All posts by Dr. Michael Forster

Dr. Michael Forster

Mental health parity on the way at last

This is a very big story, as reported in today’s New York Times by Jackie Calmes and Robert Pear:

WASHINGTON — The Obama administration on Friday will complete a generation-long effort to require insurers to cover care for mental health and addiction just like physical illnesses when it issues long-awaited regulations defining parity in benefits and treatment.       

The rules, which will apply to almost all forms of insurance, will have far-reaching consequences for many Americans. In the White House, the regulations are also seen as critical to President Obama’s program for curbing gun violence by addressing an issue on which there is bipartisan agreement: Making treatment more available to those with mental illness could reduce killings, including mass murders….       

“We feel actually like we’ve made a lot of progress on mental health as a result in this year, and this is kind of the big one,” said a senior administration official, one of several who described the outlines of the regulations that Kathleen Sebelius, the secretary of health and human services, will announce at a mental health conference on Friday in Atlanta with the former first lady Rosalynn Carter.       

While laws and regulations dating to 1996 took initial steps in requiring insurance parity for medical and mental health, “here we’re doing full parity, and we’ve also taken steps to extend it to the people covered in the Affordable Care Act,” the senior official said. “This is kind of the final word on parity.”…

Mental health parity is long overdue in America, quite apart from the (terribly important) issue of gun violence.  The next challenge will lie in supplying an adequate number of mental health professionals to meet the need for services.

Dr. Michael Forster

SNAP cuts will damage state’s economic well-being

I commented last month that I thought cuts to the SNAP (“food stamps”) program in Mississippi would undermine the public’s health, given our high poverty rate and heavy dependence on the program, especially by vulnerable populations like children and the poor elderly.  Now that the November 1 cuts have kicked in, we might soon add the state economy itself to the list of damages.

According to the Mississippi Economic Policy Council (mepconline.org), SNAP is a significant factor in the health of local economies throughout the state.  At mid-year, nearly 3500 Mississippi retailers – primarily grocery stores and convenience stores – were authorized to accept SNAP benefits.  In FY 2012, these retailers redeemed $1 billion in SNAP benefits, a figure that’s almost sure to hold for the year following, but will decline as a result of cuts.  Moreover, for every dollar spent, economists say there’s at least $1.70 in economic activity generated - activity that goes well beyond the stores to everyone involved in the food industry production and supply chain, from farmers to truck drivers.

So cuts to safety net programs like SNAP – often cheered by critics who think such programs only encourage dependency and sloth – are felt not only by the recipients, but much more broadly by businesses that provide jobs and communities that need them.

 

Dr. Michael Forster

Are we getting closer to a single-payer health care system?

As criticisms of “Obamacare” and its many shortfalls mount – seemingly from all points along the ideological spectrum (loyal supporters of the president excepted, of course) – one can’t help wondering if we’re not witnessing at last the beginnings of a movement toward a single-payer system.

Just about everyone seems agreed on the following: Our current “system” (because one may only call it a system euphemistically) is broken.  The Affordable Care Act is a patchwork of partial solutions at best, and an unworkable disaster at worst.  It is both economically foolish and morally reprehensible that millions of Americans (many of them our most vulnerable brothers and sisters) should go without health care altogether, go bankrupt trying to pay for it, or depend on hospital emergency rooms to get it.  Constantly rising health care costs are unsustainable and must be checked.

What we don’t agree on is what to do.  My own view – It’s time to look seriously at a single-payer system, starting with universal availability of the “public option” that was excised from early versions of the Affordable Care Act, aka “Medicare for all.”

Dr. Michael Forster

Attack on SNAP will undermine public health

Okay.  Enough people in Congress despise Obamacare (aka, the Affordable Care Act) enough that they’re willing to shut down the government and perhaps disrupt the national (and even world) financial system to try crippling its rollout.  But Obamacare, unfortunately, isn’t the only policy target the fate of which has major public  health implications.  So-called “hard Right” Republicans seem insistent on dismantling what’s left of the economic and social safety net protecting society’s most vulnerable – the poor, disabled, children and elderly.

A key component of this (badly frayed) net is the Supplemental Nutrition Assistance Program (SNAP), still commonly known as “food stamps.”  House Republicans are demanding major cuts to SNAP as part of a general strategy of forcing reductions in federal expenditures.   Advocates of SNAP cuts will point to the rapid increase in expenditures and invoke anecdotes of waste and fraud in the operation of the program.   Regarding the spike in spending, the reason is evident – poverty rates are going up, making more people eligible for assistance.  As for instances of waste and fraud – they are beyond question the exception, not the rule, and surely no justification for damaging reductions in spending.

Make no mistake about it – Cuts to SNAP will hit the growing number of the nation’s poor (nearly 50 million at this point) very, very hard, and will undermine the public’s health by depriving tens of millions (many of the them children and the elderly) of support for sound nutrition, and, it follows, good health.  We should be expanding, not contracting, health services and supports for the poor and vulnerable, especially during a period of protracted economic downturn.  It’s sound policy based on good science, and, in the long run, good economics.

Not to mention good morality.  According the “Feeding America,” a national food bank organization, 20% of our children do not know where their next meal is coming from; cuts to SNAP will bump that number up significantly.  Anyway you slice it, that is a moral outrage.

 

Dr. Michael Forster

A bit of good news on child abuse, but child risk remains a major public health concern

A new report by the National Academy of Science’s Institute of Medicine provides some welcome news on child abuse – over 20 years, awareness is up and the incidence of abuse is down.

But abuse – both physical and sexual – is only part of the big picture of child risk, and that picture is far from rosy.  Neglect – highly correlated with poverty – continues at an undiminished rate, and reports of psychological and emotional abuse to state child protective agencies in fact are rising.

The best epidemiological evidence suggests that at least 1.25 million children (17.2 per 1000) suffer abuse in any given year, with several times that number at risk of abuse.  Given the well-documented long-term, cumulative, and lasting damage inflicted on individuals, families, and communities, child maltreatment rates as one of our greatest public health issues.