A recent study released by the CDC (and reported on Medscape and other sites) states the blunt fact that 20% of American households have difficulty paying their medical bills. And the National Center for Health Statistics states that 1 in 5 Americans has lived in a family that could not pay its medical bills in the last 12 months.
Showing posts with label health insurance. Show all posts
Showing posts with label health insurance. Show all posts
Thursday, March 08, 2012
Tuesday, October 25, 2011
The "Occupy" Movement and Healthcare
For the last several months, I have been actively supporting the now worldwide "Occupy" movement that has swept the world following the initiation of the famous "Occupy Wall Street" action in New York City. Here in Santa Fe, New Mexico, my wife and I have taken part in marches, rallies, protests and teach-ins, and the "Occupy Santa Fe" encampment continues near downtown.
Although the issues broached by "Occupiers" throughout the country are seemingly disparate and multifaceted, I believe it is only through the communication of these different voices and concerns that central themes (and possible demands) can eventually be distilled.
As a nurse and healthcare professional, I have seen the face of the healthcare system up close, and it is (still) quite broken. With innumerable for-profit insurance companies dictating what doctors can and cannot do, and tens of millions of Americans living completely without health insurance, the system eschews the notion of universal coverage and leaves millions in the proverbial dust. And since almost every industrialized country in the world has some form of universal coverage, the United States lags far behind, not only in this respect, but also in infant mortality and other important markers of health and well-being of the citizenry at large. It is a shameful state of affairs.
Just today on National Public Radio, I heard a report quoting Republican candidate Ron Paul as he railed against the notion of universal coverage. When asked if an uninsured 30-year-old with a catastrophic illness should receive expensive care in order to save his life, Paul intimated that there are other ways for these sorts of people to be cared for (such as churches and neighbors). He stated, "That's what freedom is all about---taking your own risks." Although he wouldn't directly say that society should just allow this individual to die, some members of the audience loudly proclaimed that, indeed, this uninsured American's care should not be paid for and he should be allowed to meet his (uninsured) fate. A shocking notion, especially since doctors (and Ron Paul is himself an M.D.) take an oath to "do no harm". (I have always wondered about the relative similarity between the words "Hippocratic" and "hypocritical".)
When it comes to the "Occupy" movement, my sense is that a more fair distribution of wealth, corporate responsibility (in terms of taxes, etc), economic justice (an admittedly broad and relatively ill-defined phrase), jobs, the end of war, and the initiation of broader protections (such as universal health coverage) are some of the mainstays of the movement's demands.
As autocracies around the world crumble before our eyes, it was only a matter of time until such a popular people's movement erupted from its latent slumber here in the U.S.. People can only take so much, and when the number of uninsured Americans topped 52 million just last year (40% higher than in 2001), there was no reason for Americans to not decide to speak out and demand change. And if you couple the nationwide jobless numbers with the numbers of uninsured citizens (let alone the list of companies---like Wal-Mart---who are jettisoning their healthcare coverage), the recipe for popular unrest only grows.
Rates of obesity, diabetes and heart disease are ballooning in this country, and childhood obesity and chronic illness are equally on the rise. As Americans get sicker and fatter, the nation's largest employers are cutting their healthcare coverage and leaving millions of American workers (and their families) in the lurch.
Meanwhile, the American right proclaims that "Occupiers" are dirty hippies, unemployed and looking for a handout. From my perspective, this is both unenlightened thinking and plain ignorant hyperbole. I have marched and rallied with retired schoolteachers, nurses, housepainters, unemployed laborers, and gainfully employed citizens from multiple sectors of society. Yes, some "Occupiers" are unemployed, but every unemployed protester I have spoken with simply wants a job and benefits for them and their family, and they're willing to pay taxes to get what they want. (They just want wealthy Americans and American corporations to pay their fair share.)
The noise and perceived "inconvenience" of massive protests will, in my opinion, continue as the movement galvanizes a broader spectrum of Americans and gains clarity as it works internally to crystallize its main messages. And as the protests continue, those 50 million Americans still languish without health insurance, millions more look for work that cannot be found, and the corporate and political powers that be bide their time in hopes that the restless citizenry will fall back into a television-induced slumber. Aside from a nationwide campaign to taint drinking water with Ambien or Lunesta in hopes of a sleepier and more ignorant nation, the chances of this movement simply being lulled into complacency is more remote than Wal-Mart offering its workers the benefits they deserve.
Although the issues broached by "Occupiers" throughout the country are seemingly disparate and multifaceted, I believe it is only through the communication of these different voices and concerns that central themes (and possible demands) can eventually be distilled.
As a nurse and healthcare professional, I have seen the face of the healthcare system up close, and it is (still) quite broken. With innumerable for-profit insurance companies dictating what doctors can and cannot do, and tens of millions of Americans living completely without health insurance, the system eschews the notion of universal coverage and leaves millions in the proverbial dust. And since almost every industrialized country in the world has some form of universal coverage, the United States lags far behind, not only in this respect, but also in infant mortality and other important markers of health and well-being of the citizenry at large. It is a shameful state of affairs.
Just today on National Public Radio, I heard a report quoting Republican candidate Ron Paul as he railed against the notion of universal coverage. When asked if an uninsured 30-year-old with a catastrophic illness should receive expensive care in order to save his life, Paul intimated that there are other ways for these sorts of people to be cared for (such as churches and neighbors). He stated, "That's what freedom is all about---taking your own risks." Although he wouldn't directly say that society should just allow this individual to die, some members of the audience loudly proclaimed that, indeed, this uninsured American's care should not be paid for and he should be allowed to meet his (uninsured) fate. A shocking notion, especially since doctors (and Ron Paul is himself an M.D.) take an oath to "do no harm". (I have always wondered about the relative similarity between the words "Hippocratic" and "hypocritical".)
When it comes to the "Occupy" movement, my sense is that a more fair distribution of wealth, corporate responsibility (in terms of taxes, etc), economic justice (an admittedly broad and relatively ill-defined phrase), jobs, the end of war, and the initiation of broader protections (such as universal health coverage) are some of the mainstays of the movement's demands.
