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.
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.
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.
Is the health care bill so bad we have to put it out of its misery, or can we save something and work for better? Salon has a prescription.
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.
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.
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.
The heat, the humidity, the hate, the stupidity… It’s hard to think straight. To my Republican friends, I apologize. The Larouchites defy categorization, and Larouche likes to run in Democratic primaries. He did pretty well at times in the South.
Of course, in the South they have a saying. ‘Just ’cause the cat has kittens in the oven don’t make them biscuits.’ The Democratic Party doesn’t want anything to do with him, but they can’t legally keep him from claiming any label he wants.
Larouche accuses President Obama of failing to adopt the single-payer plan he is advocating–
There is no rational argument that can be made against LaRouche’s proposals. They provide health care and funding sources—whereas the Obama plan provides neither. What Obama’s does, instead, is to provide a British-Nazi-style apparatus to kill people, as part of a British imperial drive to utterly destroy the only threat to their world domination, the republic of the United States. And that must be stopped.
I don’t know how long Larouche has had any interest in health care, but he has a history of attacking politicians from both the left and the right flank. I don’t stay up at night worrying that the Redcoats are coming, but some do. The British, of course, have a single-payer system that insures all their citizens.
Insuring all our citizens is not an agreed goal. I talked to a lot of people at the Town Hall meetings, and often the same ones who were carrying signs about the evils of rationing explained to me that some Americans were just going to have to die of preventable diseases.
We don’t have enough doctors.
We don’t have enough money.
They made bad choices and chose not to buy insurance–tough luck.
Women have too many babies they can’t afford. (This from a man who said he was a pro-lifer)
The Constitution doesn’t mention health insurance.
They can go to the Emergency Room.
Most of them are illegal aliens anyway.
I am not an economist or a Constitutional scholar. All I can offer is my own witness to the waste, stupidity, heartlessness and mis-allocation of resources that I see every day in our current ‘system’. I think that some of the anger being turned against efforts to fix this mess comes from a sense of the insecurity most of us face with our job-linked insurance. We need reform and we need it now.
I recognized the Larouche disciples because I had encountered them in New Hampshire, in 1977, when I was part of the Clamshell Alliance organization against nuclear power. The Clam was an education in all that can go wrong and right with a political organization. I remember hearing rumors that provocateurs had infiltrated, and finding the thought laughable. We were quite capable of fouling things up on our own without outside help. But years later Freedom of Information Act records showed that there were indeed spies and provocateurs.
Which leads me to the tough practicality of Martin Luther King. Nonviolence and civility are morally powerful tools for persuading opponents and winning allies. They are also powerful safeguards against infiltrators who try to undermine your cause by provoking violence in word or deed.
When I went to the Town Hall, I did not name-call, my sign was pro-reform, not anti anyone. I talked to people and tried to use persuasion. I clapped for Rep. Langevin, to let him know he had supporters, but I didn’t boo anyone.
To my Republican friends, I would ask you to strongly disown the Nazi and ‘death panel’ rhetoric, and all who use them. If the Larouchites show up with their sign tell them that they do not represent your views. Stop accepting their magazines with the vile picture on the back cover. To my Democratic friends, I would remind you that non-violence and civility are the tools of the strong. There were a good number of people in West Warwick who were not from there. There will be no shortage of provocation. Counter lies with truth- the arc of the moral universe is long but it bends towards justice.
If I had known I would have brought a sign. I got there at 3:30 and the anti-reform people were out in force, at least a hundred were there already. The pro-reform people arrived later, but enough were able to get inside to form a loud cheering section for Congressman Langevin to balance out the loud boos.
A couple of young men had set up a lunch table as a slam at ACORN, who they believed was going to lure hundreds to the site at noon by offering box lunches. I didn’t see ACORN anywhere, and the lunch table was wilting in the sun.
I got into conversation with one of them, a guy named Ryan. He had studied government and business, I work in nursing. I told him what I see happen to Americans who don’t get coverage until their health is wrecked and they qualify for disability. He acknowledged that people die for lack of care but said we can’t afford to cover everyone, and we don’t have enough doctors. If people choose not to get insurance they take the consequences. ‘This is not a Democracy’, he said, ‘it’s a Constitutional Republic.’ Not being a political scientist, I had no answer for this. I heard the same words exactly from a questioner inside later, so this is a talking point, clearly.
