S.

President Lyndon Baines Johnson formally signed Medicare and Medicaid into law, offering government health care to two segments of the U.S. population as former president Harry S. Truman and his wife, Bess, looked on. . . . Johnson proclaimed Mr. Truman as “the real daddy of Medicare.” Truman later called the failure to pass a national health insurance program one of the most bitter and troubling disappointments in his presidency. Forty-five years after Medicare and Medicaid became law, the Patient Protection and Affordable Care Act of 2010 expanded government health care to the general population. https://www.pbs.org/newshour/health/november-19-1945-harry-truman-calls-national-health-insurance-program

“Well, we can’t say we haven’t been warned.”

One of the traditional methods of imposing statism or socialism on a people has been by way of medicine. It's very easy to disguise a medical program as a humanitarian project, . . . Now, the American people, if you put it to them about socialized medicine and gave them a chance to choose, would unhesitatingly vote against it. We had an example of this. Under the Truman Administration it was proposed that we have a compulsory health insurance program for all people in the United States, and, of course, the American people unhesitatingly rejected this. . . .

https://www.americanrhetoric.com/speeches/ronaldreagansocializedmedicine.htm

Now, Congressman Ferrand brought the program out on that idea of just for that particular group of people. But Congressman Ferrand was subscribing to this foot-in-the-door philosophy, because he said “If we can only break through and get our foot inside the door, then we can expand the program after that.” Well, let’s see what the socialists themselves have to say about it. They say: "Once the Ferrand bill is passed, this nation will be provided with a mechanism for socialized medicine capable of indefinite expansion in every direction until it includes the entire population." Well, we can’t say we haven’t been warned.

https://www.americanrhetoric.com/speeches/ronaldreagansocializedmedicine.htm

Phase I: Clinton’s National Healthcare Plan

“One of the traditional methods of imposing statism or socialism on a people has been by way of medicine.” Ronald Reagan Speaks Out Against Socialized Medicine (1961)

Unique Patient Identifiers (UPI)

https://www.nytimes.com/1993/09/23/us/clinton-s-health-plan-transcript-president-s-address-congress-health-care.html

https://www.presidency.ucsb.edu/documents/1992-democratic-party-platform

In 1948, the World Health Organization declared health care as a right.

Clinton’s Health Security Act of 1993

The Heath Security Act of 1993, or "Hillarycare," . . . , proposed providing Americans with universal healthcare coverage.

Clinton's plan for universal coverage was "based on consumer choice among competing private health plans, operating under a cap on total spending (an approach known, in the shorthand of health policy, as 'managed competition within a budget')."

The effort to get the plan passed was spearheaded by Hillary Clinton. [The Association American Physicians and Surgeons sued Hillary Clinton because of the secrecy surrounding her task force meetings. Dr. Ezekiel Emanuel was a member of the task force].

https://ballotpedia.org/%22Hillarycare%22_(The_proposed_Health_Security_Act_of_1993

https://www.aapsonline.org/clinton/AAPS/APPOPIN.PDF

Bill Clinton Justifies Johnson and Refutes Reagan

The Health Security Act of 1993 as a comprehensive bill never came to a vote, failing for a number of reasons. It was large in scope, which made it difficult to explain to Congress and the public, but parts of it were passed, including the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and it Unique Patient Identifier. https://www.youtube.com/watch?v=3K1d3E-BoUw

Congressman Ron Paul (R-TX), introduced language to the Labor-HHS appropriations bill in 1998 to restrict the use of federal funds to develop the Unique Patient Identifier (UPI), and such a ban has been continually renewed in each Labor-HHS appropriations bill since, however, the ban was almost repealed in 2019.

https://www.paul.senate.gov/news/dr-rand-paul-introduces-legislation-repeal-national-patient-id-protect-americans%E2%80%99-medical

• In June 2019, Speaker Pelosi’s Democrat majority in the U.S. House voted for an amendment to the appropriations bill to repeal the 21-year old ban on using taxpayer funds to implement a UPI.

• Senator Rand Paul introduced legislation (S. 2538) to repeal the House amendment, to ensure the Senate version of the Labor, Health and Human Services, and Education bill maintains the ban on using federal funds to create a UPI.

• The ban was restored in conference.

Phase II: Obama’s Affordable Care Act, making health care affordable (for the government)

https://www.americanhealthline.com/analysis-and-insight/features/why-hillarycare-failed-and-obamacare-succeeded

https://www.presidency.ucsb.edu/documents/2008-democratic-party-platform

Ensure all Americans are captured in government regulated health care program, not just Medicaid and Medicare enrollees – a requisite of socialized medicine

Our vision of a strengthened and improved health care system for all Americans stands in stark contrast to the Republican Party's . . .

https://www.hhs.gov/sites/default/files/ppacacon.pdf

“But we have to pass the bill so that you can, ah, find out what is in it away from the fog of the controversy.”

March 9, 2010 https://www.youtube.com/watch?v=hV-05TLiiLU

. . . the American people, if you put it to them about socialized medicine and gave them a chance to choose, would unhesitatingly vote against it

Ronald Reagan Speaks Out Against Socialized Medicine (1961)

The Department of Health and Human Services put out a sole-source solicitation for MIT Economics Professor Jonathan Gruber titled “Technical Assistance in Evaluating Options for Health Reform.” The document said Gruber was the only person “reasonably available to satisfy agency requirements.”

As a consultant on the ACA, Gruber appeared on a panel and suggested that many lawmakers and voters didn't know what was in the law or how its financing worked, and that this helped it win approval.