As autocracies around the world crumble before our eyes, it was only a matter of time until such a popular people's movement erupted from its latent slumber here in the U.S.. People can only take so much, and when the number of uninsured Americans topped 52 million just last year (40% higher than in 2001), there was no reason for Americans to not decide to speak out and demand change. And if you couple the nationwide jobless numbers with the numbers of uninsured citizens (let alone the list of companies---like Wal-Mart---who are jettisoning their healthcare coverage), the recipe for popular unrest only grows.
Rates of obesity, diabetes and heart disease are ballooning in this country, and childhood obesity and chronic illness are equally on the rise. As Americans get sicker and fatter, the nation's largest employers are cutting their healthcare coverage and leaving millions of American workers (and their families) in the lurch.
Meanwhile, the American right proclaims that "Occupiers" are dirty hippies, unemployed and looking for a handout. From my perspective, this is both unenlightened thinking and plain ignorant hyperbole. I have marched and rallied with retired schoolteachers, nurses, housepainters, unemployed laborers, and gainfully employed citizens from multiple sectors of society. Yes, some "Occupiers" are unemployed, but every unemployed protester I have spoken with simply wants a job and benefits for them and their family, and they're willing to pay taxes to get what they want. (They just want wealthy Americans and American corporations to pay their fair share.)
The noise and perceived "inconvenience" of massive protests will, in my opinion, continue as the movement galvanizes a broader spectrum of Americans and gains clarity as it works internally to crystallize its main messages. And as the protests continue, those 50 million Americans still languish without health insurance, millions more look for work that cannot be found, and the corporate and political powers that be bide their time in hopes that the restless citizenry will fall back into a television-induced slumber. Aside from a nationwide campaign to taint drinking water with Ambien or Lunesta in hopes of a sleepier and more ignorant nation, the chances of this movement simply being lulled into complacency is more remote than Wal-Mart offering its workers the benefits they deserve.
Friday, February 26, 2010
The National Health Service
As Congress argues about whether national health care can ever be a reality here in the United States (with fears of socialism abounding), the British National Health Service (NHS) is often brought up as an example of socialized medicine gone awry.
Just a few days ago, I received an email from a contact who wanted me to share with my readers some real facts about the NHS in order to counter many of the falsehoods bandied about. The NHS was established in 1948 for the benefit of the residents of England, Wales, Scotland and Northern Ireland, and contrary to popular opinion here in the US, residents of those countries can indeed purchase private health insurance, go to private hospitals and otherwise pursue high-quality care.
An article on Health Express extolls many of the positive aspects of the NHS, readers can click here to peruse the article in its entirety.
A few highlights of this review of the NHS include:
Meanwhile, millions of American children and adults still live without any health insurance whatsoever, and a considerable percentage of home foreclosures in the US are due to health care bills which homeowners simply cannot pay.
Health care in the US is frequently a sad state of affairs, and perhaps some day we'll look back on the millions of uninsured as a sad stain on our health care history. Til then, the debate rages on........
Just a few days ago, I received an email from a contact who wanted me to share with my readers some real facts about the NHS in order to counter many of the falsehoods bandied about. The NHS was established in 1948 for the benefit of the residents of England, Wales, Scotland and Northern Ireland, and contrary to popular opinion here in the US, residents of those countries can indeed purchase private health insurance, go to private hospitals and otherwise pursue high-quality care.
An article on Health Express extolls many of the positive aspects of the NHS, readers can click here to peruse the article in its entirety.
A few highlights of this review of the NHS include:
- The first successful "test-tube baby" was born under the auspices of the NHS in 1978
- Nurses make up 30% of the NHS workforce
- Almost 1 out of every 23 residents of Wales and England are employed by the NHS
- The NHS pays for and supports 16,000 home births per year
- Life expectancy for both men and women has increased by 10 years since the NHS was founded
Meanwhile, millions of American children and adults still live without any health insurance whatsoever, and a considerable percentage of home foreclosures in the US are due to health care bills which homeowners simply cannot pay.
Health care in the US is frequently a sad state of affairs, and perhaps some day we'll look back on the millions of uninsured as a sad stain on our health care history. Til then, the debate rages on........
Wednesday, September 09, 2009
Can Obama Do It?
Even though I rarely listen to the radio anymore and no longer have TV, we tuned into President Obama's health care speech this evening, and I felt stirrings of hope as his words flowed through the airwaves.
Not having examined the speech closely, my hope is tinged with a hint of cynicism at the ways of Washington, but with the post-humous words of Ted Kennedy spurring us on, I feel that perhaps the reform we have all been waiting for may actually come to pass.
Even as the debate rages on, millions of American children still live without health insurance, the unemployed and underemployed seek primary care in emergency rooms, and the self-employed struggle to find coverage that doesn't break the bank.
Cries of socialism abound, but the President reminds us that Medicare itself was derided as being tantamount to socialism back in the day, and that "sacred trust" is now a promise that no American would ever wish to see broken.
I hold out hope that we will see comprehensive health care reform in this decade, and that my grandchildren will grow up in a country where they will never need to choose between medicine and groceries.
Health care reform? Socialism? If every American can obtain affordable coverage and no one has to go without, then I don't care what we call it. Can Obama do it? Only time will tell.
Not having examined the speech closely, my hope is tinged with a hint of cynicism at the ways of Washington, but with the post-humous words of Ted Kennedy spurring us on, I feel that perhaps the reform we have all been waiting for may actually come to pass.
Even as the debate rages on, millions of American children still live without health insurance, the unemployed and underemployed seek primary care in emergency rooms, and the self-employed struggle to find coverage that doesn't break the bank.
Cries of socialism abound, but the President reminds us that Medicare itself was derided as being tantamount to socialism back in the day, and that "sacred trust" is now a promise that no American would ever wish to see broken.
I hold out hope that we will see comprehensive health care reform in this decade, and that my grandchildren will grow up in a country where they will never need to choose between medicine and groceries.
Health care reform? Socialism? If every American can obtain affordable coverage and no one has to go without, then I don't care what we call it. Can Obama do it? Only time will tell.
Saturday, July 18, 2009
Health Insurance Blues
Most of the readers of Digital Doorway know by now that my wife Mary and I are preparing to leave our static home in New England for an itinerant life on the road. That said, leaving our home necessitates quitting our jobs, and when that paycheck stops rolling in, something else will also end----our health insurance.
Now, my European friends simply cannot comprehend this, but millions of Americans remain in jobs that they hate for one reason and one reason only---their health insurance. And many Americans who share our dream of self-employment and entrepreneurship also allow their dreams and aspirations to be thwarted by that very same health insurance bogeyman.
