Our Health Policy Matters

It is way too early to break out the champagne over the latest Medicaid expansion initiatives bubbling up around the nation.  States that have been reluctant to expand traditional Medicaid are ablaze with proposals to offer “premium support” to expansion populations.  Premium support programs may differ in their details, but they have one thing in common.  Instead of offering regular Medicaid to an expansion population, the state pays the cost of their private insurance premiums. Kaiser Health News reported last week that the Department of Health and Human Services is encouraging states to explore this approach.  MSN featured some “let’s make a deal” offers on expansion by a number of GOP legislators.  And Health News Florida reported a wave of bipartisan enthusiasm for a Florida premium support proposal that was unveiled after support for traditional Medicaid expansion collapsed. For policymakers who don’t like Medicaid but want the fe...

It is way too early to break out the champagne over the latest Medicaid expansion initiatives bubbling up around the nation.  States that have been reluctant to expand traditional Medicaid are ablaze with proposals to offer “premium support” to expansion populations.  Premium support programs may differ in their details, but they have one thing in common.  Instead of offering regular Medicaid to an expansion population, the state pays the cost of their private insurance premiums. Kaiser Health News reported last week that the Department of Health and Human Services is encouraging states to explore this approach.  MSN featured some “let’s make a deal” offers on expansion by a number of GOP legislators.  And Health News Florida reported a wave of bipartisan enthusiasm for a Florida premium support proposal that was unveiled after support for traditional Medicaid expansion collapsed. For policymakers who don’t like Medicaid but want the fe...

Why is mental illness the only chronic disease we don't begin to treat until Stage 4? I posed that question in a presentation for over 400 attendees at last week’s winter meeting of the North Carolina Hospital Association.  For an audience that witnesses first-hand the crowding of patients with mental illnesses into general hospital beds and emergency rooms, the question resonated. Stage 4 of a chronic disease is associated with the imminent threat of death – a widely metastasized cancer, for example, or kidney disease so advanced that only dialysis or a transplant keeps the person alive. The odds of recovery are long. It is the same with mental illness.  Either the patient's life or someone else's needs to be at stake before we guarantee access to treatment.  That's Stage 4. Diagnosing and treating a disease at Stage 1, 2, or 3, always improves the odds of survival and recovery. Why not apply that standard to mental illness, too?  In Stag...

Why is mental illness the only chronic disease we don't begin to treat until Stage 4? I posed that question in a presentation for over 400 attendees at last week’s winter meeting of the North Carolina Hospital Association.  For an audience that witnesses first-hand the crowding of patients with mental illnesses into general hospital beds and emergency rooms, the question resonated. Stage 4 of a chronic disease is associated with the imminent threat of death – a widely metastasized cancer, for example, or kidney disease so advanced that only dialysis or a transplant keeps the person alive. The odds of recovery are long. It is the same with mental illness.  Either the patient's life or someone else's needs to be at stake before we guarantee access to treatment.  That's Stage 4. Diagnosing and treating a disease at Stage 1, 2, or 3, always improves the odds of survival and recovery. Why not apply that standard to mental illness, too?  In Stag...

Here is one of the more intriguing headlines of Super Bowl week:  “Is the National Football League dying”? Probably not, but too many of its former players are dying young, and for reasons that may be preventable.  Many people are concerned about growing evidence of brain injury from the violence of the game. But that’s just part of the story. Linemen are too heavy. Their excessive weight is a danger to running backs now and to their own health after they hang up the cleats. Baltimore Ravens safety Bernard Pollard raised the issue when he was quoted as predicting the demise of pro football, in part because of its violence, but mostly because of the way the rule makers are responding to that violence.  “I hope I’m wrong,” he added, “but I just believe one day there’s going to be a death that takes place on the field because of the direction we’re going.”  President Obama weighed in on football safety, too, but in a less dire way.  “ I think th...

Here is one of the more intriguing headlines of Super Bowl week:  “Is the National Football League dying”? Probably not, but too many of its former players are dying young, and for reasons that may be preventable.  Many people are concerned about growing evidence of brain injury from the violence of the game. But that’s just part of the story. Linemen are too heavy. Their excessive weight is a danger to running backs now and to their own health after they hang up the cleats. Baltimore Ravens safety Bernard Pollard raised the issue when he was quoted as predicting the demise of pro football, in part because of its violence, but mostly because of the way the rule makers are responding to that violence.  “I hope I’m wrong,” he added, “but I just believe one day there’s going to be a death that takes place on the field because of the direction we’re going.”  President Obama weighed in on football safety, too, but in a less dire way.  “ I think th...