"Lack of transparency is a huge political advantage,” Gruber said. "And basically, call it the stupidity of the American voter or whatever, but basically that was really, really critical for the thing to pass.“ https://www.youtube.com/watch?v=G790p0LcgbI

https://www.globenewswire.com/news-release/2015/03/18/1046537/0/en/Judicial-Watch-Sues-HHS-Over-Failure-to-Produce-Jonathan-Gruber-Contracting-and-Consulting-Records.html

"You never want a serious crisis to go to waste. And what I mean by that it’s an opportunity to do things that you think you could not do before. . . . The five reforms that we seek, one in health care, would be in the area that deals with cost control as a principle and expansion of coverage . . .” [a.k.a. government health care rationing with cost caps determined by decision-makers at the top of a centralized hierarchical system] (Rahm Emanuel, President-elect Obama’s Chief of Staff, Shaping the New Agenda, November 19, 2008)

“It's very easy to disguise a medical program as a humanitarian project . . .” Ronald Reagan Speaks Out Against Socialized Medicine (1961)

https://www.youtube.com/watch?v=_mzcbXi1Tkk

Ezekiel J. Emanuel is the Vice Provost for Global Initiatives, the Diane v.S.[sic] Levy and Robert M. Levy University Professor at the University of Pennsylvania. He is also a Special Advisor to the Director General of the World Health Organization, as well as a Senior Fellow at the Center for American Progress. Dr. Emanuel was the founding chair of the Department of Bioethics at the National Institutes of Health and held that position until August of 2011. Until January 2011, he served [in the Obama administration] as a Special Advisor on Health Policy to the Director of the Office of Management and Budget and National Economic Council.

Dr. Emanuel is a member of the Council on Foreign Relations and the chair of the meta-council on the Future of Health Care Committee for the World Economic Forum.

http://www.ezekielemanuel.com/bio

. . . accountable care organizations will typically be paid a fixed amount per patient, along with bonuses for achieving quality targets. The organizations will make money by keeping their patients healthy and out of the hospital and by avoiding unnecessary tests, drugs and procedures.

Value Added Measurement of Health Care

https://opinionator.blogs.nytimes.com/2012/01/30/the-end-of-health-insurance-companies/

Dr. Emanuel has fought for a government takeover of health care for over a decade. In 1993, he urged that President Bill Clinton impose a wage and price freeze on health care to force parties to the table. "The desire to be rid of the freeze will do much to concentrate the mind," he wrote with another author in a Feb. 8, 1993, Washington Post op-ed. Now he recommends arm-twisting Chicago style. "Every favor to a constituency should be linked to support for the health-care reform agenda," he wrote last Nov. 16 in the Health Care Watch Blog. "If the automakers want a bailout, then they and their suppliers have to agree to support and lobby for the administration's health-reform effort."

https://www.wsj.com/articles/SB10001424052970203706604574374463280098676

Ezekiel Emanuel, (Jan 31, 2009) Principles of Allocation of Scare Medical Interventions, The Lancet. https://www.thelancet.com/action/showPdf?pii=S0140-6736%2809%2960137-9

The opioid crisis the federal government subsidized by the expansion of government health care programs ushers in ACA’s socialized medicine tools

https://www.thelancet.com/action/showPdf?pii=S0140-6736%2809%2960137-9

“We could cap the price based on objective, quantitative measures of value.” [i.e., data gathering] https://www.nytimes.com/2015/09/09/opinion/the-solution-to-drug-prices.html

DR. EMANUEL: One of the things that I think is important going forward, to make healthcare more efficient, and to get continuity of coverage better—is to have vertically integrated health plans. . . . That does require someone to vertically integrate health plans, health insurance companies. . . . Right now in America there are about 1,300 health insurance companies. . . . They cater to very small companies, but they add a lot of administrative costs —in the sense of they've got a different billing system. . . . In our plan, we would estimate that we would cut that down to about 50 or 60 plans throughout the country. [Govt picks winners and losers. See next slide] http://www.pbs.org/now/news/315.html

[Accountable Care Organizations (ACO) are developing and testing ways to coordinate, standardize, and provide care more efficiently and at consistently higher quality standards. Over the next decade many of these ACOs and hospital systems will succeed at integrating all the components of care and provide efficient, coordinated care. They will have the physician and hospital networks. They will have standardized, guideline-driven care plans for most major conditions and procedures to increase efficiency. They will have figured out how to harness their electronic medical records to better identify patients who will become sick [using data analytics] and how to intervene early as well as how to care for the well-identified chronically ill so as to reduce costs. [See table on next slide]

https://newrepublic.com/article/116752/ezekiel-emanuel-book-excerpt-end-health-insurance-companies

The outcome of these fair allocation procedures, informed by the ethical values and recommendations delineated here, should be the development of prioritization guidelines that ensure that individual physicians are not faced with the terrible task of improvising decisions about whom to treat or making these decisions in isolation. . . ., institutions may employ triage officers, physicians in roles outside direct patient care, or committees of experienced physicians and ethicists, to help apply guidelines, to assist with rationing decisions, or to make and implement choices outright . . ., but appeals should be limited to concerns about procedural mistakes, given time and resource constraints.

Dr. Emanuel recommends enforcement officers for enforcing standardized health protocols (neither patient or doctor makes decisions)

https://www.nejm.org/doi/full/10.1056/NEJMsb2005114

Emanuel’s Socialized Medicine Model Applied to COVID-19

https://www.nytimes.com/2020/03/20/us/coronavirus-in-seattle-washington-state.html

The U.S. Federal Government’s Role In Stimulating Today’s Opioid Crisis

Economists at the CDC found that with the expansion of Federal medical insurance plans, especially Medicare, the government expanded payouts for opioids. At this time, the number of deaths from prescription opioids increased.

