Our Health Policy Matters

Claiming that D.C. crime is out of control, President Trump has brought in the National Guard. Never mind that crime rates are down in the District. The optics are compelling. Trump blames homeless people. As Fox News reported , he is giving them two choices – jail or homeless shelters to treat mental health and substance use disorders. If these choices seem reasonable, they aren’t. Sending someone to jail who hasn’t committed a crime is a bad, even unconstitutional, idea. Like our new South Florida gulag, this notion offends many of us. And many, if not most, of the people who are chronically homeless have seriously undertreated mental health conditions. Jails and shelters don’t have the money or resources to provide that treatment. What this boils down to is comfort. Seeing homeless people congregating makes some people uncomfortable. President Trump is suggesting that the freedom to congregate peacefully is a freedom reserved only to some of us – not everyone. There’s bigotry t...

When a politician says he has “concepts of a plan” instead of a plan, there is no plan. And yet, that’s where we are with Donald Trump, nine years after he first launched a political campaign promising to replace Obamacare with something cheaper and better, nearly four years after he had four years to try to do just that. And fail. Doubling down during Tuesday’s debate, he claimed he had “concepts of a plan” to replace Obamacare. Really? He’s got nothing. In fact, he sounds just like Nixon sounded in 1968, when he claimed he had a “secret” plan to get us out of Vietnam. That turned out to be no plan at all (remember “Vietnamization?”) and cost us seven more years there and tens of thousands of lives. The Affordable Care Act, about which I wrote plenty in this blog a decade or more ago, wasn’t perfect. But it was a whole lot better than what we had before it – and anything (save a public option) that has been proposed since. Back then, insurers could deny coverage because of pre-exi...

A political leader from Minnesota arrived on the national scene with a message of joy, hope, and equality. He grew up in the rural Midwest and became a teacher after he moved to Minnesota. Known as the “happy warrior,” he made civil rights, the health and nutrition of school children, and support for the underprivileged centerpieces of his policy work. When our country and the world was staring at the rise of fascism, he was a patriot who volunteered three times for military service. At the beginning of his campaign for national office, he said: “Here we are, just as we ought to be, here we are, the people, here we are the spirit of dedication, here we are the way politics ought to be in America, the politics of happiness, politics of purpose, politics of joy; and that's the way it's going to be, all the way, too, from here on out. We seek an America able to preserve and nurture all the basic rights of free expression, yet able to reach across the divisions that too often sepa...

Wow. Could the mainstream media do anything more to raise our anxiety levels about the 2024 election? And diminish or negate all the recent accomplishments in our country? Over the past three-and-a-half years, our nation’s economy has been the strongest in the world. Unemployment is at record lows, and the stock market is at record highs. NATO – which last came together to defend the United States in the aftermath of 9/11 – is stronger than ever. Border crossings are down. Massive infrastructure improvements are underway in every state. Prescription drug costs are lower. We finally got out of Afghanistan – evacuating more than 100,000 U.S. citizens and supporters – with just a handful of deaths. Inflation – which rose precipitously in the aftermath of the pandemic – has come back down, and prices in many areas have even begun to decline. And yet, all the media commentators can talk about these days – and they are not “reporters” when they are clearly offering opinions to frame the...

 After 7+ years as President and CEO of Mental Health America, I retired on June 30, 2021. During that time, MHA accomplished a lot. It changed the ways we think about mental health and mental illness. We introduced our MHA screening program . It became the most successful early identification program ever, especially for children. Today, 10 million people have completed a free, anonymous screening with MHA and received targeted follow-up resources for their mental health. This number will grow by millions each year. We created our B4Stage4 messaging frame. Arguing that mental health conditions were the only chronic diseases that as a matter of public policy we waited until Stage 4 to treat, and then often inappropriately only through incarceration, we said we needed to act before Stage 4. Local, national, and international partners helped us advance this frame and change the way we approach and treat serious mental health conditions – because all mental health condition...

 After 7+ years as President and CEO of Mental Health America, I retired on June 30, 2021. During that time, MHA accomplished a lot. It changed the ways we think about mental health and mental illness. We introduced our MHA screening program . It became the most successful early identification program ever, especially for children. Today, 10 million people have completed a free, anonymous screening with MHA and received targeted follow-up resources for their mental health. This number will grow by millions each year. We created our B4Stage4 messaging frame. Arguing that mental health conditions were the only chronic diseases that as a matter of public policy we waited until Stage 4 to treat, and then often inappropriately only through incarceration, we said we needed to act before Stage 4. Local, national, and international partners helped us advance this frame and change the way we approach and treat serious mental health conditions – because all mental health condition...

