Health

Senate Health Care Bill Off Fast Track

It looks like BHCA (the Better Health Care Act, which isn’t) is not going to be voted on before the July 4 break, as Senator McConnell had hoped. I don’t see how he thought he could put such a terrible bill through committee, without hearings, without almost no debate, without amendments, and get a vote passed.  The horrible CBO score did him in.  Chaos broke loose.

Here’s a nice summary of the the bill:

Trump has invited Senators from both parties over to the White House to discuss health care. I would love to be a fly on that wall.  To discuss the issue, you have to understand the issue.

Breaking: The Senate Health Care Bill Gets Scored

The House Bill said 23 million would lose insurance under the House GOP plan to replace Obamacare.

Now the Senate version has been scored and it is…. just as bad.

The Senate bill to repeal the Affordable Care Act would increase the number of people without health insurance by 22 million by 2026, a figure that is only slightly lower than the 23 million more uninsured that the House version would create, the nonpartisan Congressional Budget Office said Monday.

Next year, 15 million more people would be uninsured compared with current law, the budget office said.

Silver lining?

The legislation would decrease federal deficits by a total of $321 billion over a decade, the budget office said.

Good news unless you are uninsured and get sick.  The deficits mostly come from GOP bill cuts, i.e., the spending cut on Medicaid by 26% by 2026

To be honest, I really thought it would be somewhere around 15 million after 10 years.  Nope, it’s 22 million.  A disaster for the GOP.  And most of that — well, 15 million — would happen right away.  That would have a huge impact on the 2018 elections if this gets passed.

All Hail ACHA 2.0

Well, after weeks of secrecy, the Senate version of Obamacare “Repeal and Rewhatever” (PDF) is here. Remember, the House version of the ACHA would result in 23 million people becoming uninsured, and even Trump called it “mean”.  Is the Senate version any better?  Not much:

Here is how the Senate bill works:

  • The Senate bill begins to phase out the Medicaid expansion in 2021 — and cuts the rest of the budget’s program too. The Senate bill would end the Affordable Care Act’s expansion of Medicaid to millions of low-income Americans. This program has provided coverage to more Americans than the private marketplaces
  • It would also cut the rest of the public insurance program. Better Care would also limit government spending on the rest of the Medicaid program, giving states a set amount to spend per person rather than the insurance program’s currently open-ended funding commitment.
  • The Senate bill provides smaller subsidies for less generous health insurance plans with higher deductibles. The Affordable Care Act provides government help to anyone who earns less than 400 percent of the federal poverty line ($47,550 for an individual or $97,200 for a family of four). The people who earn the least get the most help. The Senate bill would make those subsidies much smaller for many people, and only provide the money to those earning less than 350 percent of the poverty line ($41,580 for individuals and $85,050 for a family of four). The Senate bill will tether the size of its tax credits to what it takes to purchase a skimpier health insurance plan than the type of plans Affordable Care Act subsidies were meant to buy. Essentially, these tax credits buy less health insurance.
  • The Senate bill repeals the individual mandate — and replaces it with nothing. The bill gets rid of the Affordable Care Act’s unpopular requirement that nearly all Americans carry health coverage or pay a fine. This could cause significant disruption in the individual market because it takes away a key incentive healthy people have to buy coverage, meaning only sick people may sign up.  This drives up premiums, deductibles, and co-pays.
  • The bill would cut taxes for the wealthy. Obamacare included tax increases that hit wealthy Americans hardest in order to pay for its coverage expansion. The AHCA would get rid of those taxes. Obamacare was one of the biggest redistributions of wealth from the rich to the poor; the AHCA would reverse that.
  • The Senate bill defunds Planned Parenthood for one year. This would mean Medicaid patients could no longer seek treatment at Planned Parenthood clinics. Experts expect this would result in low-income Americans getting less medical care and having more unintended pregnancies, as access to contraceptives would decline.
  • All in all, the replacement plan benefits people who are healthy and high-income, and disadvantages those who are sicker and lower-income. The replacement plan would make several changes to what health insurers can charge enrollees who purchase insurance on the individual market, as well as changing what benefits their plans must cover. In aggregate, these changes could be advantageous to younger and healthier enrollees who want skimpier (and cheaper) benefit packages. But they could be costly for older and sicker Obamacare enrollees who rely on the law’s current requirements, and would be asked to pay more for less generous coverage.

Shorter story: the rich get tax breaks, the poor and sick get screwed. It’s a reverse Robin Hood bill.

Let’s recall what Sen. Mitch McConnell said about the Affordable Care Act in January:

MCCONNELL: Well, what you need to understand is that there are 25 million Americans who aren’t covered now. If the idea behind Obamacare was to get everyone covered, that’s one of the many failures. In addition to premiums going up, copayments going up, deductibles going up. And many Americans who actually did get insurance when they did not have it before have really bad insurance that they have to pay for, and the deductibles are so high that it’s really not worth much to them. So it is chaotic. The status quo is simply unacceptable.

McConnell was right in every criticism he made of the ACA. Then he turned around and wrote a bill that made every single problem he identified worse.

Republicans have a mere 52-48 advantage in the Senate, so if there are two “no” Republicans, the bill could pass with VP Pence breaking the tie.  But 3 “no” Republicans would kill it (assuming, as I do, that every Dem is a “no”).  Senator Rand Paul (R) has already said “no” because it doesn’t go far enough in repealing Obamacare, but that might be posturing.