What is it about America that those who wish to do something different must suffer for their choices? Why are there millions of uninsured children who go without primary care because their parents cannot pay for their care? Why do tens of millions of adult Americans with chronic illnesses languish without health care and health insurance?
My wife and I want to manifest a life of creative self-employment and entrepreneurship, a vibrant engine of economic growth upon which American society was actually built. So, why are we forced to pay extortionate amounts of money so that we can have the simplest, most basic form of catastrophic health insurance? In this country built upon the entrepreneurial genius of those willing to take a risk, why are the risk-takers economically penalized?
I ponder these questions as we look towards the end of my job, the cessation of our health insurance, and the uncertain road ahead. If we were European, this conversation would never have to occur. In fact, it would be seem ludicrous.
Will this country ever change?
Friday, June 12, 2009
Of Tetanus and Fishing Line
"I heard you have free shots here, and I think I need a Tetanus shot." He is a friendly middle-aged man with a thick accent.
"Well yes, I usually do, but I don't have any Tetanus today. I'm sorry. But call me in two weeks and I'll have some for sure. Is it urgent?" I ask.
"Not really," he says. Pulling up his sleeve, he reveals a fairly large slice on his bicep, sewn together with blue fishing line.
"I work as a carpenter, and I often cut myself," he explains. "Whenever I do, I get out my needle and fishing line and stitch it up myself." He is obviously proud but simultaneously nonchalant.
"Wow. That's impressive," I reply, examining his needlework and the reddened area around the wound. "Do you know when your last Tetanus was?"
"Not really," he replies, "but I'm sure I'll be OK."
"You can go to several places that offer free care. They may have Tetanus in stock."
"No thanks. I'll call you in a few weeks and get it then. No problem."
I give him my card and tell him to call me in a week or so. My vaccine order is late this month and I feel badly that I wasn't able to make the order in time for this month's clinic. His DIY stitching was indeed impressive, but it drives home the point that there are millions of Americans just like him who have no health insurance and no way to receive even the most basic medical care without a great deal of effort and expense.
So, this man carries fishing line and a (sterile?) needle in his toolbox when he's on the job. How many people walk around with poorly healed wounds, unnecessary infections and God knows what else while corporate executives make off with billion-dollar severance packages?
It's enough to make me want to go fishing and leave it all behind.
"Well yes, I usually do, but I don't have any Tetanus today. I'm sorry. But call me in two weeks and I'll have some for sure. Is it urgent?" I ask.
"Not really," he says. Pulling up his sleeve, he reveals a fairly large slice on his bicep, sewn together with blue fishing line.
"I work as a carpenter, and I often cut myself," he explains. "Whenever I do, I get out my needle and fishing line and stitch it up myself." He is obviously proud but simultaneously nonchalant.
"Wow. That's impressive," I reply, examining his needlework and the reddened area around the wound. "Do you know when your last Tetanus was?"
"Not really," he replies, "but I'm sure I'll be OK."
"You can go to several places that offer free care. They may have Tetanus in stock."
"No thanks. I'll call you in a few weeks and get it then. No problem."
I give him my card and tell him to call me in a week or so. My vaccine order is late this month and I feel badly that I wasn't able to make the order in time for this month's clinic. His DIY stitching was indeed impressive, but it drives home the point that there are millions of Americans just like him who have no health insurance and no way to receive even the most basic medical care without a great deal of effort and expense.
So, this man carries fishing line and a (sterile?) needle in his toolbox when he's on the job. How many people walk around with poorly healed wounds, unnecessary infections and God knows what else while corporate executives make off with billion-dollar severance packages?
It's enough to make me want to go fishing and leave it all behind.
Saturday, December 06, 2008
The Obama-Biden Health Care Agenda
The Obama-Biden Transition Team is requesting that all interested citizens pay a visit to the transition's website, Change.gov, and voice ideas and concerns regarding American health care and health care reform. By clicking here, you can go directly to the web page dedicated to the health care agenda and submit your opinions and views.
The Obama-Biden web page discusses health care in this manner:
"On health care reform, the American people are too often offered two extremes -- government-run health care with higher taxes or letting the insurance companies operate without rules. Barack Obama and Joe Biden believe both of these extremes are wrong, and that’s why they’ve proposed a plan that strengthens employer coverage, makes insurance companies accountable and ensures patient choice of doctor and care without government interference.
In terms of the plan, I would also like to see the following:
Despite my reservations, doubts, and dubiousness, it is indeed exciting to see a new administration apparently dedicated to transparency, as well as the active participation of all Americans in the process of change that is underway.
Meanwhile, I am willing to suspend my disbelief, listen to the conversation, join in on the conversation when I have something useful to say, and watch as the story unfolds. These are exciting and nerve-wracking times, and I do indeed hope that the change that has been promised will indeed be delivered. Until that time, patience is one virtue we will all need to put into practice.
The Obama-Biden web page discusses health care in this manner:
"On health care reform, the American people are too often offered two extremes -- government-run health care with higher taxes or letting the insurance companies operate without rules. Barack Obama and Joe Biden believe both of these extremes are wrong, and that’s why they’ve proposed a plan that strengthens employer coverage, makes insurance companies accountable and ensures patient choice of doctor and care without government interference.
"The Obama-Biden plan provides affordable, accessible health care for all Americans, builds on the existing health care system, and uses existing providers, doctors, and plans. Under the Obama-Biden plan, patients will be able to make health care decisions with their doctors, instead of being blocked by insurance company bureaucrats.
"Under the plan, if you like your current health insurance, nothing changes, except your costs will go down by as much as $2,500 per year. If you don’t have health insurance, you will have a choice of new, affordable health insurance options."
Allegedly, the plan would:
- Require insurance companies to cover pre-existing conditions so all Americans regardless of their health status or history can get comprehensive benefits at fair and stable premiums.
- Create a new Small Business Health Tax Credit to help small businesses provide affordable health insurance to their employees.
- Lower costs for businesses by covering a portion of the catastrophic health costs they pay in return for lower premiums for employees.
- Prevent insurers from overcharging doctors for their malpractice insurance and invest in proven strategies to reduce preventable medical errors.
