ArcaMax

Americans often complain about how far Washington debates seem to be removed from the lives of real people.

But Washington's health care debate and the nation's opioid crisis became quite real to me in new ways after a city councilman in the Ohio town where I grew up made national news by raising a provocative question: Does the city have to respond to calls from repeat opiate overdose patients?

Morality aside -- and that's pushing a lot aside -- that's a good question, especially in a town whose local government is struggling to make ends meet.

Middletown, Ohio, my old hometown, is faced with that challenge. The once-thriving factory town that I recall has become a textbook case of postindustrial job loss. With that, it has one of the highest opioids overdose rates in a state whose overdose rate currently ranks fourth nationwide, according to the Centers for Disease Control and Prevention.

The city of about 50,000 has already seen almost 600 overdoses so far this year. That's more than all of 2016. Ambulance crews say they're responding to as many as four or five calls a day.

And the cost is soaring. Addiction treatment programs cost more than $2 million, or 10 percent of the city's annual tax revenue, spokesmen say.

Fearing a fiscal train wreck, Councilman Dan Picard has asked the city's law department to investigate whether the city has a legal obligation to respond with ambulance service to repeat opiate overdose patients.

If it does not, Picard's has informally suggested include a three strikes policy: The first two times that someone overdoses, they would have to pay the city back for the cost by performing community service. If they overdose a third time without having repaid their debts from the first two, no ambulance would come.

That's pretty drastic. The thought of barring ambulance crews from an overdose patient who hasn't paid all of his or her fees reminds me of another unsettling story. Back in 2010, network news showed firefighters in rural Obion County, Tenn., who were ordered to stand aside and let a home burn to the ground. The homeowner hadn't paid a $75 fee to receive fire coverage provided by the nearby town of South Fulton.

But Picard's suggestion quickly went viral, attracting "hate mail, national news coverage and overloaded voice mail and email in-boxes," wrote city manager Doug Adkins in his blog.

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