Our Health Policy Matters

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...

The next time Florida’s Governor tells you that the only way to create private sector jobs is to cut public sector health spending, don’t believe him.   According to news reports , the Governor’s Office is already warning state health agencies to expect more budget cuts in 2012.   He wants the dollars to implement his 7-7-7 plan to create 700,000 jobs in 7 years. source: US DOL data, 2011 How’s the plan working out for Florida so far? Dismally, by two different measures.   The first is the 2011 state unemployment claims data.   The second is the story of why Florida just lost another 7,500 jobs in health research. The 2011 unemployment data show that Florida’s Governor has been more effective at killing jobs than creating them.   The week before Governor Scott took office, 14,139 Floridians lost their jobs and filed new unemployment claims.   In 36 of the 37 weeks since then, the number has been higher than that.   Another 15,713 Florid...

The next time Florida’s Governor tells you that the only way to create private sector jobs is to cut public sector health spending, don’t believe him.   According to news reports , the Governor’s Office is already warning state health agencies to expect more budget cuts in 2012.   He wants the dollars to implement his 7-7-7 plan to create 700,000 jobs in 7 years. source: US DOL data, 2011 How’s the plan working out for Florida so far? Dismally, by two different measures.   The first is the 2011 state unemployment claims data.   The second is the story of why Florida just lost another 7,500 jobs in health research. The 2011 unemployment data show that Florida’s Governor has been more effective at killing jobs than creating them.   The week before Governor Scott took office, 14,139 Floridians lost their jobs and filed new unemployment claims.   In 36 of the 37 weeks since then, the number has been higher than that.   Another 15,713 Florid...

“States’ rights” is as popular a rallying cry as ever as we enter the early stages of the 2012 election campaign.   To advocates of states’ rights, they are code words for state innovation and initiative, unhampered by the demands of a federal government.     In their minds, we are a United States of America.   To skeptics, we are a United States of America, and states’ rights are the code words of political leaders who want to run their states as fiefdoms and answer to no higher authority.   The new 2010 uninsured numbers released by the U.S. Census Bureau last week make a compelling case against the states’ rights position. In the South, where the drum roll for states’ rights beats most loudly, 19% of all people were uninsured 2010 for the entire year .   This was more than in the West, where 18% were uninsured, the Midwest, where 13% were uninsured, and the Northeast, where only 12% were uninsured. Place clearly matters where health insurance i...

“States’ rights” is as popular a rallying cry as ever as we enter the early stages of the 2012 election campaign.   To advocates of states’ rights, they are code words for state innovation and initiative, unhampered by the demands of a federal government.     In their minds, we are a United States of America.   To skeptics, we are a United States of America, and states’ rights are the code words of political leaders who want to run their states as fiefdoms and answer to no higher authority.   The new 2010 uninsured numbers released by the U.S. Census Bureau last week make a compelling case against the states’ rights position. In the South, where the drum roll for states’ rights beats most loudly, 19% of all people were uninsured 2010 for the entire year .   This was more than in the West, where 18% were uninsured, the Midwest, where 13% were uninsured, and the Northeast, where only 12% were uninsured. Place clearly matters where health insurance i...

Florida recently elected to turn down – again – over $2 million in Federal money to pay the administrative costs of expanding its Medicaid long term care program’s home and community based services. In March 2011, Florida qualified for over $35 million to join most of the rest of the nation in participating in the Money Follows the Person program.   The program was created during the Bush Administration as a way of helping people move back out of nursing homes into the community.   It became so popular in the 29 states (and District of Columbia) participating in it that it was expanded as part of health reform.   Thirteen additional states, including Florida, were invited to participate.   Former Governor Charlie Crist authorized Florida’s Agency for Health Care Administration (AHCA) to file Florida’s application. Rejecting the program means that people who want to leave Florida nursing homes won’t be given control of the resources they need to do so.   ...

Florida recently elected to turn down – again – over $2 million in Federal money to pay the administrative costs of expanding its Medicaid long term care program’s home and community based services. In March 2011, Florida qualified for over $35 million to join most of the rest of the nation in participating in the Money Follows the Person program.   The program was created during the Bush Administration as a way of helping people move back out of nursing homes into the community.   It became so popular in the 29 states (and District of Columbia) participating in it that it was expanded as part of health reform.   Thirteen additional states, including Florida, were invited to participate.   Former Governor Charlie Crist authorized Florida’s Agency for Health Care Administration (AHCA) to file Florida’s application. Rejecting the program means that people who want to leave Florida nursing homes won’t be given control of the resources they need to do so.   ...

When you’re headed in the wrong direction, running to the front of the crowd and yelling charge may not be the best strategy.   On Monday, Governor Rick Scott of Florida did this when he proposed his new state budget.   Like every state, Florida has struggled over the past few years as state revenues have declined.   The Center on Budget and Policy Priorities has documented just how tough that job has become – at least 21 states have already proposed budgets this year with inflation-adjusted spending below 2008 levels.   In presenting his bare-bones $66 billion budget, Governor Scott promised to bring new business principles to state government.   The problem is that he forgot an old one.   If you don’t increase the supply of a product when demand goes up, you’re going to pay an increased price.   He proposed $4 billion in cuts (over two years) from current Medicaid levels.   Medicaid is almost 30% of the state budget, and cutting it w...

When you’re headed in the wrong direction, running to the front of the crowd and yelling charge may not be the best strategy.   On Monday, Governor Rick Scott of Florida did this when he proposed his new state budget.   Like every state, Florida has struggled over the past few years as state revenues have declined.   The Center on Budget and Policy Priorities has documented just how tough that job has become – at least 21 states have already proposed budgets this year with inflation-adjusted spending below 2008 levels.   In presenting his bare-bones $66 billion budget, Governor Scott promised to bring new business principles to state government.   The problem is that he forgot an old one.   If you don’t increase the supply of a product when demand goes up, you’re going to pay an increased price.   He proposed $4 billion in cuts (over two years) from current Medicaid levels.   Medicaid is almost 30% of the state budget, and cutting it w...