Our Health Policy Matters

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 that those of us who love

As President Obama begins his second term, he does so with an expansive vision for America. “America's possibilities are limitless,” he said in his inaugural address , “for we possess all the qualities that this world without boundaries demands:  youth and drive; diversity and openness; an endless capacity for risk and a gift for reinvention.   My fellow Americans, we are made for this moment, and we will seize it - so long as we seize it together.” There are many potential roadblocks toward achieving that bold vision.  One is the myth that entitlement reform must be a part of it. The reason that entitlement reform is at the top of some political agendas has nothing to do with the growth in entitlement programs today. Some people with these agendas don’t like any government-run programs and won’t listen to the facts about them.  Those who do look at the facts see the rapid growth in Medicare and Medicaid spending through 2009.  Accordin g to the Center for M

The shock of sudden violence is so severe it takes your breath away. When it happens in a time and place where it is unexpected, it does more than just remind us that no one is immune to it.  It also reminds us how pervasive it is, how much it affects us all, and how important it is that we do something about it.  In the summer of 1989, I imagined that sudden, random violence was something far removed from my hometown.  But I was about to learn differently. An  article in The Atlantic has just detailed the event, dredging up some quarter century old memories of a day that changed my community’s life. I was running for Mayor of Middletown, Connecticut, at the time, and had reserved a booth at the city’s annual Sidewalk Sale in late July.  I was handing out yardsticks, asking for a vote “for government that measures up to your expectations.” Suddenly, there was a commotion about a block north of where I was standing.  I noticed people running in two directions, b

More than 11 million American adults with mental illnesses – 4.5 million of them with serious mental illnesses – are not receiving care today.  So it may not be unreasonable to conclude that the history of public mental health services over the last century can be summed up in a single brief sentence.  We replaced the chains of institutions with a chain of neglect. I have argued that this chain of neglect typically begins when children with mental health needs are still young, and continues throughout their lives.  And that it often has tragic consequences. Why is it so important that we talk about breaking it now, the month after Sandy Hook and almost exactly two years since the mass shooting in Tucson? It is because tragedies like those in Sandy Hook and Tucson remind us that it is wrong to balance budgets on the backs of children and young adults with mental illness and expect that there will be no consequences. This is a sensitive, and even complicated, issu

When the House of Representatives voted by a comfortable margin a few hours ago to approve the American Taxpayer Relief Act (ATRA) and step away from the "fiscal cliff" for another two months, it agreed to two Senate provisions affecting elders and others with long term care needs. The first was the "doc fix," which prevented a nearly 30% cut in Medicare payments to physicians.  This was important.  If it hadn't happened, doctors would have fled the Medicare program. The second was tucked away into Section 643 of the Act .  It establishes a new 15-member Commission on Long Term Care, replacing the CLASS Act provisions of the Affordable Care Act that are now finally, formally repealed by ATRA. The Commission could turn out to be a very big deal if it does it job well, because it could lead the way in changing our system of providing and financing long-term care in America. The Commission is charged with writing a bill over the next six months "to e

Will health and mental health spending be part of the next Grand Bargain, Mini-bargain, or No Bargain at all?2013 could be the ultimate transition year for health policy – a wait-and-see time before the big changes ACA brings in 2014.  Or it could be much more. Forget this week's latest budget drama.  Three often little-noticed numbers over the next few months will tell us much more about how this health policy year will eventually unfold. The first is the Medicare “cost rate” projection for the next 75 years.  It will arrive in April in the Annual Report of the Medicare Trust Fund trustees.  This projection will tell us how much we need to worry about the present and future cost of our favorite entitlement program. The second – especially in the aftermath of Sandy Hook – is the number of cuts or additions states make to their mental health budgets.  We’ll know this by the late spring or early summer.  It will tell us just how much our legislators have been moved by