The Federal Government’s Role in Creating the Opioid Crisis

https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2015.1103 https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

https://www.whitehouse.gov/wp-content/uploads/2019/04/The-Role-of-Opioid-Prices-in-the-Evolving-Opioid-Crisis.pdf

https://www.whitehouse.gov/wp-content/uploads/2019/04/The-Role-of-Opioid-Prices-in-the-Evolving-Opioid-Crisis.pdf

https://www.nejm.org/doi/full/10.1056/NEJMsa1406143#t=article

We estimate that SSDI recipients who are generally eligible for Medicare . . . Were prescribed a disproportionate share of 26 to 30 percent of total potency-adjusted opioids in 2011.

2nd Wave of opioid crisis – deaths attributed to illicit drug use due to restrictions on prescription opioids 1st Wave of opioid crisis --

pharmaceutical companies advised to market stronger opioids prescribed for longer periods of time

https://www.nytimes.com/2019/02/01/business/purdue-pharma-mckinsey-oxycontin-opiods.html

West Virginia’s lawsuit was such a serious threat to Purdue Pharma, that in 2004 Purdue called in former Deputy Attorney General Eric Holder ,who was at that time a private attorney working for the Washington, DC law firm Covington and Burling . Just before a jury was to try the case, Holder and Purdue Pharma settled West Virginia’s lawsuit for $10 million. Purdue Pharma did not have to admit to any wrongdoing.

http://americannewsreport.com/west-virginia-uses-oxycontin-settlement-money-to-build-a-gym-8814021

https://www.marketplace.org/2017/12/13/health-care/purdue-statement/

More than 20 years later, it’s still unresolved who exactly wrote the sentence, but some lawyers argued that the idea behind it came from Purdue.

https://www.marketplace.org/2017/12/13/opioid/

https://www.nytimes.com/2019/07/25/business/mckinsey-johnson-and-johnson-opioids.html

https://www.nejm.org/doi/pdf/10.1056/NEJMsa1406143?articleTools=true

As prescription opioids are reduced, deaths due to illicit heroin increased.

Democrat U.S. Senators, including Claire McCaskill, . . .

https://www.durbin.senate.gov/newsroom/press-releases/durbin-presses-dea-administrator-to-lower-2018-opioid-quotas

Despite evidence that reduced availability of prescription opioids is associated with increased deaths from illicit opioids . . .

The Obama White House Re-purposing of PDMPs

from Law Enforcement to

Medical Enforcement For ACA Cost Cap Enforcement

And “Research”

Originally developed as a law enforcement tool, PDMPs were re-purposed as a “medical mechanism” to address the opioid crisis (initially caused by the Federal government’s expansion of health care programs, and the FDA and pharmaceutical companies’ labeling of OxyContin* as non addictive) to put a standards of care and national data gathering system in place. Following the principles of systems thinking, a de facto national drug surveillance system created through linkages of state-managed PDMPs would help to cap Federal government health care expenses by surveillance control, that is, using the PDMP to control doctors’ prescribing behaviors with the threat of investigation and restricting patient treatment options. Later, states would expand the list of prescriptions in the PDMP from Schedule II, III, and IV to all prescriptions. The Federal government’s assumptions in merging the law enforcement purpose of PDMPs with medical monitoring of all physicians’ script-writing behavior conflates responsible chronic pain patients prescribed opioids that effectively treat incurable pain with drug abusers and presumes specialized pain management doctors will be fraudulent prescribers. In other words, it violates a presumption of innocence – a bedrock construct of western civilization, and innocent persons’ right to privacy. *https://www.marketplace.org/2017/12/13/opioid/

https://www.mckinsey.com/industries/healthcare-systems-and-services/how-we-help-clients/center-for-us-health-system-reform https://www.mckinsey.com/industries/healthcare-systems-and-services/how-we-help-clients/americas/pharmacy-services

Rapid assessment of medical policies: We use a proprietary database to assess and structure medical policies that will improve quality outcomes, based on industry benchmarks.

McKinsey & Company is a management consulting firm headquartered in Chicago. McKinsey & Company has been provided strategic advice to corporations and governments. McKinsey opened its first international office in London in 1959, and has expanded steadily since.

Use existing technology to reinvent delivery “Repurposing” mobile-phone systems, call centers, and other existing technologies and infrastructure allows innovators to extend health care access, increase the standardization of care, and improve labor productivity.

The use of the existing technology infrastructure would be useful in any part of the world where health care resources are scarce. Yet this approach can also provide benefits in developed countries.

https://assets.mckinsey.com/industries/healthcare-systems-and-services/our-insights/the-emerging-market-in-health-care-innovation

Standardize operating procedures Whenever possible, successful innovators use highly standardized operating procedures to minimize waste and improve the utilization of labor and assets. The use of standardized clinical protocols also raises the quality of care and facilitates the transfer of knowledge.

Borrow someone else’s assets Smart innovators use existing institutions, infrastructure, and networks of people to reduce capital investments and operating costs. They then pass the savings on to consumers.

