Wednesday, April 24, 2013

The Blog is on vacation this week.  Check in next Wednesday. 

Wednesday, April 17, 2013

Mental health rising as an issue in state and federal proposed legislation needs our support

Like a plant breaking through a heap of destruction debris in search of daylight, legislation focusing on buttressing an inadequate mental health system is breaking through the detritus of the gun control debate. So far, Congress is in the process of watered down, stone walling, altering, any attempts to limit access to assault rifles, clips, and purchasers' records in the controversy of what is and what is not protecting the second amendment. Colorado, bucked the trend somewhat with stronger gun control legislation. However, bi partisan agreements at both the Colorado legislature and Congress levels have now begun to zero in on the mental health factors that contributed to the mass shootings of Columbine, Aurora, Virginia Tech, Newtown, and Tucson.

The ability of the shooters to access guns were not the issues in most of these mass shooting tragedies. A common thread was the mental health of the perpetrators. For a period of time, mental health professionals were reluctant to jump on the bandwagon of gun control motivated legislation for fear that all who had a mental illness or autism diagnoses would be viewed as potential mass killers. The public's sophistication seems to have rejected those blanket suppositions. There was also fear that there would be an expansion of requirements of professionals reporting who was not fit to buy a gun would result in unfairly harming patients' rights. Currently, the process is one of a determination by a third party, a judge, and nothing in any proposed legislation so far changes that.

Recently, mental health organizations are realizing that there is a motivation provided by the mass shootings to fund better mental health treatment . An amendment to gun control legislation proposed by Sen. Debbie Stabenow (D- MI) would provide for more mental health centers and a program to train teachers to spot problems of students and to make a referral. . It has an excellent chance of receiving bi-partisan support. Gov. Hickenlooper's proposal to set up hot lines and more mental health centers is also progressing through the Colorado legislature.

Stabenow's proposal addresses a very important point. What if these mass killers had psychiatric intervention in their child hood years? Many parents are quick to spot a problem child, but others are in denial or believe their kid “will grow out of it”, or like the Columbine shooters, their child became expert at hiding their intent from even their parents. What if the slasher of female student's faces in a community college last week had gotten help earlier. The attacker admitted on arrest he had had a fantasy of committing such a deed since he was a child. What if Newtown shooter's mother had realized the danger of including her son in her gun hobby. ?

Stabenow's proposal to train teachers to spot problems of younger students early and to get them to a psychiatrist could be helpful. Our daughter, the teacher, and my husband the doctor rarely get such training in their professional lives. As our daughter said, it is now left to a teacher's instincts to spot that a child is “not normal,

The missing links are whether the parents take the advice of professionals seriously and can afford the follow up. The parents in the Gabby Giffords shooter recognized their son had problems, but according to Giffors husband in a recent CNN interview they , lacked the ability to seek help. Sen. Stabenow proposes to expand Medicaid to provide treatment. The hotline proposed by Gov. Hickenlooper and the expanded mental health centers can help guide perplexed parents and teachers. Obamacare requires health insurance to cover mental health treatment and his proposed budget would provide $130 million for training teachers and providing more mental health centers. These are steps in the right direction that deserve our support.
My column appearing in the online edition of the
Sky Hi Daily News today

Wednesday, April 10, 2013

Whether the President's compromise budget succeeds will depend on the sequester impact

The President's budget proposal was released as a trial balloon last Friday in advance of its formal rollout this Wednesday. It is similar to the Grand Bargain he proposed last summer, and the GOP rejected, to cut future entitlement benefits in return for increasing revenues provided by the rich. What chance the proposal has most likely will depend upon the impact of the sequester, the-across-the-board cuts that are beginning to take effect.

GOP House Speaker John Boehner slammed the door on the President's plan because it contains what he called tax increases and he claimed the White House was holding hostage the GOP desire to cut spending for an agreement to increase taxes. The GOP's budget already passed by the House of Representatives includes continuing the sequester cuts and begins reducing the debt by solely cutting government services and programs, including entitlements. Their bottom line: No new taxes.

Come on, Mr Speaker. The President is not hostage-taking; there is a direct relationship and that is why the President's version is a package plan. Here it is: the more revenue produced, the less amount of unpopular cuts need to be made to reduce the debt in the long-term.

Until the President checked in with his budget proposal, Congress had made the issue a deadlocked choice between two extremes: reducing the debt the GOP/House way versus the plan Senate Democrats are considering of raising taxes on the rich to save Social Security and Medicare “entitlements” in the form we know it. They also want to spend 1 percent more for safety nets for the poor and invest in education, research, roads and port infrastructure. The GOP plan would trim infrastructure, education and research by 16 percent.

