Parents protesting 'critical race theory' identify another target: Mental health programs

Tyler Kingkade and Mike Hixenbaugh

NBC News

Originally posted 15 NOV 21

At a September school board meeting in Southlake, Texas, a parent named Tara Eddins strode to the lectern during the public comment period and demanded to know why the Carroll Independent School District was paying counselors “at $90K a pop” to give students lessons on suicide prevention.

“At Carroll ISD, you are actually advertising suicide,” Eddins said, arguing that many parents in the affluent suburban school system have hired tutors because the district’s counselors are too focused on mental health instead of helping students prepare for college.

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In Carmel, Indiana, activists swarmed school board meetings this fall to demand that a district fire its mental health coordinator from what they said was a “dangerous, worthless” job. And in Fairfax County, Virginia, a national activist group condemned school officials for sending a survey to students that included questions like “During the past week, how often did you feel sad?”

Many of the school programs under attack fall under the umbrella of social emotional learning, or SEL, a teaching philosophy popularized in recent years that aims to help children manage their feelings and show empathy for others. Conservative groups argue that social emotional learning has become a “Trojan horse” for critical race theory, a separate academic concept that examines how systemic racism is embedded in society. They point to SEL lessons that encourage children to celebrate diversity, sometimes introducing students to conversations about race, gender and sexuality.

Activists have accused school districts of using the programs to ask children invasive questions — about their feelings, sexuality and the way race shapes their lives — as part of a ploy to “brainwash” them with liberal values and to trample parents’ rights. Groups across the country recently started circulating forms to get parents to opt their children out of surveys designed to measure whether students are struggling with their emotions or being bullied, describing the efforts as “data mining” and an invasion of privacy.

The information is here.

Wit et al. vs. United Behavioral Health and Alexander et al. vs. United Behavioral Health

U.S. Federal Court Finds United Healthcare Affiliate Illegally Denied Mental Health and Substance Use Coverage in Nationwide Class Action

• Landmark Case Challenges the Nation’s Largest Mental Health Insurance Company for Unlawful, Systematic Claims Denials – and Wins

• Groundbreaking Ruling Affects Certified Classes of Tens of Thousands of Patients, Including Thousands of Children and Teenagers 

• Judge Rules, “At every level of care that is at issue in this case, there is an excessive emphasis on addressing acute symptoms and stabilizing crises while ignoring the effective treatment of members’ underlying conditions.”

In a landmark mental health ruling, a federal court held today that health insurance giant United Behavioral Health (UBH), which serves over 60 million members and is owned by UnitedHealth Group, used flawed internal guidelines to unlawfully deny mental health and substance use treatment for its insureds across the United States. The historic class action was filed by Psych-Appeal, Inc. and Zuckerman Spaeder LLP, and litigated in the U.S. District Court for the Northern District of California.

The federal court found that, to promote its own bottom line, UBH denied claims based on internally developed medical necessity criteria that were far more restrictive than generally accepted standards for behavioral health care. Specifically, the court found that UBH’s criteria were skewed to cover “acute” treatment, which is short-term or crisis-focused, and disregarded chronic or complex mental health conditions that often require ongoing care.

The court was particularly troubled by UBH’s lack of coverage criteria for children and adolescents, estimated to number in the thousands in the certified classes.

“For far too long, patients and their families have been stretched to the breaking point, both financially and emotionally, as they battle with insurers for the mental health coverage promised by their health plans,” said Meiram Bendat of Psych-Appeal, Inc. and co-counsel for the plaintiffs who uncovered the guideline flaws. “Now a court has ruled that denying coverage based on defective medical necessity criteria is illegal.”

In its decision, the court also held that UBH misled regulators about its guidelines being consistent with the American Society of Addiction Medicine (ASAM) criteria, which insurers must use in Connecticut, Illinois and Rhode Island. Additionally, the court found that UBH failed to apply Texas-mandated substance use criteria for at least a portion of the class period.

The legal opinion is here.