ACA signed into law March 23,2010

https://www.jpain.org/article/S1526-5900(14)00694-4/fulltext

https://prevention.nih.gov/sites/default/files/documents/programs/p2p/ODPPainPanelStatementFinal_10-02-14.pdf

• Prescription monitoring programs were originally designed to assist with law enforcement and decrease opioid abuse and diversion;

• PDMPs have secondarily facilitated addressing public health concerns by allowing

monitoring of physician prescribing and identifying opportunities for addiction services.

https://www.pharmacist.com/sites/default/files/files/NationwidePDMPBackgroundPaper.pdf

https://www.pdmpassist.org/

PDMPs were originally a law enforcement tool “repurposed” for monitoring prescription costs

https://www.pdmpassist.org/PMIX

Not the individual’s rights and control of data

https://www.pdmpassist.org/pdf/Status%20Standard%20final%20-%20rev%201.pdf

https://www.pharmacist.com/sites/default/files/files/NationwidePDMPBackgroundPaper.pdf

https://www.fda.gov/safety/fdas-sentinel-initiative

https://www.sentinelinitiative.org/

https://www.sentinelinitiative.org/drugs/assessments/optimal-initial-length-opioid-prescription

https://www.sentinelinitiative.org/drugs/about

Analyzes and interprets prescription drug data to regulate prescribing practices

https://www.sentinelinitiative.org/sentinel/data/distributed-database-common-data-model

FDA access to patients’ Personally Identifying Information

Info used to reconstruct identity

Current Strategy of Categorizing Chronic Pain Patients Taking Prescription Opioids as Patients Having Substance Abuse Disorder in

Stimulus Package to Alleviate the COVID-19 Crisis

https://www.scribd.com/document/452416417/McConnell-coronavirus-stimulus-plan

https://www.pharmacist.com/sites/default/files/files/NationwidePDMPBackgroundPaper.pdf

https://obamawhitehouse.archives.gov/sites/default/files/ondcp/Fact_Sheets/pdmp_fact_sheet_4-8-11.pdf

The Obama Administrations ONDCP encouraged states’ adoption of PDMPs, promising it would reduce opioid deaths in the United States

. . . In 17 states and the District of Columbia, drug‐induced deaths are now the leading cause of injury death. . . .

Obamacare: Purpose of PDMP for “Research”

Such as Google

https://publichealth.hsc.wvu.edu/media/3327/paw_pdmp_3_email_no-samhsa-logo.pdf

PDMPs monitor health insurance costs for planning adjustments in services – a function of socialized medicine.

Standardized Care

Standardized reporting

Govt access

PDMPs: Cost Saving Tool for Government Health Care – a function of socialized medicine for Medicaid Patients

http://files.kff.org/attachment/Issue-Brief-Federal-Legislation-to-Address-the-Opioid-Crisis-Medicaid-Provisions-in-the-SUPPORT-Act

Integrated eligibility systems (IESs) are the enabling technology behind state-

level Medicaid and human services programs in the United States. The core of an IES is automated rules and a case management and workflow system that encodes logic to enable timely and accurate eligibility determinations for Medicaid and other human services programs. Because many low-income individuals and families qualify for multiple public benefit programs, most states use the same technology and staff to process eligibility for programs such as Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and the Temporary Assistance for Needy Families program (TANF) in order to avoid duplication of effort for case workers as well as individuals and families applying for such programs, reduce duplicative administrative costs, and ensure program integrity. Starting in 2011, the Centers for Medicare & Medicaid Services, driven by requirements and deadlines associated with the Patient Protection and Affordable Care Act, announced it would increase its funding match to 90 percent for Medicaid programs to build new or enhance existing, up from 50 percent, and increase maintenance and operations matching to 75 percent, also up from 50 percent.

https://www.mckinsey.com/industries/public-sector/our-insights/insights-into-better-integrated-eligibility-systems#

https://www.cdc.gov/mmwr/volumes/65/rr/pdfs/rr6501e1.pdf

The Department of Justice’s Drug Enforcement Administration (DEA) is using these guidelines as a basis for identifying “over-prescribers.” These types of responses often don’t take into account the fact that certain kinds of doctors—such as those who specialize in the treatment of pain, or treat more people from certain populations or professions—will be inherently required to prescribe more opioids than others. [In other words, the DEA is using descriptive statistics to identify doctors with high frequency of prescribing opioids without any reference to the context of their patient population and assuming they are “guilty until proven innocent.”] Doctors avoid DEA investigation by resorting to “Abandonment of Care” – creating a Civil Rights issue. These changes are linked to the same misinformation and stigma that keep hundreds of thousands of opioid use disorder patients from accessing the most effective medicines. Some abandoned patients have become so overwhelmed by their pain that they have resorted to suicide.

https://filtermag.org/how-stigma-against-addiction-devastates-pain-patients/

. . . But, “ranges given in the guidelines related to opioid dosages and the number of days for which an opioid should be prescribed were often translated to “inflexible” limits that have been pushed, mandated and incentivized by countless insurers, state agencies, and regulators in ways that exceed or even contravene the guidelines.” https://www.statnews.com/2019/04/26/no-shortcuts-prescribing-opioids-chronic-pain/

Phase IV: Expand PDMPs to Create National Database that includes ALL Prescriptions

“. . . this nation will be provided with a mechanism for socialized medicine capable of indefinite expansion in every direction until it includes the entire population. . . . “If we can only break through and get our foot inside the door, then we can expand the program after that.”” Ronald Reagan Speaks Out Against Socialized Medicine (1961)

https://www.healthcareitnews.com/news/hhs-plan-opioid-crisis-track-prescribing-patterns-medicaid-data

Medicaid patients are disproportionately affected by government surveillance now, but every American will be tracked when plans for data integration are complete.

