Our Health Policy Matters

Are women with depression more stoic than men, or are men just getting preferential treatment? According to the National Institute on Mental Health, women are 70 percent more likely than men to experience depression during their lifetime.  Depression hits women harder than men in nearly every age group. But if some fascinating data from the Centers for Medicare and Medicaid Services are any indication, we also spend a lot less on treating them than we do men.    Are women more stoic, or are we just neglecting their mental health needs? The data that shed some disturbing light on this subject come from the CMS Chronic Conditions Public Use Files .  These files include data for every 2010 Medicare beneficiary – approximately 48 million people. In 2010, according to the CMS data, 9296 men between the ages of 65 and 69 who were newly-enrolled in Medicare Part B had depression and no other chronic condition.  And so did many more newly-enrolled women in the same age

The Boston marathon bombing is a horrifying, ongoing tragedy this week. Three people died when the bombs exploded, and scores of others were maimed or otherwise injured. But there was one bright spot for the wounded and their families.  According to the American Trauma Society , “it now appears that every one of the wounded alive when rescuers reached them will survive.” The reason for this is that they were all fortunate to have almost immediate access to some of the finest, most extensive trauma services in the nation.  According to an interview with the chief of medicine of one of the area hospitals, there were four Level I trauma centers within a mile or so of the marathon finish line – Boston Medical Center, Brigham and Women’s, Mass General, and Tufts Medical Center.  They were already treating victims within thirty minutes of the blast. There are five levels of trauma centers in the United States and there are slight differences in how these are designated

A relatively modest Medicare proposal put forward by President Obama in his 2014 budget may help to rekindle the debate about how we pay for long term care services in the coming years.  But where will we draw the line about our own responsibilities and those of the government? This is because the President’s proposal is simple and easy to understand, and it will affect nearly all of us sooner or later. He has asked for a $100 Medicare co-pay, starting in 2017, for five or more home care visits that are not preceded by a stay in an institution, according to a story this week in Kaiser Health News .  KHN added that “home care is one of the few areas in Medicare that does not have cost sharing.” So should it? While there is cost-sharing throughout most of the Medicare program – hospital deductibles, nursing home benefits, drug payments, and physician co-pays, for example – home health care has always been something of a special case. A century ago, home care was p

Should all school children be screened for mental health? The evidence suggests that if we do not screen them, then we will be continuing a persistent and historical pattern of neglecting the mental health needs of our children.  But why let evidence get in the way of fear? Over the past several months, legislators in a number of states have considering mandating – or at least offering – mental health screening for all children, either in the schools or in pediatricians’ offices.  But when the Connecticut Legislature had a public hearing on a mental health screening bill recently, opponents came out in force .  One parent called mandatory screening an “unnecessary invasion.”  The Connecticut Civil Liberties Union argued that mental health screenings should be optional.  A treatment provider asserted that the problem wasn’t with a lack of assessment, but the lack of treatment options. And in recent days, a Palm Beach Post writer in Florida joined the chorus wh

I never ate yogurt, avocadoes, or tofu until I was in my twenties.  When I first went to the dentist as an eight year old, I had twelve cavities.  And the Connecticut River smelled like raw sewage when I was a kid – because it was filled with raw sewage. This is Public Health Week; the theme is “return on investment.”  The good news – spending on public health  (as a percentage of all health spending) has doubled in the last fifty years.  The bad news, this is still less than 3 percent of our national health budget. Despite that meager investment, the return has been big.  Here are my top ten public health initiatives ever – or at least in my lifetime. 10. From Twinkies to Tofu.  Nutrition education has come a long way in the last fifty years. Twinkies, snowballs, chocolate cupcakes, and sugary cereals “fortified” with vitamins were staples of my youth.  We knew so little about nutrition in those days.  I never ate yogurt.  I never even heard of tofu.  And an avocado ne