Our Health Policy Matters

I started writing Our Health Policy Matters three and a half years ago, right after the 2010 mid-term elections. Since then, I have written about two policy areas about which I am passionate – public health and mental health.  As I explain below, I am about to change my professional focus.  And while I will be speaking about one more than the other in the future, for me these two areas are related. Let me explain why. Mental health and public health are first and foremost about wellness.  They are about identifying risk factors for disease and eliminating or mitigating them. Many of the same environmental risk factors contribute to poor health, especially poor mental health.  These include poverty, violence, abuse, and neglect.  When we address or mitigate these risk factors, we improve our nation’s health and mental health together. We often place the burden of responsibility for maintaining one’s health squarely on the shoulders of individ...

I started writing Our Health Policy Matters three and a half years ago, right after the 2010 mid-term elections. Since then, I have written about two policy areas about which I am passionate – public health and mental health.  As I explain below, I am about to change my professional focus.  And while I will be speaking about one more than the other in the future, for me these two areas are related. Let me explain why. Mental health and public health are first and foremost about wellness.  They are about identifying risk factors for disease and eliminating or mitigating them. Many of the same environmental risk factors contribute to poor health, especially poor mental health.  These include poverty, violence, abuse, and neglect.  When we address or mitigate these risk factors, we improve our nation’s health and mental health together. We often place the burden of responsibility for maintaining one’s health squarely on the shoulders of individ...

It was good news when Congress recently agreed on a budget for the first time in forever.  It was the product of compromise, and everyone expected to give at least a little.  But when the details came out last week, it turned out that some had to give more than others.  And the ones who probably gave up the most were the people who have saved the greatest number of lives over the past century – the public health and prevention community. Last week, the House introduced the FY2014 Omnibus Labor, Health, Human Services, and Education bill – one of twelve appropriations bills that will implement the FY2014 budget.  As the bill summary noted, the legislation includes $156.8 billion in discretionary federal spending for all these important areas combined. That is a big number, and comes to around $500 per person.  By comparison, Defense – which is often considered to be the other “big” area of discretionary spending – will get around $1500 per person. ...

It was good news when Congress recently agreed on a budget for the first time in forever.  It was the product of compromise, and everyone expected to give at least a little.  But when the details came out last week, it turned out that some had to give more than others.  And the ones who probably gave up the most were the people who have saved the greatest number of lives over the past century – the public health and prevention community. Last week, the House introduced the FY2014 Omnibus Labor, Health, Human Services, and Education bill – one of twelve appropriations bills that will implement the FY2014 budget.  As the bill summary noted, the legislation includes $156.8 billion in discretionary federal spending for all these important areas combined. That is a big number, and comes to around $500 per person.  By comparison, Defense – which is often considered to be the other “big” area of discretionary spending – will get around $1500 per person. ...

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 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....

Health and mental health policy stories dominated 2012.  From how the Affordable Care Act framed the health policy debate at the start of the year to how the Sandy Hook tragedy framed the mental health and public health debate at year’s end, 2012 will go down in history as the most significant year in health policy since the 1960s. Here are summaries of a few of the biggest news stories. The Supreme Court Decision on the Affordable Care Act.   Nothing quite compares to the drama of the day in June when the Supreme Court ruled the Affordable Care Act to be constitutional .  Few people guessed right in advance that the decision would come down to finding the “individual mandate” to be constitutional because it is a tax, but mandatory Medicaid expansion unconstitutional because it tied future federal funding for the existing state Medicaid programs to the Medicaid expansion. People on both sides of the debate came away wanting more, and states reluctant to acce...

Health and mental health policy stories dominated 2012.  From how the Affordable Care Act framed the health policy debate at the start of the year to how the Sandy Hook tragedy framed the mental health and public health debate at year’s end, 2012 will go down in history as the most significant year in health policy since the 1960s. Here are summaries of a few of the biggest news stories. The Supreme Court Decision on the Affordable Care Act.   Nothing quite compares to the drama of the day in June when the Supreme Court ruled the Affordable Care Act to be constitutional .  Few people guessed right in advance that the decision would come down to finding the “individual mandate” to be constitutional because it is a tax, but mandatory Medicaid expansion unconstitutional because it tied future federal funding for the existing state Medicaid programs to the Medicaid expansion. People on both sides of the debate came away wanting more, and states reluctant to acce...