https://www.congress.gov/115/plaws/publ271/PLAW-115publ271.pdf

https://www.congress.gov/bill/115th-congress/house-bill/6/text

https://nebraskalegislature.gov/laws/statutes.php?statute=71-2454

https://www.healthcareitnews.com/news/nebraska-becomes-first-state-require-all-drugs-be-reported-prescription-monitoring-program

http://legislature.maine.gov/legis/bills/getPDF.asp?paper=HP1511&item=1&snum=129

On June 19, 2019, the U.S. House of Representatives passed Rep. Bill Foster’s (D-IL) amendment to allow federal funding of UPIs, stripping Congressman Ron Paul’s 2003 language prohibiting funding for UPI from House Labor, HHS, and Education Appropriations Bill.

https://www.c-span.org/video/?c4802600/user-clip-foster-offers-amendment-patient-identifier

No evidence to support claim

Special Interest Group

Same talking points Made to support PDMP

Code for “national data base”

https://www.healthit.gov/sites/default/files/page/2019-10/Experian%20Health%20PDMP%20Presentation%2009062019.pdf

PDMPs do not stop doctor shopping. . . . In four of the five years that can be compared, the percentage of individuals who misuse prescription pain medicine and obtained it by doctor shopping actually increased (Figure 3)

Survey question was changed; 2015-2017 not comparable to 2011-2014

Figure 2 shows the source of misused pain medication in 2017: 85.0% of the misused pain medicine came from one doctor; 12.5% did not go through a doctor; only 2.5% were obtained through doctor shopping.

National Statistics Do Not Support Representative Foster’s Claims About UPI-PDMPs

https://www.jpands.org/vol24no2/lilly.pdf

A unique patient identifier (UPI) would allow federal bureaucrats and government-favored special interests to access health information simply by entering an individual’s unique patient ID into a database. This system would also facilitate the collection of health information without a warrant by surveillance state operatives. The health records database could easily be linked to other similar databases, such as those containing gun purchase records or education records. If health records are linked to E-Verify data, employers may access a prospective employee’s medical history.

Non-Governmental Organizations Move Ahead To Assign UPIs Without Federal Money

https://ncpdp.org/NCPDP/media/pdf/pressrelease/NCPDP-Experian-Health-UPI-press-release-121919.pdf

Merging Medical Data with Education and Employment Data

to Monitor Americans’ Health, Education, & Labor From Cradle-to-Grave for

a Healthy Society

Missouri’s 2010 Race To The Top Grant Application to U.S. Dept. of Ed. Verifies intent to

Merge Student School and Medical Records

https://www2.ed.gov/programs/racetothetop/phase2-applications/missouri.pdf

Statewide Longitudinal Data Systems data, including medical data will be merged with Department of Labor data for a cradle to grave system of monitoring

WDQI funding is made available through competitive grants administered by DOL in support of a parallel and much larger effort, the Statewide Longitudinal Data System (SLDS) grants administered by the U.S. Department of Education. These two programs encourage the development of state education and workforce longitudinal administrative databases. Ultimately, databases developed through WDQI should be linked to education data at the individual level. Collecting these and other data sources longitudinally will provide a comprehensive picture of workers' earnings throughout their careers. Through analysis, these data will demonstrate the relationship between education and training programs, as well as the additional contribution of the provision of other employment services.

https://www.doleta.gov/performance/workforcedatagrant09.cfm

In 2010, the U.S. Department of Labor (DOL) launched round one of WDQI to fund the development, or enhancement, of state workforce longitudinal administrative databases. These state longitudinal databases will, at a minimum, include information on programs that provide training and employment services and will be linked longitudinally at the individual level to allow for analysis leading to enhanced opportunity for program evaluation and better information for customers and stakeholders of the workforce system.

https://www.chicagotribune.com/opinion/editorials/ct-obamacare-fail-health-care-insurance-medicine-0911-jm-20160909-story.html

PDMPs Promoted as “Promising” not Proven, PDMP Data Do Not Support the Claims

https://www.wsj.com/articles/SB10001424127887324110404578628542498014414

https://bmchealthservres.biomedcentral.com/track/pdf/10.1186/s12913-017-2354-5

https://annals.org/aim/article-abstract/2680723/association-between-prescription-drug-monitoring-programs-nonfatal-fatal-drug-overdoses

See next slide

https://docs.google.com/document/d/1RzQDSppUKhjiAsEmhW2WbTXlP5V8vJ4M_vBPQLKhK_8/edit

https://www.ajmc.com/newsroom/doctors-wait-to-see-how-cms-opioid-changes-play-out-for-patients-in-pain

Opioid-related Deaths increase 30% after STL Co. PDMP was established in 2016

https://www.stltoday.com/news/local/metro/number-of-opioid-related-overdose-deaths-continues-to-increase-according/article_f48856d3-c181-5569-8780-bf277944ec57.html

http://ncada-stl.org/press-release-addiction-continues-to-expand-in-st-louis-region/

Fentanyl smuggled to U.S. from China and Mexico

No mention of federal health programs subsidizing opioid use or diversion of attention & resources away from new wave of illicit drugs if statewide MO PDMP is established.

