Sen. Whitehouse Steps Up for Mental Health Parity

Good news for the mental health professions, who desperately need better tools for managing health Information:

Whitehouse Introduces Legislation to Improve Mental Health Care


Washington, DC – In 2009, the American Recovery and Reinvestment Act (ARRA) made an unprecedented investment in our medical infrastructure, providing almost $20 billion in incentive funds for health information technology.  However, an important group of health care providers were excluded from these incentives: behavioral health, mental health, and substance abuse treatment professionals and facilities.  Today, U.S. Senator Sheldon Whitehouse (D-RI) introduced the Behavioral Health Information Technology Act (S. 1517) to correct that inequity.


“In the wake of this week’s tragic mass shooting in Washington, we are once again confronting questions about the treatment of mental illness in America,” said Whitehouse.  “Many questions remain about the shooting, but one thing is crystal clear: mental health is just as important as physical health.  This legislation will extend to mental and behavioral health professionals the same assistance given to other health providers, which will help them invest in vital health information technology.”


The Behavioral Health Information Technology Act would enable behavioral health providers, including psychologists, community mental health centers, and psychiatric hospitals, among others, to receive incentive payments for the adoption and meaningful use of electronic health records.  More specifically, it would:

  • ·         Expand the types of providers eligible for Medicare incentives for the use of electronic health records to include licensed psychologists, licensed clinical social workers, and psychiatric hospitals;
  • ·         Expand eligibility for Medicaid meaningful use incentive payments to include community mental health centers, mental health and substance abuse treatment facilities, psychiatric hospitals, licensed psychologists, and licensed clinical social workers; and
  • ·         Allows electronic health record incentive payments to eligible professionals and hospitals under Medicare Advantage plans.

Senator Whitehouse previously introduced a version of this bill in the Senate in 2010.  Former Congressman Patrick Kennedy also championed this issue in the House until he left office. 



Free to Die

Economist Paul Krugman in today’s New York Times takes a closer look at Libertarian views about ‘freedom’. Millions of American children, for instance, make the ‘bad choice’ of being born to to poor parents– should taxpayers bail them out?

So would people on the right be willing to let those who are uninsured through no fault of their own die from lack of care? The answer, based on recent history, is a resounding “Yeah!”

Think, in particular, of the children.

The day after the debate, the Census Bureau released its latest estimates on income, poverty and health insurance. The overall picture was terrible: the weak economy continues to wreak havoc on American lives. One relatively bright spot, however, was health care for children: the percentage of children without health coverage was lower in 2010 than before the recession, largely thanks to the 2009 expansion of the State Children’s Health Insurance Program, or S-chip.

And the reason S-chip was expanded in 2009 but not earlier was, of course, that former President George W. Bush blocked earlier attempts to cover more children — to the cheers of many on the right. Did I mention that one in six children in Texas lacks health insurance, the second-highest rate in the nation?

This sounds like flaming partisanship but it is sober fact– such a shocking truth that we don’t want to face it. We have a highly developed system for dealing with acute health emergencies, but we are failing in preventive care. It makes no sense in terms of basic self-interest, never mind morality.

The unspoken assumption in the concept of ‘choice’ is that we are all born with a menu of choices before us, and some foolishly choose to be sick, or poor, or victims of discrimination. In real life, most of us choose as best we can from what seems possible. If health care is available and affordable to most, but out of reach for some, then individual choice is not the problem. The problem is justice and wise leadership.

It is the role of government to promote the public good, and especially the good of the next generation. We will all be older, most of us won’t be richer. What kind of nation do we want to be?

MORE: Echidne of the Snakes has a good explanation of why the current mess, which has disincentives for young people to buy health insurance or use preventive care, is economically dumb.

Listen to the Nuns

Thanks to Daily Kos for a link to E.J. Dionne’s editorial on the eloquent letter defending health care reform issued by American Catholic nuns.

This stance is in contrast to some Bishops who are organizing politically to kill any health reform bill that doesn’t meet their definition of ‘pro-life’. The nuns, many of whom work in hospitals, have an interest in the born as well as a the unborn.

I have to get going with my own health care work, but I want to connect this to an older story that has got lost in the back pages. That is the dire situation of some elderly nuns who dedicated their life to the Church, but had to look to the State for health insurance.

Some nuns have direct experience of health care and financial insecurity. This may have sensitized them to an issue that the higher ranking members of the Church hierarchy never have to experience first hand.