Decreasing mental health services increases mental health emergencies

Science Daily
Originally published November 20, 2015

Countywide reductions in psychiatric services -- both inpatient and outpatient -- led to more than triple the number of emergency psychiatric consults and 55 percent increases in lengths of stay for psychiatric patients in the emergency department. The before and after study of the impact of decreasing county mental health services was published online in Annals of Emergency Medicine ('Impact of Decreasing County Mental Health Services on the Emergency Medicine').

"As is often the case, the emergency department catches everyone who falls through the cracks in the health care system," said lead study author Arica Nesper, MD, MAS of the University of California Davis School of Medicine in Sacramento. "People with mental illness did not stop needing care simply because the resources dried up. Potentially serious complaints increased after reductions in mental health services, likely representing not only worse care of patients' psychiatric issues but also the medical issues of patients with psychiatric problems."

The entire article is here.

The Problem with Drug Monopolies: Ethics and Money

How the Government Could Punish That Hedge Fund Bro Who Wanted to Raise a Drug’s Price 5,000 Percent

By Jordan Weissmann

Slate.com

Originally published September 22, 2015

Here is an excerpt:

Assuming his conscience doesn't send Daraprim's price all the way back to $13.50 a tablet, Shkreli will be able to get away with his price gouging for a simple reason: Even though the drug's patents are long-expired, nobody else makes it. Thus, he has an effective monopoly over a life-saving treatment that lacks an alternative. One could argue that this speaks to the fundamental flaws of American oversight of the pharmaceutical industry. While the rest of the developed world uses price controls to keep medication affordable, the U.S. allows drug companies to charge whatever they please, with the hope that once their patents expire, competition from generics will drive down costs. To some slight extent, that's worked—about 8 out of every 10 prescriptions filled in this country are for generic drugs. But as production has become concentrated in the hands of fewer and fewer manufacturers, the prices of some generics have rapidly risen in recent years. And the costs of some specialty medications, like Daraprim, have skyrocketed.

The entire article is here.

VA watchdog shelves 36,000 complaints, draws ire from whistleblowers

By Donovan Slack
USA TODAY
Originally published September 23, 2015

The chief watchdog at the Department of Veterans Affairs investigates less than 10 percent of the nearly 40,000 complaints it receives annually about problems at the agency, even when they concern potential harm to veteran health, Deputy Inspector General Linda Halliday said Tuesday.

The Office of Inspector General, which is responsible under federal law for rooting out mismanagement and abuse at the agency, simply doesn't have the resources, Halliday said at a hearing of the Senate Homeland Security and Governmental Affairs Committee.

"There is a serious discrepancy between the size of our workforce and the size of our workload," Halliday said. She said her office has roughly 650 professional staff members while the agency they investigate has more than 350,000 employees and a budget greater than $160 billion. "The OIG is not right-sized to respond to all the complaints that we currently receive."

The entire article is here.

#BlackLivesMatter — A Challenge to the Medical and Public Health Communities

By Mary T. Bassett
The New England Journal of Medicine
Originally posted February 18, 2015

Here is an excerpt:

As New York City's health commissioner, I feel a strong moral and professional obligation to encourage critical dialogue and action on issues of racism and health. Ongoing exclusion of and discrimination against people of African descent throughout their life course, along with the legacy of bad past policies, continue to shape patterns of disease distribution and mortality. There is great injustice in the daily violence experienced by young black men. But the tragedy of lives cut short is not accounted for entirely, or even mostly, by violence. In New York City, the rate of premature death is 50% higher among black men than among white men, according to my department's vital statistics data, and this gap reflects dramatic disparities in many health outcomes, including cardiovascular disease, cancer, and HIV. These common medical conditions take lives slowly and quietly — but just as unfairly. True, the black–white gap in life expectancy has been decreasing, and the gap is smaller among women than among men. But black women in New York City are still more than 10 times as likely as white women to die in childbirth, according to our 2012 data.

The entire article is here.