There’s a new disease this year along with the winter flu.  It is called Secession Fever.  Secession Fever has reached epidemic stage across the south.  As of Monday, there were more than 25,000 cases in each of eight southern states – North Carolina, South Carolina, Georgia, Florida, Alabama, Tennessee, Louisiana, and Texas.  A ninth, Arkansas, had over 23,500.  Collectively, these states had almost 402,000 cases, and the number was still growing. Secession Fever is a self-reportable disease.  People who have it signed a petition on the White House website .  Secession Fever is characterized by the irrational belief that the federal government does more harm than good, and that states would be better off if they seceded from the Union. So what if these nine states did secede and form a new Southern Confederacy?  Would their citizens be better off?  Some data from the Kaiser Family Foundation and the Central Intelligence Agen...

There’s a new disease this year along with the winter flu.  It is called Secession Fever.  Secession Fever has reached epidemic stage across the south.  As of Monday, there were more than 25,000 cases in each of eight southern states – North Carolina, South Carolina, Georgia, Florida, Alabama, Tennessee, Louisiana, and Texas.  A ninth, Arkansas, had over 23,500.  Collectively, these states had almost 402,000 cases, and the number was still growing. Secession Fever is a self-reportable disease.  People who have it signed a petition on the White House website .  Secession Fever is characterized by the irrational belief that the federal government does more harm than good, and that states would be better off if they seceded from the Union. So what if these nine states did secede and form a new Southern Confederacy?  Would their citizens be better off?  Some data from the Kaiser Family Foundation and the Central Intelligence Agen...

It took Super Storm Sandy to remind us how much we need our government. And how rarely we see government leaders truly cooperate. Cooperation has been a dirty word in politics for close to two decades.  But in responding to the crisis caused by Sandy, President Obama and Governor Christie showed us that political adversaries are at their best when they work together to meet our needs. It took an environmental holocaust for this to happen.  But as the pictures of destruction in state after state circulated throughout the media, no one talked about privatizing FEMA.  No one complained that the government was spending too many taxpayer dollars rescuing people from death.  It was a fine way for the President to end his first term in office – one that may ultimately have won him his re-election.  And also won him a new opportunity to collaborate with the states. In the storm’s aftermath, we understand that one of the prices of having the freedom t...

It took Super Storm Sandy to remind us how much we need our government. And how rarely we see government leaders truly cooperate. Cooperation has been a dirty word in politics for close to two decades.  But in responding to the crisis caused by Sandy, President Obama and Governor Christie showed us that political adversaries are at their best when they work together to meet our needs. It took an environmental holocaust for this to happen.  But as the pictures of destruction in state after state circulated throughout the media, no one talked about privatizing FEMA.  No one complained that the government was spending too many taxpayer dollars rescuing people from death.  It was a fine way for the President to end his first term in office – one that may ultimately have won him his re-election.  And also won him a new opportunity to collaborate with the states. In the storm’s aftermath, we understand that one of the prices of having the freedom t...

Now that the ACA decision is behind us, what’s on the horizon in the world of public health, mental health, and health policy? The truth is that ACA was essentially neutral with respect to prevention and public health.  3% of our nation’s health funding went to these services last year, and 3% will continue to go to these services with or without ACA. That won’t stop the assault on public health.  Federal, state, and local governments have all cut public health services in recent years and, unless we have a public health crisis, may well cut further. And Chief Justice Roberts took a swipe at public health programs in his majority decision, when he wrote on page 22 and 23: “To consider a different example in the health care market, many Americans do not eat a balanced diet. That group makes up a larger percentage of the total population than those without health insurance…. The failure of that group to have a healthy diet increases health care costs, to a grea...

Now that the ACA decision is behind us, what’s on the horizon in the world of public health, mental health, and health policy? The truth is that ACA was essentially neutral with respect to prevention and public health.  3% of our nation’s health funding went to these services last year, and 3% will continue to go to these services with or without ACA. That won’t stop the assault on public health.  Federal, state, and local governments have all cut public health services in recent years and, unless we have a public health crisis, may well cut further. And Chief Justice Roberts took a swipe at public health programs in his majority decision, when he wrote on page 22 and 23: “To consider a different example in the health care market, many Americans do not eat a balanced diet. That group makes up a larger percentage of the total population than those without health insurance…. The failure of that group to have a healthy diet increases health care costs, to a grea...