Our Health Policy Matters

A Kaiser Health News sampling of the latest headlines about Obamacare reflects our continuing anxiety over the law just months before it is fully implemented. The most interesting to me was this one.  According to a new CNN poll, only 43 percent of the public favors Obamacare .  But of those who oppose it, only 35 percent do so because it is too liberal.  Sixteen percent say that it is not liberal enough! No matter how you feel about Obamacare, one of the most significant changes it facilitates will be the integration of health and behavioral health care – meaning that care for both physical and mental illnesses will soon be delivered together. This only makes sense.  People with cancer, for example, often develop depression or anxiety that complicates their care.  And people with mental illness often develop physical conditions – sometimes as a side effect from the medications they take – that can cut twenty-five years from their lives. Integrating health and behav

Fifty-four percent of Iraq and Afghanistan war veterans who have sought treatment in the VA system since 2001 have been treated for mental disorders. This is the second most-frequent diagnosis among these veterans.  It is an indicator of the profound effect recent war service is having on the mental health and well-being of our veterans. The data come from a March, 2013, report entitled Analysis of VA Healthcare Utilization Among Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF) and Operation New Dawn (OND) Veterans .   Here are some numbers that reflect how extensive the use of VA services has been during the last decade. As of the end of 2012, 2.5 million troops had served since the beginning of the Iraq and Afghanistan wars.  Just over 1.6 million had become eligible for VA healthcare.  Of that group, almost 900,000 had used VA healthcare services by the end of 2012. These 900,000 veterans most often sought treatment in VA centers in the south o

Health policy has often been in the news headlines this month.   To cite three examples, CDC released a new report about causes of death.  CMS published data showing wide variations in hospital charges for common procedures.  And, in the context of a newly-reported Oregon Medicaid expansion study, states have been making decisions about Medicaid expansion. Let's look at the mental health policy stories behind the headlines. Suicide on the Rise The CDC reported this month that as of 2009, there were more deaths from suicide in the United States than there were from motor vehicle accidents. Suicide rates increased by over 28 percent among men and women aged 35-64 from 1999 to 2010.  While men were three times more likely to commit suicide, the rate increased more for women (32 percent) than for men (27 percent). Suicide rates are highest in the west, but they are increasing in 39 states. Men are most likely to commit suicide with firearms, women wit

On a recent bright and sunny Monday afternoon, I took the sixteen-minute BART ride from Oakland – where I was doing some work – into downtown San Francisco.  I went to several places where people who are homeless tend to congregate.  What I saw made me wonder.  Do we realize that if we do nothing, up to half of the people who are chronically homeless are likely to die in the next ten years? I exited the BART train at the Civic Center/UN Plaza station.  When I arrived above ground, I saw more than a hundred homeless people in the vicinity of the station.  They were sitting or resting on the plaza, pretty much keeping to themselves. Scores of tourists, business people, and shoppers hurried about their business.  There was no interaction between the two groups.  It reminded me of the way old-time cartoons had the action layered on top of a static backdrop – a crowd bustling with activity set against the backdrop of stationary homeless people. I witnessed something simila

You would expect Medicare to spend about the same for a man with heart, lung, or kidney disease as it does for a woman.  And if you looked at the actual numbers, you would not be surprised.  On average, it does.  So why does Medicare spend so much more on men when you couple these disease with depression? That is a question that deserves an answer. The startling numbers, which show just how wide the disparity is, are in the chart accompanying this column.  They are very similar to some others that I shared in my column last week . They all come from the 2010 CMS Medicare public use data files , the most recent ones available.  The CMS file includes information on all 48 million Medicare recipients.  Last week, I wrote that men with depression in the 65-69 year old age group enjoyed an 11% Medicare spending advantage over women in the same age group.  (The men were those on Medicare only, not both Medicare and Medicaid.)  I also wrote that the disparity persisted bo