Equitable Access to Care — How the United States Ranks Internationally

Karen Davis, Ph.D., and Jeromie Ballreich, M.H.S.
N Engl J Med 2014; 371:1567-1570
October 23, 2014
DOI: 10.1056/NEJMp1406707

Here are two excerpts:

According to a 2013 Commonwealth Fund survey of adults in 11 high-income countries, the United States ranks last on measures of financial access to care as well as of availability of care on nights and weekends. Uninsured people in the United States are particularly likely to report encountering barriers to care.

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The United Kingdom, France, Germany, Norway, Sweden, and Switzerland stand out as leaders in ensuring equitable financial access to care. Switzerland, which provides coverage through nonprofit private insurance plans with deductibles, ensures that cost sharing is lower for lower-income individuals. The United Kingdom, Norway, and Sweden have public health care systems for the entire population with little or no patient cost sharing and allow a limited role for private insurance. France has a public insurance system, and Germany has a social insurance system with competing private “sickness funds.”

The entire article is here.

Bottlenecks in Training Doctors

By The Editorial Board
The New York Times
Originally published July 19, 2014

The new head of the Department of Veterans Affairs, Sloan Gibson, told a Senate committee last week that he needed $17.6 billion over the next three years to hire some 1,500 doctors, 8,500 nurses and other clinicians to reduce the unconscionably long waiting times that many veterans now endure before they are able to see a doctor.

That news was bad enough, but the department’s problems are emblematic of an even deeper problem: a nationwide shortage of doctors, especially primary care doctors, and other health care professionals, that will only get worse in coming years. No less alarming, the current medical education system is ill-equipped to train the number of professionals needed.

Experts disagree over how bad the current shortages are. But virtually all agree that the problem is acute in rural areas and in poor urban neighborhoods. As of June 19, according to one estimate cited by analysts in the Department of Health and Human Services, there was a shortage of 16,000 primary care physicians in such underserved areas.

The entire story is here.

Architect Of Health Law Says Reform Is 'Never Finished'

The University of New Orleans
Originally published May 7, 2014

Two polls released this week reveal challenges ahead for the Affordable Care Act.

Gallup found the nation’s uninsured rate dropped to 13.4 percent last month, the lowest monthly uninsured rate since the company began tracking it in 2008. But that means 32 million people remain without coverage.

And a Pew Research Center poll shows that 55 percent of Americans disapprove of the 2010 health care reform law, which mandates that everyone have health insurance and that it be made available to even those with pre-existing medical conditions.

The entire story is here.

The States With the Worst Healthcare Systems

Nearly a quarter of West Virginians have lost six or more teeth, and other findings from a new Commonwealth Fund report.

By Olga Khazan
The Atlantic
Originally published May 1, 2014

Here is an excerpt:

Healthcare in Mississippi and in other Southern states is unlikely to become more equitable anytime soon, however. As the study authors note, 16 of the states in the bottom half of the ranking have opted not to expand Medicaid under the Affordable Care Act to adults making up to 138 percent of the federal poverty level.

The entire article is here.

Full Disclosure — Out-of-Pocket Costs as Side Effects

Peter A. Ubel, M.D., Amy P. Abernethy, M.D., Ph.D., and S. Yousuf Zafar, M.D., M.H.S.
N Engl J Med 2013; 369:1484-1486October 17, 2013DOI: 10.1056/NEJMp1306826

Few physicians would prescribe treatments to their patients without first discussing important side effects. When a chemotherapy regimen prolongs survival, for example, but also causes serious side effects such as immunosuppression or hair loss, physicians are typically thorough about informing patients about those effects, allowing them to decide whether the benefits outweigh the risks. Nevertheless, many patients in the United States experience substantial harm from medical interventions whose risks have not been fully discussed. The undisclosed toxicity? High cost, which can cause considerable financial strain.

Since health care providers don't often discuss potential costs before ordering diagnostic tests or making treatment decisions, patients may unknowingly face daunting and potentially avoidable health care bills. Because treatments can be “financially toxic,”1 imposing out-of-pocket costs that may impair patients' well-being, we contend that physicians need to disclose the financial consequences of treatment alternatives just as they inform patients about treatments' side effects. Health care costs have risen faster than the Consumer Price Index for most of the past 40 years.