- Make employer contributions more fair by requiring large employers that do not offer coverage or make a meaningful contribution to the cost of quality health coverage for their employees to contribute a percentage of payroll toward the costs of their employees' health care.
- Establish a National Health Insurance Exchange with a range of private insurance options as well as a new public plan based on benefits available to members of Congress that will allow individuals and small businesses to buy affordable health coverage.
- Ensure everyone who needs it will receive a tax credit for their premiums.
- Lower drug costs by allowing the importation of safe medicines from other developed countries, increasing the use of generic drugs in public programs, and taking on drug companies that block cheaper generic medicines from the market.
- Require hospitals to collect and report health care cost and quality data.
- Reduce the costs of catastrophic illnesses for employers and their employees.
- Reform the insurance market to increase competition by taking on anticompetitive activity that drives up prices without improving quality of care.
In terms of the plan, I would also like to see the following:
- details regarding a more robust national plan of preventive health care initiatives
- sufficient funding for public health initiatives
- sufficient funding for emergency preparedness and the national Medical Reserve Corps
- a comprehensive plan to decrease the nursing shortage, including grants and loan forgiveness
- a plan to assuage the nationwide shortage of primary care physicians
- a plan to create an Office of the National Nurse
Despite my reservations, doubts, and dubiousness, it is indeed exciting to see a new administration apparently dedicated to transparency, as well as the active participation of all Americans in the process of change that is underway.
Meanwhile, I am willing to suspend my disbelief, listen to the conversation, join in on the conversation when I have something useful to say, and watch as the story unfolds. These are exciting and nerve-wracking times, and I do indeed hope that the change that has been promised will indeed be delivered. Until that time, patience is one virtue we will all need to put into practice.
Friday, December 05, 2008
Young Adults, Healthcare and the Economy
A recent study by Medco Health Solutions reveals that the current economic downturn and increasing healthcare costs are having a severe effect on young adults.
With an increasing number of young adults in their 20s and 30s living with chronic health conditions, health insurance and prescription drug coverage are no longer just issues for middle-aged and older adults. The survey further revealed that young adults are considerably less savvy when it comes to finding ways to save money on healthcare.
Other recent reports show that the prevalance of mental illness among young adults is significantly high, but only a small percentage ever actually seek treatment. With potentially 50% of young college-age adults meeting criteria for substance abuse disorders, personality disorders or other conditions, it is disconcerting that less than 25% are under active medical care.
If the lack of health insurance, the prohibitive costs of prescription medications, or exponentially increasing college tuition is keeping young adults from seeking medical or psychiatric treatment at a very vulnerable time of development and maturation, important outreach and motivational education needs to be set in motion in order to counterbalance such a trend. Whereas older adults might make healthcare expenses more of a personal economic priority in times of fiscal stress, perhaps young adults are less likely to eschew social outings, travel, and other activities in order to save money to cover their healthcare costs. This trend is worrisome since untended health maintenance issues early in adulthood can often come back to haunt the unsuspecting person in middle age.
I am not at all suggesting that young adults are categorically frivolous or laissez-faire about their health, but studies do clearly suggest that they are less likely to understand how to manipulate the economic system to their personal advantage vis-a-vis healthcare expenses. Additionally, having once been a young adult myself, health is generally not as great a priority when one is twenty-something as when one crosses the threshold into middle-age and the first half of one's life comes to a resounding close.
Universal healthcare and free higher education would most likely go a long way towards easing the economic strain on today's young adults, but I would be interested to see a study comparing the healthcare-seeking habits of European young adults (who already have free medical care and higher education) and their American counterparts. It would be revealing to ascertain if it is indeed the cost of healthcare that prevents young adults from seeking care, or if it is more of a developmental issue which is part and parcel of the maturation process.
While considering the underlying causes of the phenomena revealed by the studies mentioned above, it is important to consider what social and economic interventions might increase access to medical care for this important population, as well as what forms of education and outreach might prove to be positively motivational to that desired end. Increased access to affordable healthcare is certainly a very good first step, and while students attending college are required by law to have health insurance, young adults who choose to not go to college---or who simply cannot afford it---are left with few economically viable options once they can no longer be covered under their parents' policies.
Young adults are our future, and it is in our best collective interest to make sure that they receive the necessary preventive healthcare that can detect chronic disease---or even the potential for such disease---long before any lasting damage is done. Healthcare should be affordable, accessible, and understandable for our young adults, and in these hard economic times, too many young people may see healthcare as a luxury that they simply cannot afford. I hope that the new administration in Washington will decrease the costs of both healthcare and higher education, ease the burden on American young adults, and simultaneously educate this population about the crucial importance of detecting chronic illness before it starts to take its toll.
As the father of a young man in his twenties, I have a vested interest in his stellar generation reaching their productive middle-age with good health, economic security, and the means to live a long, happy, healthy and satisfying life.
With an increasing number of young adults in their 20s and 30s living with chronic health conditions, health insurance and prescription drug coverage are no longer just issues for middle-aged and older adults. The survey further revealed that young adults are considerably less savvy when it comes to finding ways to save money on healthcare.
Other recent reports show that the prevalance of mental illness among young adults is significantly high, but only a small percentage ever actually seek treatment. With potentially 50% of young college-age adults meeting criteria for substance abuse disorders, personality disorders or other conditions, it is disconcerting that less than 25% are under active medical care.
If the lack of health insurance, the prohibitive costs of prescription medications, or exponentially increasing college tuition is keeping young adults from seeking medical or psychiatric treatment at a very vulnerable time of development and maturation, important outreach and motivational education needs to be set in motion in order to counterbalance such a trend. Whereas older adults might make healthcare expenses more of a personal economic priority in times of fiscal stress, perhaps young adults are less likely to eschew social outings, travel, and other activities in order to save money to cover their healthcare costs. This trend is worrisome since untended health maintenance issues early in adulthood can often come back to haunt the unsuspecting person in middle age.
I am not at all suggesting that young adults are categorically frivolous or laissez-faire about their health, but studies do clearly suggest that they are less likely to understand how to manipulate the economic system to their personal advantage vis-a-vis healthcare expenses. Additionally, having once been a young adult myself, health is generally not as great a priority when one is twenty-something as when one crosses the threshold into middle-age and the first half of one's life comes to a resounding close.