From time to time, I take a look at this blog - a collection of nearly 200 essays now aging in place - because I want to remind myself about how I thought about health policy broadly and the health and mental health policy issues that were hotly debated around the time the Affordable Care Act was being crafted and implemented. I think about how my own narrative and the narratives of my family members were affected by policy decisions made by others. There are plenty of commentators and scholars who know a whole lot more about this stuff than I ever did. So, most of my blogs have no historical significance at all - although one may someday.  It includes my first written expression of the "Before Stage 4" concept that became a hashtag (#B4Stage4) and the messaging frame for the work of Mental Health America beginning in 2014, a frame that was widely embraced by the mental health advocacy world. I posted only a handful of new blogs here while I was the position as President and ...

From time to time, I take a look at this blog - a collection of nearly 200 essays now aging in place - because I want to remind myself about how I thought about health policy broadly and the health and mental health policy issues that were hotly debated around the time the Affordable Care Act was being crafted and implemented. I think about how my own narrative and the narratives of my family members were affected by policy decisions made by others. There are plenty of commentators and scholars who know a whole lot more about this stuff than I ever did. So, most of my blogs have no historical significance at all - although one may someday.  It includes my first written expression of the "Before Stage 4" concept that became a hashtag (#B4Stage4) and the messaging frame for the work of Mental Health America beginning in 2014, a frame that was widely embraced by the mental health advocacy world. I posted only a handful of new blogs here while I was the position as President and ...

This is the view outside my hotel deck this afternoon in Half Moon Bay, CA. It's really beautiful. But it's not the view I was expecting. I was expecting a grittier view as I visited for a few hours with my son Tim somewhere in downtown San Francisco's Mission Street area. I travel a lot for my job as President and CEO of Mental Health America. When those trips bring me to northern California, I always try to build in some extra time so I can visit with Tim. Today was no exception. I got up at 3:15 am to catch a 5:30 am flight out of Washington that got me to San Francisco by 11. I have something for work at 6, so I expected to have several hours with Tim. But visiting with Tim takes planning in advance. Tim has schizophrenia. He has lived in San Francisco for the last decade. He has often been homeless, or in jail, or in treatment. Even when he has housing, he doesn't stay in one place very long, and he doesn't have a phone. So I make my plans through t...

This is the view outside my hotel deck this afternoon in Half Moon Bay, CA. It's really beautiful. But it's not the view I was expecting. I was expecting a grittier view as I visited for a few hours with my son Tim somewhere in downtown San Francisco's Mission Street area. I travel a lot for my job as President and CEO of Mental Health America. When those trips bring me to northern California, I always try to build in some extra time so I can visit with Tim. Today was no exception. I got up at 3:15 am to catch a 5:30 am flight out of Washington that got me to San Francisco by 11. I have something for work at 6, so I expected to have several hours with Tim. But visiting with Tim takes planning in advance. Tim has schizophrenia. He has lived in San Francisco for the last decade. He has often been homeless, or in jail, or in treatment. Even when he has housing, he doesn't stay in one place very long, and he doesn't have a phone. So I make my plans through t...

I have at least two members of my immediate family who would be affected directly by the so-called Better Care Reconciliation Act (BCRA). It could cost them – and others like them – their money and their lives. The Senate bill released this week has two important improvements over the House American Health Care Act. First, like Obamacare but unlike the House version, it requires insurers to continue to offer coverage in the regular marketplace to people with pre-existing conditions. Second, it corrects a major flaw in the Affordable Care Act – as interpreted by the Supreme Court – by extending health insurance subsidies to everyone below poverty who is ineligible for Medicaid. Today, the poorest pay the same as the richest for health insurance, because the subsidies are limited to those between 100 and 400 percent of poverty. That’s the good news. But it all quickly unravels after this. Here are ten reasons why. First, while pre-existing conditions are cove...

I have at least two members of my immediate family who would be affected directly by the so-called Better Care Reconciliation Act (BCRA). It could cost them – and others like them – their money and their lives. The Senate bill released this week has two important improvements over the House American Health Care Act. First, like Obamacare but unlike the House version, it requires insurers to continue to offer coverage in the regular marketplace to people with pre-existing conditions. Second, it corrects a major flaw in the Affordable Care Act – as interpreted by the Supreme Court – by extending health insurance subsidies to everyone below poverty who is ineligible for Medicaid. Today, the poorest pay the same as the richest for health insurance, because the subsidies are limited to those between 100 and 400 percent of poverty. That’s the good news. But it all quickly unravels after this. Here are ten reasons why. First, while pre-existing conditions are cove...