Without that socialized Medicare some elderly nuns would have no health insurance. Bishops ride Cadillacs, nuns take the bus. Bishops dine in Washington, nuns run food pantries. I’ll bet the Bishops wish more of them had taken a vow of silence, because they see what’s going on and they can testify.

I want to link to an earlier post called ‘Homeless Nuns’. A Bishop in California, pressed to find money to pay damages in child sexual abuse cases, decided to sell a convent and evict the nuns. You see, the nuns are religious, and unlike Bishops they do not have personal wealth, so they did not own their convent. The nuns lived in a poor neighborhood and provided services to the people living there. The neighborhood organized on behalf of the nuns. You can see more on this story at a site called ‘Bishop Accountability’. If there had been more accountability in the past few decades the Church wouldn’t have to be selling convents, would she?

We may not be hearing so much from American nuns in the future. The Vatican is running an inquisition investigation of American orders of nuns to determine if they have strayed from orthodoxy.

UPDATE: Bishops are telling the nuns not to worry their pretty little heads about men’s business.

Senator Whitehouse Meets Constituents

Senator Whitehouse appeared at an informal community meeting October 16, at the Butcher Block Deli on Elmgrove Ave. in Providence. Present in the crowd were state reps, Rhoda Perry, Cliff Wood, David Segal and Seth Yurdin.

The cafe filled up a half hour before he arrived, the crowd was respectful, but focused. People came with questions about health care, the economy, Afghanistan and other issues.

On the public option, Sen. Whitehouse was supportive and optimistic that the final bill will include one.

He talked about bipartisanship, ‘chasing the ghost of bipartisanship’. Later, asked why the Democrats needed 60 votes to pass a health care bill he explained tactics, such as adding amendments, that could drag out the debate endlessly. He said that even cloture allows three days, which opponents of the bill would drag out to the last second, ‘burning up days’ that Congress needs for other urgent business. He favored getting the Democrats to support a bill and get it passed, and said when that happened Republicans would get on board. He said that cost-control measures would include wellness, preventive care, cutting hospital re-admission rates with improved discharge planning and electronic medical records. He cited ‘Safeway’ supermarket corporation as a model for a wellness program with voluntary incentives for healthy changes that cut costs of treatment.

He seemed disappointed that the White House was not demanding more concessions from the pharmaceutical industry. He referred to Medicare Part D and the ‘donut hole’ for drug coverage.

In response to a question about the banking crisis he said that re-regulation will be the big challenge. If it’s too big to fail it shouldn’t exist. There is bankruptcy protection for almost everything but home mortgages, and said he supported reforms that would allow homeowners to avoid eviction.

He said that the country is behind on essential infrastructure repair, such as water and sewer lines, estimated at 662 billion dollars that will have to be paid for sooner or later. He proposed ‘moving public spending’ to stimulate the economy by creating jobs today in a time of 13% unemployment rather than waiting.

He also said he supports a reporter shield law, of which he is a co-sponsor.

A young woman asked him about the ACORN controversy. Whitehouse said that the film shot by conservative activists was embarrassing, and no one in Congress wanted that fight, but he voted against censure because the response in Congress had ‘the odor of a stampede’. He said that he had served as attorney general and he is committed to due process, not conviction without a fair trial.

He compared another large, national organization, American Airlines. Recently several AA employees were arrested for using the airline to ship cocaine, but no rational person would demand that the airline be closed down because of the wrongdoing of a few employees.

‘I’ll defend my vote to anyone’, he said.

A man in a Vietnam Veterans cap asked him about the National Guard and credit for time deployed for veterans who served in a particular time period and the Senator thought the time would be credited, but referred the questioner to one of his aides to look up the specifics.

I left believing that the Senator will fight for a public option, but what that option will be remains to be seen. Stay tuned.

I would have placed a link here to the Providence Journal, but there isn’t one. Your roving reporter, nurse, artist multitasker may be the only source for this story, but if you have any other coverage, please send it here.

Governor Carcieri Opposes Health Care Reform

It’s not that there’s not valid questions about how we are going to pay for a plan that will insure everyone, and it’s not that there’s not reason to be wary of the details, but Governor Carcieri’s stance is–no we can’t.

Using language that pits uninsured Americans against insured ‘taxpayers’– as if uninsured don’t pay taxes, as if any working person isn’t at risk of losing their insurance along with their job– this is not leadership, it’s division.