Universal healthcare and free higher education would most likely go a long way towards easing the economic strain on today's young adults, but I would be interested to see a study comparing the healthcare-seeking habits of European young adults (who already have free medical care and higher education) and their American counterparts. It would be revealing to ascertain if it is indeed the cost of healthcare that prevents young adults from seeking care, or if it is more of a developmental issue which is part and parcel of the maturation process.
While considering the underlying causes of the phenomena revealed by the studies mentioned above, it is important to consider what social and economic interventions might increase access to medical care for this important population, as well as what forms of education and outreach might prove to be positively motivational to that desired end. Increased access to affordable healthcare is certainly a very good first step, and while students attending college are required by law to have health insurance, young adults who choose to not go to college---or who simply cannot afford it---are left with few economically viable options once they can no longer be covered under their parents' policies.
Young adults are our future, and it is in our best collective interest to make sure that they receive the necessary preventive healthcare that can detect chronic disease---or even the potential for such disease---long before any lasting damage is done. Healthcare should be affordable, accessible, and understandable for our young adults, and in these hard economic times, too many young people may see healthcare as a luxury that they simply cannot afford. I hope that the new administration in Washington will decrease the costs of both healthcare and higher education, ease the burden on American young adults, and simultaneously educate this population about the crucial importance of detecting chronic illness before it starts to take its toll.
As the father of a young man in his twenties, I have a vested interest in his stellar generation reaching their productive middle-age with good health, economic security, and the means to live a long, happy, healthy and satisfying life.
Monday, December 01, 2008
Temporarily Joining the Ranks
So, dear Readers, as of 12:01 am today, my wife and I are officially uninsured. Caught in that painfully ubiquitous American conundrum, we are both gainfully employed, both starting new jobs (that, admittedly, don't pay exceedingly well), and our new insurance will not kick in until January 1st. With several chronic illnesses between us and a number of medications we take on a regular basis, this could be cause for concern.
Counting our blessings, we indeed realize that, unlike the majority of the other 38 million uninsured Americans waking up this morning, our uninsured status is, in fact, temporary. A month from now, as we ring in the New Year, we will also ring in the renewed security that paying monthly health insurance premiums can bring. Our privilege is not lost on us, but having just been to the emergency room on Thanksgiving Day, I am given pause to remember that life and illness do indeed sometimes happen on their own schedule. But like I've said before, middle class privilege is something we do not take for granted, and our very survival is in no way threatened by this unfortunate but temporary turn of events.
Meanwhile, my incredulous friends in Canada and Europe wonder how such a "powerful" country can leave so many of its citizens in the lurch, many actually going bankrupt when they cannot pay their medical bills. My response is that the United States' free market system coupled with an ingrained Puritan work ethic and "pick-yourself-up-by-your-boot-straps" cowboy mystique leads many mainstream Americans to think of themselves rather than of others, assuming that those who "have not" probably don't deserve it anyway. Ronald Reagan's evisceration of Public Assistance---further decimated by Bill Clinton in the 90's---painted "Welfare Moms" as deadbeats who purportedly birthed children just to get on the dole. We were all expected to make it on our own, and those who didn't were expected to eat our crumbs.
If I sound cynical, it's because there has been a great deal to be cynical about in the last decade of American life. With the economy in shambles, healthcare on the rocks, two never-ending wars, and poverty and hunger on the rise, some healthy cynicism is indeed in order.
So, as the Obama administration revs its engines, I wait patiently along with my fellow citizens, hoping for some change, but admittedly less starry-eyed than many of my brethren. I honestly expect little to change in the next year in terms of the machinations of American healthcare economics, although I do hold out hope that the ranks of the uninsured will somehow be decreased as rapidly as possible. Changing such an entrenched system will not be easy, and some say it is truly impossible with so many economic and political toes to be stepped on. Well, the poor, uninsured and hungry in this country have been repeatedly stepped on throughout the decades, so if the insurance industry cries "foul" as it suffocates, let's simply call it just desserts.
This next month of "insurancelessness" does certainly give me a lot of food for thought. I am grateful that this chapter will be short-lived, but I am all too well aware that, for many others, it is a chapter that seems to never end.
Counting our blessings, we indeed realize that, unlike the majority of the other 38 million uninsured Americans waking up this morning, our uninsured status is, in fact, temporary. A month from now, as we ring in the New Year, we will also ring in the renewed security that paying monthly health insurance premiums can bring. Our privilege is not lost on us, but having just been to the emergency room on Thanksgiving Day, I am given pause to remember that life and illness do indeed sometimes happen on their own schedule. But like I've said before, middle class privilege is something we do not take for granted, and our very survival is in no way threatened by this unfortunate but temporary turn of events.
Meanwhile, my incredulous friends in Canada and Europe wonder how such a "powerful" country can leave so many of its citizens in the lurch, many actually going bankrupt when they cannot pay their medical bills. My response is that the United States' free market system coupled with an ingrained Puritan work ethic and "pick-yourself-up-by-your-boot-straps" cowboy mystique leads many mainstream Americans to think of themselves rather than of others, assuming that those who "have not" probably don't deserve it anyway. Ronald Reagan's evisceration of Public Assistance---further decimated by Bill Clinton in the 90's---painted "Welfare Moms" as deadbeats who purportedly birthed children just to get on the dole. We were all expected to make it on our own, and those who didn't were expected to eat our crumbs.
If I sound cynical, it's because there has been a great deal to be cynical about in the last decade of American life. With the economy in shambles, healthcare on the rocks, two never-ending wars, and poverty and hunger on the rise, some healthy cynicism is indeed in order.
So, as the Obama administration revs its engines, I wait patiently along with my fellow citizens, hoping for some change, but admittedly less starry-eyed than many of my brethren. I honestly expect little to change in the next year in terms of the machinations of American healthcare economics, although I do hold out hope that the ranks of the uninsured will somehow be decreased as rapidly as possible. Changing such an entrenched system will not be easy, and some say it is truly impossible with so many economic and political toes to be stepped on. Well, the poor, uninsured and hungry in this country have been repeatedly stepped on throughout the decades, so if the insurance industry cries "foul" as it suffocates, let's simply call it just desserts.
This next month of "insurancelessness" does certainly give me a lot of food for thought. I am grateful that this chapter will be short-lived, but I am all too well aware that, for many others, it is a chapter that seems to never end.