Back in 1980, Republicans nominated a television star with a limited understanding of federal government, zero foreign policy experience, and a platform of platitudes about reigning in a big government run amok. Image copyright unclear (on multiple websites); His main populist appeal was to middle class moderates and conservatives who were struggling both to keep their heads above water in a frightening economy and to understand the enormous changes that had democratized (and integrated) our society during the late 1960s and early 1970s.   To reassure us he led with this – a new theory of “trickle down” economics.  It held that if the government made the rich richer through historic tax cuts for the wealthy, they would re-invest those dollars in jobs for everyone else, and we would all become wealthier for generations to come. That didn't happen, but Ronald Reagan promised a new approach to governing, and a new way of life for the American people. Today, ...

Back in 1980, Republicans nominated a television star with a limited understanding of federal government, zero foreign policy experience, and a platform of platitudes about reigning in a big government run amok. Image copyright unclear (on multiple websites); His main populist appeal was to middle class moderates and conservatives who were struggling both to keep their heads above water in a frightening economy and to understand the enormous changes that had democratized (and integrated) our society during the late 1960s and early 1970s.   To reassure us he led with this – a new theory of “trickle down” economics.  It held that if the government made the rich richer through historic tax cuts for the wealthy, they would re-invest those dollars in jobs for everyone else, and we would all become wealthier for generations to come. That didn't happen, but Ronald Reagan promised a new approach to governing, and a new way of life for the American people. Today, ...

This might just be the year for mental health reform in Congress. A few months ago, practically no one would have said that. But on Wednesday of this week, the House Energy and Commerce Committee voted 53-0 to send H.R. 2646 - a significant mental health reform bill - on its way, most likely to the House floor for a July vote.  And in recent weeks, a Senate bill has gathered steam, too, and that chamber could also now take up this legislation this summer. So what happened to make mental health reform a real possibility? First, members of Congress sincerely wanted to do something.  The House proposal, sponsored by Rep. Tim Murphy of Pennsylvania and Rep. Eddie Bernice Johnson of Texas, has 199 co-sponsors as of today.  Our mental health system has been in disarray since - well, since as long as anyone can remember. Second, members have finally decoupled mental health reform from gun control.  Mental illnesses and violence have never been stron...

This might just be the year for mental health reform in Congress. A few months ago, practically no one would have said that. But on Wednesday of this week, the House Energy and Commerce Committee voted 53-0 to send H.R. 2646 - a significant mental health reform bill - on its way, most likely to the House floor for a July vote.  And in recent weeks, a Senate bill has gathered steam, too, and that chamber could also now take up this legislation this summer. So what happened to make mental health reform a real possibility? First, members of Congress sincerely wanted to do something.  The House proposal, sponsored by Rep. Tim Murphy of Pennsylvania and Rep. Eddie Bernice Johnson of Texas, has 199 co-sponsors as of today.  Our mental health system has been in disarray since - well, since as long as anyone can remember. Second, members have finally decoupled mental health reform from gun control.  Mental illnesses and violence have never been stron...

One of the most controversial elements of bipartisan mental health reform bills in Congress is a surprising one. It’s an effort to amend a 45 year-old regulation that outlived its useful life twenty-five years ago when the Americans with Disabilities Act (ADA) was signed into law.  It is referred to in Washington as “42 CFR Part 2.”  You might know it as the rule that forces you to sign at least two authorizations, instead of one, just to get your own health records sent from one place to another. Today, if you sign an authorization stating “please share all of my health records and medical history with another provider,” you might think that second provider is going to get everything.  But 42 CFR says substance use disorder isn’t covered by that – for that, you need a second one. Keep in mind that in 1970, when 42 CFR was being considered, you could discriminate against someone with a substance use disorder.  You could even fire them from their job....

One of the most controversial elements of bipartisan mental health reform bills in Congress is a surprising one. It’s an effort to amend a 45 year-old regulation that outlived its useful life twenty-five years ago when the Americans with Disabilities Act (ADA) was signed into law.  It is referred to in Washington as “42 CFR Part 2.”  You might know it as the rule that forces you to sign at least two authorizations, instead of one, just to get your own health records sent from one place to another. Today, if you sign an authorization stating “please share all of my health records and medical history with another provider,” you might think that second provider is going to get everything.  But 42 CFR says substance use disorder isn’t covered by that – for that, you need a second one. Keep in mind that in 1970, when 42 CFR was being considered, you could discriminate against someone with a substance use disorder.  You could even fire them from their job....