Using undocumented immigrants as a scare tactic is something the Governor has been doing for years. His business experience hasn’t translated into better employment for the state, and he does a lot more for big business than small business. Never mind workers. Emergency rooms across the state are feeling the strain as people come in for routine care they can’t get anywhere else. Rhode Islanders are losing jobs and health care and the Governor has no constructive solutions.

Today’s ProJo editorial supports a public option to control costs and insure people who would not be well served by private plans. A little competition won’t hurt either.

And another thing. Representatives of Lifespan were at the meeting. Rhode Island Hospital emergency room is one of the places of last resort for people who have no primary care. They have a lot to gain by reform that insures all Rhode Islanders and keeps non-emergency cases out of the emergency room. Big hospitals are compensated for the free care they give, so actually we already are paying. It’s just that we’re paying for fragmented, money-driven, ineffective care. We can keep applying duct tape to the bottom of the boat and pray it sticks, or we can face reality and fix it right.

On Hartford Ave.

It’s not yet 6am and the brain isn’t awake yet, so here’s some quick impressions of last night’s Town Hall at the Johnston Senior Center.

I made a sign, ‘Health for America, Yes We Can’ in red, white and blue. I could have made one that said, ‘I would really prefer that a single-payer system like the Federal Employees insurance benefit enjoyed by Congress be made available to all but I’ll support an incremental reform like the public option now under discussion because I believe in harm-reduction and I’ll welcome any change for the better’. But the traffic whizzing by on Hartford never would have been able to read that.

The anti people had it easier. They had slogans like–‘No more taxes’. I’m sorry, I think this is dumb. We are going to pay taxes, our right and responsibility is to make sure the taxes are spent for the common good.

Anyway, since the strip of sidewalk at the entrance of the Senior Center was occupied by anti-reform people, I decided to plant myself there to make a visual statement of support–get some diversity out there.

I was next to an anti-tax guy, and I tried to start simple. ‘Do you think that every American should be able to access basic health care?’ He said the insurance companies needed reform. He started to consider that no one should be shut out of health care due to lack of money, but then backtracked. This was off the ‘no tax’ message, end of discussion. He moved to the other end of the sidewalk, and some time later another anti-tax guy showed up smoking what had to be the world’s biggest cigar. He looked real proud, I guess he had the tobacco equivalent of the Hummer. If he ever gets lung disease, are we supposed to tsk, tsk him about his ‘bad choices’? (a stupid sanctimonious phrase I hate. show me any human who never made bad choices.)

I was there about 2 hours. Passing cars honked but it was seldom sure who they were honking for. Two of us were holding signs for health care reform when a tall, blonde woman joined us with an anti sign. We eventually started talking. She complemented me on being capable of making a sign. “I didn’t know that liberals could make their own signs, I thought they just took what the Unions gave them.” We had a fascinating discussion.

She continued to use the word ‘liberal’ the way some use the word ‘queer’, that is, not in a good way. I’m still processing that having different politics would make me seem so alien to her. But I suspect she reads Ann Coulter.

I suspected other things about her. I’ve been baptized three times, never took. The most recent was in Apponaug Pentecostal Church. I have a sensitive nose for the odor of sanctity. I guessed that she was religious, and I came out as a Unitarian, just to be contrary.

She ended up telling me that the Holy Spirit told her I would accept Jesus into my heart as Lord and Savior. She was saying these words of love and holiness with eyes full of anger, with a voice high with rage. I would have been scared, but I’ve been through this before, at a much younger age. I have no use for generic love, especially when they hate everything I believe in.

The discussion stuck at the same point as all the others I’ve had at three Town Halls. Anti-tax, Christian, whatever, they say that if Americans have to die for lack of health care, that’s just how it is. They made bad choices, we can’t afford it, they should just go to the emergency room, that’s our safety net.

I left the sidewalk and checked out the Senior Center. Feelings were high, but it was an orderly question and answer session. Only one or two Larouchites remained to peddle their magazines, from a table outside the door.

Good people can disagree on how to make health care available to all Americans, but when we can’t agree whether, I don’t know what to say.

‘Yes We Can’ was the spirit that put a man on the moon. Yes, we are a great nation, and we can build a system that works well and effectively. ‘No We Can’t’ is the spirit of fear and retreat. Any action we take will be messy, will require investment today for rewards later. Inaction is worse. The least we can do is start bailing, what we really need is to patch up the holes.