All parties agree the costs of Medicare determine the amount of the long-term federal debt and Social Security could go broke in the distant future. The clash of the three budget proposals is also about how to bring those entitlements under control.

To finance Medicare, the GOP House plan would reduce benefits to future recipients by issuing them vouchers (premium support) to buy private insurance, though the amount of support would not keep up with the increasing cost of health care, causing future seniors to pay more out-of-pocket. The Democrats would decrease reimbursements to hospitals and doctors and increase taxes on the rich even more.

Instead of vouchers, President Obama proposes less reimbursement to health providers too, but revenue would be increased by putting a cap of $3 million on the amount the well-off could squirrel away in an IRA, a method used to avoid current taxes.

The President renewed his proposal to lower the way increases in Social Security benefits in the future would be calculated, using the “chained CPI,” tying the cost-of-living raises to different, more real-life factors than they are now, resulting in slowing the benefit increases to future seniors.

Since none of these proposals affect current seniors, a more important factor in forcing compromise is the sequester's impact on the economy and jobs. Polls show those two issues are the top concerns of voters now. The President would replace the sequester with “smart cuts” and increase education, research, and infrastructure funding while protecting the safety net. The President believes his plan would continue to support job growth in a recovering economy and the sequester contained and continued in the GOP's budget is a job and growth retardant. Economic growth is a critical contributor to debt reduction.

By the end of summer, we will know if the GOP/sequester budget will harm jobs and growth because that is when the Great Austerity Experiment we call the sequester will have fully kicked in. This summer's experience will be the ultimate convincer.

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This is my column in the Sky Hi News today. Note: in the rollout this morning, the President also included a $560 billion tax increase on the wealthy and $78 billion increase in cigarette taxes over 10 years. 

Wednesday, April 3, 2013

Medicare...the political hot potato and a compromise brewing

There are political hot potatoes of varying degrees, but one of the hottest is how to keep Medicare viable in the future.

We have come to a polarized legislative standstill full of poison pills fed by one partisan-dominated house of Congress to the other. A third way is sorely needed and boiling up underneath the partisan rhetoric may be a possible compromise.

The decision time is now, since the cost of Medicare in the future is part of the current budget debate before Congress. Those under 55 should keep their eyes wide open as they make plans for their retirement.

I recall attending some political events four or five years ago when angry senior citizens with hand printed signs waived “Don't let government take my Medicare away.” My takeaway was that seniors feel passionately about Medicare, which presents tough political challenges for those seeking to make sure Medicare is available for the next generations.

So far proposed solutions are either unrealistic or politically too hard for constituents to swallow. Those solutions cover the map: to do nothing but to raise taxes or to reduce benefits to all or some, to increase eligibility age, to increase co pays and contributions, or to get it out of government budgets by privatizing it with government subsidized vouchers (aka premium support) that are not enough to keep up with future costs.

The “do nothing” option is no option at all. There is a bulge in numbers of baby boomers tapping into Medicare that is just beginning and costs of medical care have skyrocketed with increasing availability of life extending treatments and equipment. Obamacare helps some, changing reimbursement methods, providing greater access to preventative care, and efficiencies, but that still is not enough to stop costs from increasing until there is nothing left in the non-military budgets to fund infrastructure, education, and social safety nets .

What both political parties have done is what holders of hot potatoes do … toss it to someone else. In this case, they promise no changes will affect those 55 and older. Grandfathers and grandmothers have been grandfathered in.

Republicans have the most motivation to find a third way. For Republicans it is a particularly sensitive topic since seniors exempted by age from proposed changes in Medicare were the only demographic they carried in 2012, other than non-minority men. Their plan to issue inadequate vouchers and move future seniors into the private sector is not popular with voters in general, nor is reducing the debt, the GOP argument for doing it. The voucher concept polled badly in 2012 per Kaiser Health Tracking, and giving seniors the choice between government or private insurance changed little. Debt reduction is a top concern for a mere 5 percent of voters per a recent CBS News/New York Times poll, finishing far behind jobs and the economy and “other.” If they are not careful, the GOP could lose recently retired seniors in future elections.

A potential way out is emerging quietly from the White House and some Republicans seeking an alternative to vouchers. Traditional government-provided Medicare would continue, except the deductibles for doctors visits would increase and the ones for hospital care would be reduced. The theory is that the costs of doctors visits are not increasing nearly as much as the costs of hospital care. The advantage is that seniors would no longer have to pay high prices for supplementals to cover the cost of hospital care. The price the White House may demand for the compromise is to increase some revenue, but it may be the only way the GOP budget hawks can get their way without ticking off a demographic that means so much to them.

My column in the Sky Hi Daily News today

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