Sunday, October 12, 2008
The Irony of Mental Health Parity
(Note: This is my ninth post under the auspices of the nurse blogger scholarship which I recently received from Value Care, Value Nurses.)
In June of this year, I reported on Nurse LinkUp that Congress was poised to once again begin a concerted push to pass legislation bringing parity for insurance coverage for mental health, including addiction, eating disorders, and any illness classified in the DSM-IV. That effort basically failed, and it is only now, just prior to the end of this Congress, that mental health parity legislation has actually become law.
We are all by now (nauseatingly) familiar with the $700 billion financial bailout recently passed by Congress and signed into law by President Bush in the waning days of his presidency (more on that in future). As a part of that package, most health plans are now required to cover mental illness and addiction with the same level of access and cost as any physical illness. After years of struggle, editorials abound, almost ubiquitously praising the legislation which was added to the latest---and ultimately successful---version of the bailout plan.
Beginning, I believe, in 2009, all group insurance plans and companies with more than 50 employees must offer health insurance coverage that provides equal benefits for mental health treatment, potentially benefiting 113 million insured Americans, as well as approximately 82 million self-insured Americans who are not protected by state-mandated mental health parity legislation. Interestingly, 38 states currently have some form of parity laws on the books, a fact of which I was previously ignorant.
Paul Wellstone (D-MN), the late Senator from Minnesota, was one of the great champions of the mental health parity cause, along with his colleague Pete Domenici (R-NM). The bill, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, was named for the two senators and honors the posthumous legacy of Wellstone's tireless fight for the rights of Americans living with mental illness and addiction. And it was Senator Edward Kennedy (D-MA) and his son Representative Patrick Kennedy (D-RI), who used their political muscle and clout to ease the bill through the Senate and the House.
As someone who has struggled with depression since childhood, I can attest that obtaining coverage for mental health can be a challenge, especially if one needs ongoing treatment rather than the "episodic care" often covered by many health plans. I can also confirm that many health insurance plans charge much higher co-payments for mental health visits, and impose nonsensical and arbitrary limits on the number of outpatient visits per year.
In terms of inpatient care, insurance regulations regarding mental health are notorious for prematurely cutting short crucial inpatient treatment for mental illness, addiction, and eating disorders. It is plainly obvious that inpatient treatment teams know best vis-a-vis the length of stay which would be most efficacious for a particular patient. Naturally, some oversight should be involved so that billing abuses do not occur, but bureaucrats and statisticians should not be making decisions that only clinically trained professionals should make. The imposition of arbitrary limits on the length of stay for the treatment of such chronic conditions belies the fact that insurance companies are generally more concerned with profitability than the effectiveness and quality of care. In fact, I would hazard a guess that forcing a patient out of detox or an inpatient psychiatric unit before they are clinically ready for discharge more than likely leads to worse outcomes, more frequent relapse, and higher costs over the long term.
Global Ironies: Mind the Gap
Ironically, on October 10th, World Mental Health Day (one week after mental health parity became a legal reality in the United States), the World Health Organization announced that as many as 75% of people living with mental disorders in developing countries receive no care or treatment of any kind. The irony is that while we in the United States pine for lower co-payments and equal access to care, those living in war-torn nations, developing nations, and non-industrialized countries suffer immeasurable harm without even the merest hope of treatment.
The WHO study points out that nine out of ten people in Africa who live with epilepsy are entirely untreated. It also starkly points out that while most countries spend approximately 2% of their health dollars on mental health, one-third of people with schizophrenia, half of those living with depression, and seventy-five percent of those struggling with addiction go untreated worldwide. And tragically, one person dies from a completed suicide every forty seconds of every day, somewhere in the world, mostly due to untreated mental illness.
These numbers tell a story, and even as the United States prepares to tackle the issues of mental illness and substance abuse more fairly, the WHO is calling for governments, foundations, donors and mental health activists to increase funding for treatment worldwide. The program, entitled Mental Health Gap Action Program (mhGAP): Scaling Up Care for Mental Health and Substance Use Disorders, asserts, according to the WHO press release, that "with proper care, psychosocial assistance and medication, tens of millions could be treated for diseases such as depression, schizophrenia, and epilepsy and begin to lead healthy lives, even where resources are scarce."
To bolster their case, the WHO's recent studies demonstrate that "in low-income countries, scaling up a package of essential interventions for three mental disorders – schizophrenia, bipolar disorder and depression – and for one risk factor – hazardous alcohol use – requires an additional investment as low as $US 0.20 per person per year." Claiming that treatment of mental illness, addiction and neurological disorders such as epilepsy should not only be "evidence-based" but "value-based", the WHO plan includes "assessing countries' needs and resources; developing sound mental health policy and legislation; and increasing human and financial resources" in order that "people with these disorders are not denied opportunities to contribute to social and economic life and that their human rights are protected."
Global Parity: A Laudable Goal
So, as mental health parity becomes law in the United States and we continue to wrestle with the needs of the uninsured and the under-insured, the rest of the world---especially the developing world---needs our assistance to offer even the most basic of mental health care to millions and millions of deserving citizens. Mental health is not a luxury, and many in the fields of mind-body medicine (and also mainstream medicine, for that matter) strongly believe that good physical health is simply not possible without solid mental health. In fact, recent research demonstrates quite clearly that untreated depression can absolutely lead to physical symptoms including chronic pain.
I would assert that those who have so valiantly and tirelessly fought for the rights of the mentally ill here in the United States should now challenge themselves to broaden their visual field, take in the big picture of global mental health, and direct some of their energies in supporting the timely efforts of the World Health Organization.
As the global financial system continues its apparent implosion, we can naturally expect the incidence of anxiety, depression and substance abuse to rise as people attempt to manage lives thrown into chaos by economic hardship. We in the United States recently won a long twelve-year battle, happily enough. But now is not the time to rest on our laurels. Now is the time for action on a global scale. It is in humanity's best interest to see that all people have access to treatment for improved mental health, and it is our moral and ethical duty to further that cause.
In June of this year, I reported on Nurse LinkUp that Congress was poised to once again begin a concerted push to pass legislation bringing parity for insurance coverage for mental health, including addiction, eating disorders, and any illness classified in the DSM-IV. That effort basically failed, and it is only now, just prior to the end of this Congress, that mental health parity legislation has actually become law.
