Cash-Only Psychiatry

Fox News psych pundit Keith Ablow warns that having affordable insurance makes America soft and infantile.

But Fox News’ resident psychiatrist Dr. Keith Ablow may win the prize for the most outrageous reaction. In a column posted on and during an interview Monday afternoon on the network, Ablow claimed that the court’s decision will “iInfantilize” Americans:

ABLOW: [T]oday it could be healthcare, tomorrow it could be a hybrid vehicle that you are penalized financially for not buying. It takes control of your behavior in the way that a parent would of a child, and it diminishes us in terms of our autonomy and ability to achieve things even for liberty on the world stage, quite literally.

I’m only a nurse, but in my observation, mental illness takes control of people’s behavior in ways that devastate their own lives and the lives of people close to them. Mental illness often strikes in early adulthood, turning promising students into people who struggle all their lives with disability. People with mental illness are likely to suffer loss of earning power, to the point of living in chronic poverty. It’s not that people can’t recover, but mental illness is common, difficult to treat, and often undiagnosed. Good psychiatrists and counselors are often not available to the people who need them the most. This care is expensive, and when states are cutting costs mental health treatment programs disappear while the need grows.

If Dr. Ablow has refused gummint insurance, such as Medicare, Medicaid, VA— then he gets credit for being consistent. He would only spend his non-TV time ministering to the wealthy, but the wealthy suffer from mental illness too.

If he takes the gummint money and goes on Fox to try to shame people for wanting affordable health care– I think there’s a name for that kind of thing. Projection? Reaction Formation? Denial? Snake Oil Peddling?

Be Fair to Those Who Care

Salon has a review of the third day of the Supreme Court hearings on the Affordable Care Act, titled ‘A Brutal Day for Health Care.’

What I hear on the radio and read in the news as I work in the industry has me heartsick. Science, common sense and common decency say we cannot be a healthy or just nation when some of our hardest workers are one health problem away from bankruptcy. I see the expensive and devastating consequences of having to postpone basic preventive care. With a demographic bulge of older Americans entering Medicare, it seems insane to set them up to enter with dire needs when basic primary care could keep most of us healthy.

On the front lines of health care are millions of low-wage workers, many of whom lack health insurance themselves. They will be some of the first people who will benefit from strong health care reform. If you don’t think of a family, a worker, or an elder when you hear the word, ‘Medicaid’, you should. These are the people I serve. Why should those whose labor makes a public good possible be denied the benefits?

The federal spending issue turns on the expansion of Medicaid. Under the ACA, millions of the working poor – people with incomes up to 133 percent of the federal poverty level – are eligible for Medicaid. From 2014 to 2016, the federal government will pay 100 percent of the costs. Then its share decreases, to 90 percent after 2020. Because the ACA also gives states assistance with their new administrative costs, overall state spending will actually be lowered.

Twenty-six states are claiming that this conditional spending unconstitutionally coerces them, because they cannot realistically forgo the money, and because if they refuse to expand their rolls, they might lose every cent of Medicaid money. But let’s be clear: This is not about the states wanting to conserve their own money. It is about the states refusing to spend federal money, to help people that they do not want to help. (Paul Clement, the attorney for the challenging states, declared that his argument would not change if the federal government permanently paid 100 percent of the costs.)

Last week at Brown I heard a legal expert, Sara Rosenbaum, say that this case is the most important since Brown v. Board of Education. Those times also were contentious and painful. This time I fear that we will land on the wrong side of history.

Enlightened Self-Interest

This study puts numbers on what nurses and providers who work with low-income Americans already know– medical care when it’s needed saves lives, health and money…

When poor people are given medical insurance, they not only find regular doctors and see doctors more often but they also feel better, are less depressed and are better able to maintain financial stability, according to a new, large-scale study that provides the first rigorously controlled assessment of the impact of Medicaid.

Part of our health care problem is that we fail to prevent disease, and end up spending huge bucks in the hospital. Most of the people I work for are on Medicaid, most of them are elderly or disabled. There’s a trickle-down effect when a grandmother babysits so a mother can work. There’s security for middle aged people whose parents have health insurance. That’s not even taking into account the lifelong benefits of maternal-child health.

It will take more than this study to convince politicians who believe that tax breaks for the rich are more important than life-saving services for the poor, but it’s good to have the numbers to back up what we see every day.

Tough Week for Women

Good thing my gyn gave me a reminder call for my yearly tuneup. I’d have hated to miss that, it takes months to reschedule and the doctor is very busy. I told her I was tired all the time, and she gave me a slip for some blood tests. Gyn is a form of primary care, for some women the only primary care they get.

This made me more sensitive to the situation of women in Indiana, who depend on Planned Parenthood for their health care. Planned Parenthood will no longer be reimbursed for Medicaid patients…

Medicaid patients are now paying for their own health services at Indiana’s Planned Parenthood clinics or looking for alternatives after the group ran out of private donations that had been paying those patients’ bills.

A state law that took effect in May denied Planned Parenthood Medicaid funds for general health services it provides to low-income women, including breast exams, birth control and Pap smears.

Over 90% of Planned Parenthood’s services are primary, preventive and educative.

Like all the young women I knew, I went there when I needed a prescription for birth control. I also got blood pressure checks, health advice and pap smears. I never got better care from private doctors than I got at Planned Parenthood.

I asked the secretary at my gyn whether they accept Medicaid patients. She looked at me sympathetically, and said that if I switched to Medicaid they could probably still see me. I said I was looking for gynecologists who accept Medicaid and she said they don’t take that insurance for new patients. She mentioned the Women’s Cancer Screening Program as a resource.

I used to refer women to them, and they do the best they can with a number of different providers. They save lives, they could do much more with more resources. Still, it’s not like having a clinic you can go to when you need a doctor.

Gyn, like dental, is one of those essential services that gets cut and cut again. I think about women in Indiana who will wait longer to see a doctor for cancer screening, for primary care, for birth control. They will search for a private doctor who accepts Medicaid, and maybe not find one.

This is not a good time for women who don’t have money or influence. Shutting down clinics is good politics, a few anonymous women giving up on cancer screening because no doctor will accept their insurance won’t get much attention because, frankly, we’re used to it.

The Federal Government has appealed
, the judge will decide on July 1. This action by the Feds is an example of why it matters who we elect as president and why the two parties are not the same.

WOMEN’S CANCER SCREENING- Several years ago I referred a woman to the Women’s Cancer Screening Program. She was uninsured and had never been able to get follow-up care for an ominous lump she had discovered in her breast. She did get help through the program, though it took a while. She had her breast removed on Valentines Day, that always seems especially sad to me. I ran into her a couple of years later, she was well, happy to be alive. She was working in a low-wage job caring for the elderly. It’s not uncommon for those who give care to be uninsured. The Women’s Cancer Screening Program doesn’t have a central location where women can walk in for care, but has a list of providers who will give free care to qualified women. It’s a tough process, and the heart of the program are the dedicated outreach workers who go where the need is and talk to women one-on-one.