Mounting evidence points to a worrisome rise in methamphetamine use nationally. The presence of cheap, purer forms of meth in the drug market coupled with a decline in opioid availability has fueled the stimulant’s popularity. The number of drug overdose deaths involving the meth tripled from 2011 to 2016, the CDC reported. Hospitalizations involving amphetamines — the class of stimulants that includes methamphetamine — are spiking. And it is harder to address. Treatment options for this addiction are narrower than the array available for opioids. In light of the increase in deaths related to other substances, are these grants the best way to fund states’ response to opioids? [States] can’t use the federal opioid grants to treat meth addiction. https://khn.org/news/federal-grants-a-lifesaver-in-opioid-fight-but-states-still-struggle-to-curb-meth/

Illicit Drugs Responsible for Rise In Overdose deaths in STL Region

https://www.ksdk.com/article/news/local/st-louis-drug-overdose-deaths-rising/63-7c045ba3-6ca2-46a9-9da7-9d837ec21d07

https://www.researchgate.net/publication/324578588_Government_Actions_to_Curb_the_Opioid_Epidemic/link/5b9754ef4585153a5327e77e/download

PDMPs & Privacy Concerns

Privacy is not private, because the effectiveness of these and other private or public surveillance and control systems depends upon the pieces of ourselves that we give up — or that are secretly stolen from us.

https://www.nytimes.com/2020/01/24/opinion/sunday/surveillance-capitalism.html

https://fas.org/sgp/crs/misc/R42593.pdf

A PDMP is not a HIPAA covered entity, nor is it generally a business associate as defined by HIPAA, and in these cases the HIPAA requirements and standards for maintaining the security and privacy of the PHI or for its re disclosure that apply to HIPAA covered entities would not apply to PDMPs.

the “Part 2” rule’s prohibition on re disclosure without patient consent discourages federally assisted substance abuse programs from contributing to PDMPs’ information about controlled substances dispensed for the treatment of opioid addiction (i.e., methadone or buprenorphine) due to concerns that authorized redisclosures of the data could not be prevented.

https://www.cdc.gov/about/pdf/organization/cdc-org-chart.pdf

https://www.fda.gov/media/133184/download

Google’s statement is deliberately misleading (see next 2 slides)

https://edelson.com/wp-content/uploads/2016/05/Dinerstein-Google-DKT-001-Complaint.pdf

https://www.nytimes.com/2019/06/26/technology/google-university-chicago-data-sharing-lawsuit.html

https://www.cdc.gov/mmwr/volumes/69/ss/pdfs/ss6901a1-H.pdf

No mention of AG lawsuits exposing deceptive marketing campaigns as the source of prescribing patterns.

https://www.cdc.gov/drugoverdose/pdmp/states.html

https://coloradosun.com/2019/11/11/dea-subpoena-opioid-pharmacy-board/

Personal health information can be transferred between organizations as part of a so-called business associate agreement, said Lucia Savage, a health privacy lawyer with the digital health company Omada Health. These agreements ensure that personal health information is provided in a secure manner. And there are guidelines around the use of limited data sets in medical research.

https://www.cnbc.com/2019/06/28/google-u-chicago-hipaa-lawsuit-shows-next-battleground-privacy.html

https://www.politico.com/tipsheets/morning-ehealth/2015/02/icd-10-approved-by-gao-will-the-implementation-date-stay-the-same-mobile-health-thrilled-by-finalized-fda-regs-212543

https://www.usnews.com/news/business/articles/2015/02/06/anthem-hacker-tried-to-breach-system-as-early-as-dec-10

Big Tech Partners with Big Government for Surveillance Capitalism

https://articles.mercola.com/sites/articles/archive/2020/03/28/surveillance-capitalism.aspx

Social psychologist and Harvard Professor Shoshana Zuboff

What is role of the World Health Organization in Developing U.S. PDMP

Policy & Legislation?

https://www.who.int/medicines/areas/quality_safety/safety_efficacy/National_PV_Centres_Map/

PDMP proponents need to answer these questions: Does the definition of “researchers” in U.S. Federal law include WHO analysts? Do “researchers” from foreign countries access

our data? If so, why aren’t we told?

https://www.who-umc.org/research-scientific-development/scientific-development/

What is role of WHO in Developing Obama’s Health Care Policy & Legislation?

https://apps.who.int/gb/archive/pdf_files/WHA55/ewha5518.pdf

Ezekiel Emanuel, Special Adviser To The Director-general of the World Health Organization; Member Special Advisor on Health Policy to the Director of the Office of Management and Budget and National Economic Council

What is the role of the WHO in monitoring U.S. UPI-PDMP data?

https://www.who.int/patientsafety/medication-safety/strategic-framework.pdf

https://apps.who.int/iris/bitstream/handle/10665/255263/WHO-HIS-SDS-2017.6-eng.pdf;sequence=1

https://www.who.int/medicines/areas/quality_safety/guide_nocp_sanend/en/

https://apps.who.int/medicinedocs/pdf/whozip39e/whozip39e.pdf

https://www.incb.org/documents/Narcotic-Drugs/Yellow_List/58th_Edition/Yellow_List_-ENG.pdf

The narcotic drugs under international Control are the Schedule II, III, and IV drugs listed in the MO’s SS#2 HB 1693

https://apps.who.int/medicinedocs/en/d/Js2289e/

https://apps.who.int/medicinedocs/en/d/Js2289e/

One possible reason for using the drug use indicators is to supervise the performance of a set of health facilities on an ongoing basis. The primary objective of such a monitoring process is not necessarily the estimation of the precise values of the indicators in each facility, but rather the identification of facilities which do not meet explicit standards of performance. As we have seen, examination of at least 100 encounters in a facility is necessary to obtain an estimate with a 95% confidence interval of plus or minus 10%. This number would be impractical to examine on a regular basis during routine supervisory visits. To make the use of indicators for monitoring feasible, the procedures need to rely on sampling as small a number of encounters as possible, and there needs to be a rapid way of identifying those facilities which do not meet a specified norm. This annex describes such an approach using a technique called Lot Quality Assurance Sampling. Practical details of this approach will need further development as the indicators begin to be applied for monitoring and supervision. Those interested in a fuller treatment can refer to other recent publications on this topic

https://apps.who.int/medicinedocs/en/d/Js2289e/8.4.html

https://apps.who.int/medicinedocs/pdf/s2289e/s2289e.pdf

https://apps.who.int/iris/bitstream/handle/10665/331486/9789240001848-eng.pdf

https://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_R6-en.pdf

See next slide

Sections of the ACA and subsequent actions from HHS and related agencies have created research guidelines and policies, however, that attempt to combine individual health needs and societal needs into one single silo.