We are all by now (nauseatingly) familiar with the $700 billion financial bailout recently passed by Congress and signed into law by President Bush in the waning days of his presidency (more on that in future). As a part of that package, most health plans are now required to cover mental illness and addiction with the same level of access and cost as any physical illness. After years of struggle, editorials abound, almost ubiquitously praising the legislation which was added to the latest---and ultimately successful---version of the bailout plan.
Beginning, I believe, in 2009, all group insurance plans and companies with more than 50 employees must offer health insurance coverage that provides equal benefits for mental health treatment, potentially benefiting 113 million insured Americans, as well as approximately 82 million self-insured Americans who are not protected by state-mandated mental health parity legislation. Interestingly, 38 states currently have some form of parity laws on the books, a fact of which I was previously ignorant.
Paul Wellstone (D-MN), the late Senator from Minnesota, was one of the great champions of the mental health parity cause, along with his colleague Pete Domenici (R-NM). The bill, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, was named for the two senators and honors the posthumous legacy of Wellstone's tireless fight for the rights of Americans living with mental illness and addiction. And it was Senator Edward Kennedy (D-MA) and his son Representative Patrick Kennedy (D-RI), who used their political muscle and clout to ease the bill through the Senate and the House.
As someone who has struggled with depression since childhood, I can attest that obtaining coverage for mental health can be a challenge, especially if one needs ongoing treatment rather than the "episodic care" often covered by many health plans. I can also confirm that many health insurance plans charge much higher co-payments for mental health visits, and impose nonsensical and arbitrary limits on the number of outpatient visits per year.
In terms of inpatient care, insurance regulations regarding mental health are notorious for prematurely cutting short crucial inpatient treatment for mental illness, addiction, and eating disorders. It is plainly obvious that inpatient treatment teams know best vis-a-vis the length of stay which would be most efficacious for a particular patient. Naturally, some oversight should be involved so that billing abuses do not occur, but bureaucrats and statisticians should not be making decisions that only clinically trained professionals should make. The imposition of arbitrary limits on the length of stay for the treatment of such chronic conditions belies the fact that insurance companies are generally more concerned with profitability than the effectiveness and quality of care. In fact, I would hazard a guess that forcing a patient out of detox or an inpatient psychiatric unit before they are clinically ready for discharge more than likely leads to worse outcomes, more frequent relapse, and higher costs over the long term.
Global Ironies: Mind the Gap
Ironically, on October 10th, World Mental Health Day (one week after mental health parity became a legal reality in the United States), the World Health Organization announced that as many as 75% of people living with mental disorders in developing countries receive no care or treatment of any kind. The irony is that while we in the United States pine for lower co-payments and equal access to care, those living in war-torn nations, developing nations, and non-industrialized countries suffer immeasurable harm without even the merest hope of treatment.
The WHO study points out that nine out of ten people in Africa who live with epilepsy are entirely untreated. It also starkly points out that while most countries spend approximately 2% of their health dollars on mental health, one-third of people with schizophrenia, half of those living with depression, and seventy-five percent of those struggling with addiction go untreated worldwide. And tragically, one person dies from a completed suicide every forty seconds of every day, somewhere in the world, mostly due to untreated mental illness.
These numbers tell a story, and even as the United States prepares to tackle the issues of mental illness and substance abuse more fairly, the WHO is calling for governments, foundations, donors and mental health activists to increase funding for treatment worldwide. The program, entitled Mental Health Gap Action Program (mhGAP): Scaling Up Care for Mental Health and Substance Use Disorders, asserts, according to the WHO press release, that "with proper care, psychosocial assistance and medication, tens of millions could be treated for diseases such as depression, schizophrenia, and epilepsy and begin to lead healthy lives, even where resources are scarce."
To bolster their case, the WHO's recent studies demonstrate that "in low-income countries, scaling up a package of essential interventions for three mental disorders – schizophrenia, bipolar disorder and depression – and for one risk factor – hazardous alcohol use – requires an additional investment as low as $US 0.20 per person per year." Claiming that treatment of mental illness, addiction and neurological disorders such as epilepsy should not only be "evidence-based" but "value-based", the WHO plan includes "assessing countries' needs and resources; developing sound mental health policy and legislation; and increasing human and financial resources" in order that "people with these disorders are not denied opportunities to contribute to social and economic life and that their human rights are protected."
Global Parity: A Laudable Goal
So, as mental health parity becomes law in the United States and we continue to wrestle with the needs of the uninsured and the under-insured, the rest of the world---especially the developing world---needs our assistance to offer even the most basic of mental health care to millions and millions of deserving citizens. Mental health is not a luxury, and many in the fields of mind-body medicine (and also mainstream medicine, for that matter) strongly believe that good physical health is simply not possible without solid mental health. In fact, recent research demonstrates quite clearly that untreated depression can absolutely lead to physical symptoms including chronic pain.
I would assert that those who have so valiantly and tirelessly fought for the rights of the mentally ill here in the United States should now challenge themselves to broaden their visual field, take in the big picture of global mental health, and direct some of their energies in supporting the timely efforts of the World Health Organization.
As the global financial system continues its apparent implosion, we can naturally expect the incidence of anxiety, depression and substance abuse to rise as people attempt to manage lives thrown into chaos by economic hardship. We in the United States recently won a long twelve-year battle, happily enough. But now is not the time to rest on our laurels. Now is the time for action on a global scale. It is in humanity's best interest to see that all people have access to treatment for improved mental health, and it is our moral and ethical duty to further that cause.
Tuesday, August 26, 2008
The Uninsured in America
Please be so kind as to click here to read a new article that I've posted on Nurse Linkup about the plight of the uninsured in America.
Tuesday, January 23, 2007
Aegis
aegis \EE-jis\, noun:
1. Protection; support.
2. Sponsorship; patronage.
3. Guidance, direction, or control.
4. A shield or protective armor; -- applied in mythology to the shield of Zeus.
What will it take for this country to insure everyone, when the numbers of uninsured Americans continues to climb? As of August of last year, The Center on Budget and Policy Priorities reported that the number of uninsured Americans stood at 46.6 million in 2005, a shocking 15.9% of the total population. Additionally, the 2006 CBPP report underscored the fact that "the number of children who are uninsured rose from 7.9 million in 2004 to 8.3 million in 2005."