Ryan and I talked back and forth, but finally could agree only on the point that disease is bad and cures are welcome. At least the conversation was civil. I told Ryan that this ‘Nazi’ talk was offensive and he denied that anyone from their side would use such language. I was almost embarrassed to have brought it up. But before the line of citizens was allowed into the hall, someone had set up a huge picture of Barack Obama with a Hitler mustache, and later I saw a woman holding a glossy magazine with the same picture on the back cover. There was a bald guy with a bullhorn wearing ‘Joker’ makeup, I tried to make eye contact but maybe my nurse’s scrubs put him off, he avoided me.
A couple of Brown medical students were there in doctor garb advocating for the public option. Some friends over age 65 came with signs for health care reform.
Chris Young’s associate, a pretty young woman I have seen with him at hearings before, was holding an anti-abortion sign. This led to me getting into another conversation, with an intense man who decried ‘ripping babies from the womb’, but supported the Governor cutting insurance for pregnant women because women shouldn’t have babies they can’t afford. I guess I’m fortunate that my father was in the Army when I was born, and my mother got government health insurance.
To both of these men I argued that Medicare lifts a burden off my generation by giving us peace of mind about our parent’s medical care. Neither of them really had an answer to that, other than that Medicare’s okay, but we don’t want any expansion.
Having arrived so early I was toward the front of the line, I think about 400 were able to get in, filling all the seats and the gallery in back, with about 10 people in wheelchairs down front.
A screen displayed myths and facts about the health care legislation.
The Congressman was calm, had answers to all the questions, and firm on the benefits of reform and expanding coverage. There were many questions, mostly from the opposition. Many had come prepared with speeches, they were generally able to be heard.
It would have been even better if a loud contingent, mostly in the center of the room, had not taken the call to shut down discussion so literally. They hollered, they booed, they even drowned out questions from their own side, prompting others to yell, ‘shut up’. They set a nasty tone and slowed everything down. Chris Young hollered, he was escorted out, he came back and began hollering at intervals again. His associate shrieked, but only once. Thank you for your restraint, miss.
One of the most interesting moments was when a man with an accent asked if the plan would fill America’s hospitals with illegal aliens working as doctors and nurses so that we wouldn’t have to pay citizens. He heard it on Glenn Beck.
Many of my fellow-workers in health care were born outside of the US. They are here legally. We all undergo background checks every time we change jobs. Is it going to be open season on them now? A woman sitting in front of me, when Congressman Langevin asked ‘who are the uninsured?’ shouted–‘illegal aliens!’
The town hall wrapped up sometime around 7:30. The shouters managed to obstruct enough to prevent a large number of people from having a chance to speak by slowing things down.
Outside, the crowd was exuberant, the cameras were there. The anti-reform group had won the PR contest.
We don’t have a health care system. We have a fragmented mess. I think some of the fuel for this anger is a justified sense of insecurity. I think the blame is misplaced and that delay and half-measures will cost more and accomplish less.
I had a sense of religious zeal when I heard people speak about the ‘free market’– a faith I don’t share. But I’m a Unitarian, and I believe in the worth and dignity of every person, so religion motivates me as well.
I was not expecting to be face to face with nice, well-informed people who conceded that Americans will die for lack of care, but that’s how it is. It’s a philosophical gap I can’t get over.
I’ll probably be off the net for a couple of days, because I’m working this weekend, but I have one more thing to say.
Sarah Palin, according to some accounts, is declaring victory over something because she scared people with her ‘death panel’ accusations. The Dems are backing away from funding patient’s consultations with their doctors about advance directives.
The elderly people I work with, for the most part, face mortality with more grace and courage than you would know if you get your news from the stupid popular press–which mostly covers face lifts.
They are hard working people who survived the Depression and a World War–hard times national and personal.
I don’t presume to speak for them, because each person has her own idea of what is right and what is wrong. But they are quite capable of speaking to their doctors and families about what they want. Given an option to schedule time to speak to their doctor about advance directives, some will take it and some won’t. But they can still count, and they are not afraid of the ‘D’ word.
Trying to shame the elderly out of speaking about death will work about as well as shaming the young out of speaking about sex. A frank discussion of the kind that might have helped Sarah Palin’s daughter to avoid becoming a mother at such a young age.
Maybe Palin believes she will be Raptured up and will not have to be exposed to the messy realities. Or maybe she creates her own reality, and has a talent for collecting a following.
Be a part of the flock if you want. You know what they do to sheep. Getting fleeced is the least of it.