Numerous laws have already been enacted to permit this study to even take place. It appears consumer and patient privacy is still at risk as the laws warp and bend to accommodate the “needs” of researchers. Most recently, the federal docket has proposed changes to HIPAA that would allow for increased healthcare information sharing in order to permit the gathering of Americans’ private Electronic Medical Records and Electronic Health Records by investigators and other stakeholders, including data mining organizations that assign “opioid risk scores” to humans (based on unknown algorithms), such as Appriss Health [vendor for STL Co PDMP].

https://idpc.net/publications/2019/05/dossier-the-violation-of-a-nation

Example of How Personal Data Are Used – Algorithms Assign “Opioid Risk Scores”

https://www.wsj.com/articles/world-health-coronavirus-disinformation-11586122093

https://www.wsj.com/articles/the-world-health-organization-draws-flak-for-coronavirus-response-11581525207

https://www.politico.eu/article/bill-gates-who-most-powerful-doctor/ https://www.politico.eu/pro/who-cements-ties-with-bill-and-melinda-gates-foundation/

• Many points of data transfer in the PDMP schematic indicate many opportunities for internal violation of patient privacy or external data hacking.

• A 2018 Federal law, SUPPORT mandates access to Medicaid patients’ PDMP data.

• The act allows Federal departments’ access to all prescription information states authorize in their state laws. Nebraska and Maine have expanded their PDMP data collection to all prescription drugs.

• Though the public is told PDMP data are encrypted, HIPPA does not prohibit hospitals from transferring personally identifiable information to “researchers” such as Google.

• Available graphic of PDMP information flow does not mention access of FDA and DEA access to PDMP data or possible role of state PDMP in populating WHO prescription drug monitoring database.

State Medicaid Access

PDMP & Civil Rights Concerns

https://www.cs.cornell.edu/~shmat/courses/cs5436/warren-brandeis.pdf

Osborn v United States (1966) U.S. Supreme Court Justice William O. Douglas wrote in his dissenting opinion: Osborn v. United States presents the question whether the Government may compound the invasion of privacy by using hidden recording devices to record incriminating statements made by the unwary suspect to a secret federal agent. Privacy, though not expressly mentioned in the Constitution, is essential to the exercise of other rights guaranteed by it. . . .: "[S]pecific guarantees in the Bill of Rights have penumbras, formed by emanations from those guarantees that help give them life and substance . . . The Fourth Amendment explicitly affirms the 'right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures.' The dossiers on all citizens mount in number and increase in size. Now they are being put on computers, so that, by pressing one button, all the miserable, the sick, the suspect, the unpopular, the off-beat people of the Nation can be instantly identified. "Once electronic surveillance...is added to the techniques of snooping that this sophisticated age has developed, we face the stark reality that the walls of privacy have broken down and all the tools of the police state are handed over to our bureaucracy." Taken individually, each step may be of little consequence. But when viewed as a whole, there begins to emerge a society quite unlike any we have seen -- a society in which government may intrude into the secret regions of man's life at will. . . . It is indicative of a philosophy that the ends justify the means.

If a man's privacy can be invaded at will, who can say he is free? https://supreme.justia.com/cases/federal/us/385/323/

. . . the zeal with which we have traditionally pursued supply reduction measures to address drug-related harms reflects the legal and system design of PDMPs, as well as the street-level implementation of these programs. This also explains why the success of PDMPs has been measured primarily by their impact on suppressing medication supply with little regard for truly meaningful metrics. But, when it comes to improving patient care and addressing drug-related harms, the evidence of PDMP benefit is far from clear.

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3175299

. . . a critique of PDMPs as dragnet electronic surveillance is long overdue. At the population level, these collateral impacts can hamper much-needed surveillance and control efforts, aggravating the very problems these policies and programs were intended to ameliorate.

The Tuskegee Experiment: U.S. Government’s Promises of Medical Care in Exchange For Data Gathering Without Informed Consent

https://www.history.com/news/the-infamous-40-year-tuskegee-study

FDR’s Administration

Is the PDMP’s mandated surrender of patient data which may cause physicians to deny or with hold patient care any more ethical than the unethical medical practices of the Tuskegee Experiment?

https://www.history.com/news/the-infamous-40-year-tuskegee-study

Roe v. Wade was a landmark legal decision issued on January 22, 1973, in which the U.S. Supreme Court struck down a Texas statute banning abortion, effectively legalizing the procedure across the United States. The court held that a woman’s right to an abortion was implicit in the right to privacy protected by the 14th Amendment to the Constitution. https://www.history.com/topics/womens-rights/roe-v-wade

Why did Hillary Clinton believe individual women have a constitutional right to privacy for abortions as “health care,” but not prescription drugs?