What do those numbers say about our society and how can citizens force their legislators to tackle such a contentious issue? For those of us in the healthcare fields, seeing the effects of poor health coverage on the ground, the continued effects of this emergent situation will only exacerbate the overall poor health of the American citizenry. With no health insurance, low earning power, a frozen minimum wage, exorbitant rents, high gas prices and increasing food costs, the working poor are left to their own devices, often faced with devastating hospital bills and nowhere to turn. Cheap foods laden with sugar and fat feed the obesity epidemic, and the poor feel they have no other choice but to fill their children's bellies with such fare. And those children, developing diabetes in record numbers, will only further stress the healthcare infrastructure as they age and face complications from poorly controlled chronic illness. (And we thought the care of the Baby Boomers would break the bank.)
It is a stark and frightening picture, but just like global warming, there is a window of opportunity to turn the tide before the levees break and there is no turning back. Burying our heads in the proverbial health insurance sand will do little to assuage the coming calamity, and meanwhile millions of children go to sleep not only hungry, but with no means to have their basic health needs met. Something has to give, and it had better give soon. We will all bear responsibility for the outcome---just as we will vis-a-vis climate change---and the potential for success has to be our driving engine.
There must be an aegis, a shield, and that protection is long, long overdue. From where will it emerge?
Saturday, January 13, 2007
Deus ex machina
deus ex machina: an agent who appears unexpectedly to solve an apparently insoluble difficulty.
Healthcare in this country is in crisis. Rising drug costs, millions of uninsured Americans, bankrupt hospitals, Big Pharma run amok---the most powerful and influential nation in the world still cannot care well enough for all of its citizens. While Senators and members of Congress have health coverage to die for (pun intended), so many of the working poor are denied even the most minimal of coverage. Seniors are forced to choose between paying for prescriptions or groceries, and insurance companies continue to deny certain types of care as costs skyrocket out of control.
Enter the deus ex machina, or at least the hope for some solution which will fall out of the sky and save us. Is it Canadian-style universal healthcare? Is it a market system? (Oh wait, that already failed miserably, right?) Where will we find our panacea of preventive medicine and cost containment?
In Massachusetts and California, governors and legislatures grapple with critical universal coverage mandates which could break the bank, but may just be one answer which could be followed by other states around the country if they succeed. I would never have imagined that Arnold Schwarzenegger, that movie-star playing a politician, would be the one who could actually pull it off. If he does, I'll gladly eat my hat. And here in New England, in Massachusetts specifically, perhaps Deval Patrick---the first African-American governor of that state, and only the second in all of U.S. history---is also poised to tackle universal healthcare which is mandated by law to swing into action on July 1st of this year. And who knows, maybe Nancy Pelosi will perform the miraculous, only to be thwarted by a cantankerous and staid Senate. (Talk about The Bride Stripped Bare By Her Bachelors, even.)
My patients are relatively lucky, receiving the benefits of a cutting-edge program which provides that with high quality care, timely follow-up, and personalized service. Still, drugs are denied, certain procedures and equipment are not covered, and certain specialties are becoming almost impossible to refer patients to as those provider groups stop accepting Medicaid all together. Something has to give, and usually the first thing to go is quality and equality.
So is there a deus ex machina? Will someone or something save us? Will Arnold's proclamations bear fruit, his iconic super-hero status actually managing to be the springboard to bring healthcare to the disenfranchised? Or will Deval Patrick, a descendant of the disenfranchised himself, turn a tide that has been carrying the poor out to sea for decades? Both of these scenarios are possible, and still others are yet to be born, or are now being hatched in minds around the country. But the rest of us cannot necessarily sit on our laurels and wait for others to solve the dilemma. Letters to the editor, calls to legislators, op-ed pieces, dreams and meditations, or even water-cooler chat---all are potential places for the birth of a kernel of an idea that could turn the tide. So, where is the deus ex machina? Apparently it is us.
Healthcare in this country is in crisis. Rising drug costs, millions of uninsured Americans, bankrupt hospitals, Big Pharma run amok---the most powerful and influential nation in the world still cannot care well enough for all of its citizens. While Senators and members of Congress have health coverage to die for (pun intended), so many of the working poor are denied even the most minimal of coverage. Seniors are forced to choose between paying for prescriptions or groceries, and insurance companies continue to deny certain types of care as costs skyrocket out of control.
Enter the deus ex machina, or at least the hope for some solution which will fall out of the sky and save us. Is it Canadian-style universal healthcare? Is it a market system? (Oh wait, that already failed miserably, right?) Where will we find our panacea of preventive medicine and cost containment?
In Massachusetts and California, governors and legislatures grapple with critical universal coverage mandates which could break the bank, but may just be one answer which could be followed by other states around the country if they succeed. I would never have imagined that Arnold Schwarzenegger, that movie-star playing a politician, would be the one who could actually pull it off. If he does, I'll gladly eat my hat. And here in New England, in Massachusetts specifically, perhaps Deval Patrick---the first African-American governor of that state, and only the second in all of U.S. history---is also poised to tackle universal healthcare which is mandated by law to swing into action on July 1st of this year. And who knows, maybe Nancy Pelosi will perform the miraculous, only to be thwarted by a cantankerous and staid Senate. (Talk about The Bride Stripped Bare By Her Bachelors, even.)
My patients are relatively lucky, receiving the benefits of a cutting-edge program which provides that with high quality care, timely follow-up, and personalized service. Still, drugs are denied, certain procedures and equipment are not covered, and certain specialties are becoming almost impossible to refer patients to as those provider groups stop accepting Medicaid all together. Something has to give, and usually the first thing to go is quality and equality.
So is there a deus ex machina? Will someone or something save us? Will Arnold's proclamations bear fruit, his iconic super-hero status actually managing to be the springboard to bring healthcare to the disenfranchised? Or will Deval Patrick, a descendant of the disenfranchised himself, turn a tide that has been carrying the poor out to sea for decades? Both of these scenarios are possible, and still others are yet to be born, or are now being hatched in minds around the country. But the rest of us cannot necessarily sit on our laurels and wait for others to solve the dilemma. Letters to the editor, calls to legislators, op-ed pieces, dreams and meditations, or even water-cooler chat---all are potential places for the birth of a kernel of an idea that could turn the tide. So, where is the deus ex machina? Apparently it is us.
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