The entire article is here.

Professionalism and Caring for Medicaid Patients — The 5% Commitment?

Lawrence P. Casalino, M.D., Ph.D.
October 9, 2013 DOI: 10.1056/NEJMp1310974

Medicaid is an important federal–state partnership that provides health insurance for more than one fifth of the U.S. population — 73 million low-income people in 2012. The Affordable Care Act will expand Medicaid coverage to millions more. But 30% of office-based physicians do not accept new Medicaid patients, and in some specialties, the rate of nonacceptance is much higher — for example, 40% in orthopedics, 44% in general internal medicine, 45% in dermatology, and 56% in psychiatry. Physicians practicing in higher-income areas are less likely to accept new Medicaid patients. Physicians who do accept new Medicaid patients may use various techniques to severely limit their number — for example, one study of 289 pediatric specialty clinics showed that in the 34% of these clinics that accepted new Medicaid patients, the average waiting time for an appointment was 22 days longer for children on Medicaid than for privately insured children.

The entire story is here.

Thanks to Gary Schoener for this information.

Barter sometimes allow patients to pay for health care they otherwise could not afford

By Consumer Reports
Published: September 30

Here is an excerpt:

Avitzur, who is medical adviser to Consumer Reports, recommended pool therapy, and the patient responded to it like the proverbial fish to water, shedding all his excess weight and experiencing periods of pain relief for the first time in years. But his insurance benefits for physical therapy ran out, and he couldn’t afford to continue. Avitzur suggested that he offer to help out as a therapy assistant in exchange for free use of the pool, and the pool manager accepted the deal.

Resorting to the age-old art of bartering has helped at least some of the nearly 49 million Americans who are uninsured and the millions more whose health benefits are so skimpy they often can’t afford care.

The entire story is here.

New bill breaks down telehealth barriers

By Eric Wicklund
Healthcare IT News
Originally published September 13, 2013

A bill introduced in Congress this week would enable healthcare providers to treat Medicare patients in other states via telemedicine without needing different licenses for each state.

The "TELEmedicine for MEDicare Act", or HR 3077, was introduced Sept. 10 in the House by Reps. Devin Nunes, R-Calif., and Frank Pallone, D-N.J. Nicknamed the TELE-MED Act, it seeks to update current licensure laws "to account for rapid technological advances in medicine," according to its sponsors.

“By reducing bureaucratic and legal barriers between Medicare patients and their doctors, it expands medical access and choice for America’s seniors and the disabled,” Nunes said in a statement.

The entire story is here.

When Doctors Discriminate

By JULIANN GAREY
The New York Times - Opinion
Published: August 10, 2013

Here is an excerpt:

If you met me, you’d never know I was mentally ill. In fact, I’ve gone through most of my adult life without anyone ever knowing — except when I’ve had to reveal it to a doctor. And that revelation changes everything. It wipes clean the rest of my résumé, my education, my accomplishments, reduces me to a diagnosis.

I was surprised when, after one of these run-ins, my psychopharmacologist said this sort of behavior was all too common. At least 14 studies have shown that patients with a serious mental illness receive worse medical care than “normal” people. Last year the World Health Organization called the stigma and discrimination endured by people with mental health conditions “a hidden human rights emergency.”

I never knew it until I started poking around, but this particular kind of discriminatory doctoring has a name. It’s called “diagnostic overshadowing.”

According to a review of studies done by the Institute of Psychiatry at King’s College, London, it happens a lot. As a result, people with a serious mental illness — including bipolar disorder, major depression, schizophrenia and schizoaffective disorder — end up with wrong diagnoses and are under-treated.

The entire sad story is here.

U.S. sees lower-than-expected Obamacare insurance costs

By David Morgan
Reuters
Originally published July 18, 2013

Hoping to gain the high ground in an escalating war of words over Obamacare, the U.S. administration on Thursday forecast sharply lower than expected insurance costs for consumers and small businesses in new online state healthcare exchanges.