Former U.S. Congressman Patrick Kennedy was in South Florida last week pushing the radical idea that all people, including those with mental illness, are created equal. What makes this idea radical in 2012 is that we continue to discriminate against the 6% of Americans who have serious mental illnesses.  Patrick Kennedy understands this, and is devoting his life after Congress to fighting on their behalf. It is a fight that affects him personally, as it does the one-fifth of all children and the one-fourth of all adults with a diagnosable mental illness each year. Discrimination against people with mental illness takes on many forms – arrests for loitering, incarceration instead of treatment, and perhaps most commonly in the unequal coverage by insurers for mental health conditions. This last form of discrimination was supposed to have ended with the passage of the Mental Health Parity and Addiction Equity Act of 2008.  But the federal “rule” implementing t...

Former U.S. Congressman Patrick Kennedy was in South Florida last week pushing the radical idea that all people, including those with mental illness, are created equal. What makes this idea radical in 2012 is that we continue to discriminate against the 6% of Americans who have serious mental illnesses.  Patrick Kennedy understands this, and is devoting his life after Congress to fighting on their behalf. It is a fight that affects him personally, as it does the one-fifth of all children and the one-fourth of all adults with a diagnosable mental illness each year. Discrimination against people with mental illness takes on many forms – arrests for loitering, incarceration instead of treatment, and perhaps most commonly in the unequal coverage by insurers for mental health conditions. This last form of discrimination was supposed to have ended with the passage of the Mental Health Parity and Addiction Equity Act of 2008.  But the federal “rule” implementing t...

In the next twenty years, more than 3 million people over the age of 65 will likely experience serious mental illness.  Are we prepared to treat them? The answer is no, according to a new Institute of Medicine report.  The report was released in July , and it contains some striking evidence of the challenges we face as we confront the growing behavioral health care needs of our aging population.  We don’t have nearly enough trained providers. And when states cut their existing state Medicaid programs or refuse to adopt the ACA Medicaid expansion, these decisions have devastating consequences for the providers we do have – and, of course, their patients.  Today, between 5.6 and 8 million adults over the age of 65 are believed to have mental illnesses.  These numbers could nearly double over the next twenty years.  There’s a reason that the range is so big.  We’ve given so little attention to this challenge in the past that we don...

In the next twenty years, more than 3 million people over the age of 65 will likely experience serious mental illness.  Are we prepared to treat them? The answer is no, according to a new Institute of Medicine report.  The report was released in July , and it contains some striking evidence of the challenges we face as we confront the growing behavioral health care needs of our aging population.  We don’t have nearly enough trained providers. And when states cut their existing state Medicaid programs or refuse to adopt the ACA Medicaid expansion, these decisions have devastating consequences for the providers we do have – and, of course, their patients.  Today, between 5.6 and 8 million adults over the age of 65 are believed to have mental illnesses.  These numbers could nearly double over the next twenty years.  There’s a reason that the range is so big.  We’ve given so little attention to this challenge in the past that we don...

Imagine what a nightmare healthcare scenario might look like. You are diagnosed with a debilitating chronic disease while young.  At first, you can’t even work because of it, and you are dependent on a family member’s insurance to help pay your medical expenses.  Eventually, your disease goes into remission, and you find a job with health insurance.  You go off your family member’s plan.  But your employer goes bankrupt, and you’re left with no job and no insurance.  Then you get another chronic disease. You try the individual health insurance market, but the only insurance available to you comes from a high risk pool in which everyone else also has at least one chronic disease.  The price is outrageous, but you pay the bill as long as you can. Eventually, you can’t afford it, and you become uninsured for a few months.  You apply to your state’s Medicaid program for help.  You are denied because your state has already s...

Imagine what a nightmare healthcare scenario might look like. You are diagnosed with a debilitating chronic disease while young.  At first, you can’t even work because of it, and you are dependent on a family member’s insurance to help pay your medical expenses.  Eventually, your disease goes into remission, and you find a job with health insurance.  You go off your family member’s plan.  But your employer goes bankrupt, and you’re left with no job and no insurance.  Then you get another chronic disease. You try the individual health insurance market, but the only insurance available to you comes from a high risk pool in which everyone else also has at least one chronic disease.  The price is outrageous, but you pay the bill as long as you can. Eventually, you can’t afford it, and you become uninsured for a few months.  You apply to your state’s Medicaid program for help.  You are denied because your state has already s...

Are the 1994 AFC Champion San Diego Chargers a cursed team, or just a reflection of a growing trend toward chronic disease and early death in America? Led by running back Natrone Means and linebacker Junior Seau, the 1994 Chargers won the AFC West with a record of 11 wins and 5 losses, and beat the Miami Dolphins and Pittsburgh Steelers to reach the Super Bowl.  The 53 players on the active roster averaged 26 years of age. According to 1995 life expectancy tables , a 26 year old male could expect to live to the age 75. But when 42 year old Lew Bush – a linebacker on that Super Bowl team – died on December 9, 2011, he was the 7 th member of the team to die more than 30 years prematurely. Source:  ESPN Official 2011 Roster Information There is talk that these 1994 Chargers are cursed.  The first player to die, linebacker David Griggs, was 28 when his car slid off an expressway ramp in Ft. Lauderdale and crashed into a pole in June, 1995.   ...