During the final debate between Clinton and Trump, held at the University of Nevada, Las Vegas, on October 19, 2016, and moderated by Chris Wallace of Fox News, Wallace opened the debate with discussion of the Supreme Court. Clinton: Well, I strongly support Roe v. Wade, which guarantees a constitutional right to a woman to make the most intimate, most difficult, in many cases, decisions about her health care that one can imagine.

The final Trump-Clinton debate transcript, annotated

https://www.washingtonpost.com/news/the-fix/wp/2016/10/19/the-final-trump-clinton-debate-transcript-annotated/

Questions for Progressives: Is Privacy a Right only in Some “Health Care” Decisions?

The lesson is that privacy is public — it is a collective good that is logically and morally inseparable from the values of human autonomy and self-determination upon which privacy depends and without which a democratic society is unimaginable.

In the absence of new declarations of epistemic rights and legislation, surveillance capitalism threatens to remake society as it unmakes democracy. From below, it undermines human agency, usurping privacy, diminishing autonomy and depriving individuals of the right to combat. From above, epistemic inequality and injustice are fundamentally incompatible with the aspirations of a democratic people.

https://www.nytimes.com/2020/01/24/opinion/sunday/surveillance-capitalism.html

The choice to turn any aspect of one’s life into data must belong to individuals by virtue of their rights in a democratic society.

SS#2 HB 1693 is NOT a Fix for PDMPs

https://www.usatoday.com/story/opinion/todaysdebate/2020/03/26/obamacare-main-thrust-radical-centralization-health-care-editorials-debates/2921965001/

[PDMPs are used for bureaucratic control of prescription drugs that can harm people seeking medical care.]

SB 677: Twin of SS#2 HB 1693 is NOT a Fix Either

This act also establishes the "Narcotics Control Act". The Department of Health and Senior Services shall be required to establish and maintain a program to monitor the prescribing and dispensing of all Schedule II, III, and IV controlled substances by all licensed professionals who prescribe or dispense these substances in Missouri. The provisions of this act shall be subject to appropriations and may also be funded with federal or private moneys. A dispenser shall electronically submit to the Department specified information for each controlled substance dispensed. The Department may issue a waiver to a dispenser who is unable to submit the required information electronically. If a waiver is obtained, a dispenser may submit the required information in paper format or by other approved means. Beginning January 1, 2022, the Department shall begin phasing in a requirement that dispensers report data in real time with all reported data to be submitted in real time by January 1, 2023. All dispensation information shall be kept confidential with specified exceptions. This act authorizes the release of non-personal, general information for statistical, educational, and research purposes. The Department shall review the dispensation information and, if there is reasonable cause to believe a violation of law or breach of professional standards may have occurred, the Department shall notify the appropriate law enforcement or professional regulatory entity and provide the dispensation information required for an investigation. No dispensation information submitted to the Department shall be used by any local, state, or federal authority to prevent an individual from owning or obtaining a firearm, or used as the sole basis for probable cause to obtain an arrest or search warrant in a criminal investigation. Beginning August 28, 2022, the Department shall maintain an individual's prescription and dispensation information obtained under this act for a maximum of 3 years, after which the information shall be deleted from the program. [By then, the data has already been shared to comply with the conditions of federal grants.]

https://www.senate.mo.gov/20info/bts_web/Bill.aspx?SessionType=R&BillID=26838058

Claims about PDMPs are part of the Progressives’ Long-Game Strategy –

Using Crises to Forward the Socialist Agenda

. . . the Pelosi-Schumer delay of the [COVID-19] rescue package over non-germane demands was meant to open a path to a larger ideological victory once this is over. (Senator Schumer video) “When you have a crisis like this, a scourge that shakes us to our bones, private industry can’t getcha out of the problem. Only government can.” https://www.wsj.com/articles/world-health-coronavirus-disinformation-11586122093

But just as no one doubts post-virus structural changes will happen everywhere, so too in the political system. Democrats and progressive writers will argue that if the virus-management model of Washington-directed “guidance” worked, that is the model we should use for other areas of national concern such as health care, education . . . https://www.wsj.com/articles/the-next-coronavirus-war-11585780097

PDMP is the “Common Core” of Health Care

Vote NO on SS#2 HB 1693 and SB 677

The accompanying handout explains the many similarities between the Obama Administration’s Common Core education reform and health care reforms that include every state adopting a PDMP for administration of cradle to grave government services. Together, Common Core State Standards Initiative and the PDMP are components of a Public-Private Partnership agenda designed to • Ensure the “general welfare” of society;

• Prepare children for human resource development;

• Populate the workforce; • Secure the national economy (rather than individuals); • To force consent to surrender personally identifiable information to a database for

government purposes in exchange for public services: • To expand government into every area of our lives.

These are the hallmarks of statism or socialism, not American freedom.

So [contact your representative] . . . . . . demand the continuation of our traditional free enterprise system. . . . If you don’t, this program, I promise you, will pass just as surely as the sun will come up tomorrow; and behind it will come other federal programs that will invade every area of freedom as we have known it in this country. Until, one day, as Norman Thomas said, we will awake to find that we have socialism. And if you don’t do this and if I don’t do it, one of these days you and I are going to spend our sunset years telling our children, and our children’s children, what it once was like in America when men were free.

https://www.americanrhetoric.com/speeches/ronaldreagansocializedmedicine.htm

Reagan’s Call to Action

Thanks to those Missourians who contributed to the development of this presentation: Tom Byrne, Medicare enrollee Ron Calzone, Missouri First Mary Cremer, Chronic Pain Patient Bev Ehlen, Concerned Women for America-Missouri John Lilly, D.O. Ron Staggs, Associate Commissioner, Monroe County