The exchanges represent the centerpiece of President Barack Obama's Patient Protection and Affordable Care Act, and their success could depend on the cost of so-called "silver plans" with mid-range premiums, which are expected to attract the largest number of enrollees.

A report by the Department of Health and Human Services (HHS) said data from 10 states and the District of Columbia shows preliminary 2014 premiums on the lowest-cost mid-range silver plans in those marketplaces to be 18 percent lower on average than earlier administration and congressional estimates.

The entire story is here.

Dementia Rate Is Found to Drop Sharply, as Forecast

By GINA KOLATA
The New York Times
Published: July 16, 2013

A new study has found that dementia rates among people 65 and older in England and Wales have plummeted by 25 percent over the past two decades, to 6.2 percent from 8.3 percent, the strongest evidence yet of a trend some experts had hoped would materialize.

Another recent study, conducted in Denmark, found that people in their 90s who were given a standard test of mental ability in 2010 scored substantially better than people who reached their 90s a decade earlier. Nearly one-quarter of those assessed in 2010 scored at the highest level, a rate twice that of those tested in 1998. The percentage severely impaired fell to 17 percent from 22 percent.

The entire story is here.

Poll: Most Americans Don’t Want Congress to Repeal Obamacare

By Alex Roarty
National Journal
July 22, 2013

Americans aren’t ready to repeal Obamacare. But that doesn’t mean they think its implementation is going well.

A majority of adults don’t want to repeal the Affordable Care Act, according to the latest United Technologies/National Journal Congressional Connection Poll, preferring instead to either spend more on its implementation or wait to see if changes are needed later.

But based on recent news that the White House is delaying its employer health insurance mandate, the public appears convinced that the law’s implementation is going poorly. A majority of Americans say the one-year delay is a sign the White House is ill-prepared for a law already facing mounting problems; only slightly more than one-third of adults say putting off the requirement shows the president wants to make sure implementation goes smoothly.

The entire article is here.

Diagnosis: Insufficient Outrage

By H. GILBERT WELCH
The New York Times - Op Ed
Published: July 4, 2013

RECENT revelations should lead those of us involved in America’s health care system to ask a hard question about our business: At what point does it become a crime?

I’m not talking about a violation of federal or state statutes, like Medicare or Medicaid fraud, although crime in that sense definitely exists. I’m talking instead about the violation of an ethical standard, of the very “calling” of medicine.

Medical care is intended to help people, not enrich providers. But the way prices are rising, it’s beginning to look less like help than like highway robbery. And the providers — hospitals, doctors, universities, pharmaceutical companies and device manufactures — are the ones benefiting.

A number of publications — including this one — have recently published big reports on the exorbitant cost of American health care. In March, Time magazine ran a cover story exposing outrageous hospital prices, from $108 for a tube of bacitracin — the ointment my mother put on the scrapes I got as a kid and that costs $5 at CVS — to $21,000 for a three-hour emergency room evaluation for chest pain caused by indigestion.

The entire story is here.

End-of-Life Care Improves But Costs Increase, Study Finds

by E.J. Mitchell
The Medicare News Group
Originally published July 12, 2013

Improvements in end-of-life care have occurred rapidly for Medicare patients but costs have increased, according to a new Dartmouth Institute brief that was released today. The study revealed that beneficiaries in their last six months of life spent fewer days in the hospital and that more patients received hospice services in 2010 compared to 2007.

However, Medicare spending for chronically ill patients at the end of life increased more than 15 percent during that time period, while the consumer price index rose only 5.3 percent.

The data from the brief, which is through the Dartmouth Atlas Project, also found that in 2010 compared to 2007:

• patients were less likely to die in the hospital;
• patients were as likely to spend time in intensive care units (ICUs) during the last six months of life;
• the variations in end-of-life care at some academic medical centers quickly changed;
• patients spent more days in hospice care; and
• patients were more likely to see more than 10 physicians during the last 6 months of life.
• The Dartmouth Atlas brief found that across hospitals improvement was variable, with some experiencing rapid change while others showed little improvement.

The entire article is here.