I wonder if Trump will endorse it.  After all, this is going to be thrown in his face:

Initial reaction is not good, and there are already some bad optics, like Capital Police dragging away protesters who are wheelchair-bound:

Senate Republicans Getting Hit From All Over

This screenshot from Memeorandum gives a sense of the bind that Senate Republicans are in over their very long and VERY SECRET internal negotiating (by 13 white men) over their healthcare bill.

House Republicans insist that their terrible mean bill (which knocks 23 million off of healthcare) doesn’t get altered too much, and Democrats — well, they just want to see the bill.  This is all revving up each day, as Senate Republicans cannot seem to decide how to fix healthcare.

I was worried this might go under the radar, but I think not. Especially if it goes into August.

The Trumpcare Fight

It was thought that Trumpcare, having passed the House, would die when it got to the grown-ups in the Senate.

Nope.  They’re trying to pass it.  Or something.

I can’t criticize the Senate version of Trumpcare.  Because nobody knows what it is.

We only know a few things. All reports say there will be no hearings on the text of the bill. There will be no amendments. Republicans are hoping to rush through an up-or-down vote on their version of the American Health Care Act passed by the House before the July 4th recess to avoid facing angry crowds who will build pressure for wavering members to vote no.

The best way to make those crowds angry? Give them something specific to be angry about. Look at the reaction to the House bill, which threatens protections for people with pre-existing conditions, would gut Medicaid and would – according to the nonpartisan Congressional Budget Office – strip 23 million people of their health insurance.

Of course people were furious. The bill is an exercise in man’s inhumanity to man. The AHCA isn’t really a health care bill at all; it’s a huge tax cut for the wealthiest Americans funded by taking health insurance away from the people who need it most. It’s designed to do as much damage as possible while still garnering the votes it needed to pass.

And pass it did in the House of Representatives, by the skin of its teeth, with both President Trump and Speaker Ryan and his whipping team going full stiff peaks on the Republican caucus. But even though the reconciliation process means the bill needs only 50 votes instead of the usual filibuster-busting 60, the House bill as passed didn’t have a chance in the Senate.

So a team of Republicans (and only Republicans) is cooking up a cauldron of tweaks and adjustments known only to them. The rest of us – the ones whose lives are going to be changed, damaged by whatever bubbling potion they concoct – don’t get to find out what’s inside. We don’t rate.

Ah, but what about those pesky reporters, always digging for the truth?  Well, this might be a clue:

So now they can hide.

New levels of low.

UPDATE:

To These Guys Everything Is A Partisan Conspiracy Against Their Perfect Great Idea

To these guys everything is a partisan, somebody else to blame conspiracy against their perfect, great idea:

It’s become the knee-jerk reaction for Republicans, in light of an ugly Congressional Budget Office analysis of their Obamacare repeal bill, to point the finger at the non-partisan research agency instead.

Office of Management and Budget Director Mick Mulvaney took it a step further this week, by questioning the abilities of Holly Harvey, the head of its health analysis division, to be non-partisan.

“At some point, you’ve got to ask yourself, has the day of the CBO come and gone?” Mulvaney told the Washington Examiner Wednesday. “How much power do we give to the CBO under the 1974 Budget Act? We’re hearing now that the person in charge of the Affordable Health Care Act methodology is an alum of the Hillarycare program in the 1990s who was brought in by Democrats to score the ACA.”

Prior to coming on to the CBO in 2009, Harvey served in the Clinton administration’s Health and Human Services Department, according to the Examiner.

The CBO director, Keith Hall, who signed off on the CBO score of the GOP health bill, was the chief economist for the  Council of Economic Advisers in the George W. Bush White House and was handpicked by then House Budget Committee Chair Tom Price (who is now Trump’s HHS secretary) to lead the CBO.

Mulvaney, in the Examiner interview, said that the CBO’s assumptions about Medicaid cuts were “just absurd,” while suggesting a bias in favor of Affordable Care Act’s individual mandate, which the GOP bill would eliminate.

“If the same person is doing the score of undoing Obamacare who did the scoring of Obamacare in the first place, my guess is that there is probably some sort of bias in favor of a government mandate,” he said.

The CBO has found that that the Republican health bill, the American Health Care Act, would lead to 23 million people losing coverage, cut $664 billion in taxes (mostly for high-earners and the industry), while saving the government $119 billion. It also found the legislation would lower premiums considerably in some places, but with the trade-off of making health coverage more expensive for older consumers and those with pre-existing conditions.

it’s problematic when one side of the debate simply argues, “Well, the other side is biased and therefore you can’t trust them.”  That’s not a fact-based argument.  And it certainly doesn’t raise counterfactuals.

One has to wonder why someone, whether it is an economist with the CBO or a climate scientist, would stake every bit of their learning and status in order to achieve a political result.  Most academics aren’t like that — in fact, it’s hard to find one willing to toss aside their expertise for the sake of reaching a pre-desired outcome.  Who does that?

Maybe conservatives do.  Maybe that’s why they think everyone else is biased and partisan — because that’s how they are.

Abomination

The Plum Line, this morning:

I won’t mince words. The health-care bill that the House of Representatives passed this afternoon, in an incredibly narrow 217-to-213 vote, is not just wrong, or misguided, or problematic or foolish. It is an abomination. If there has been a piece of legislation in our lifetimes that boiled over with as much malice and indifference to human suffering, I can’t recall what it might have been. And every member of the House who voted for it must be held accountable.

There’s certainly a process critique one can make about this bill. We might focus on the fact that Republicans are rushing to pass it without having held a single hearing on it, without a score from the Congressional Budget Office that would tell us exactly what the effects would be, and before nearly anyone has had a chance to even look at the bill’s actual text — all this despite the fact that they are remaking one-sixth of the American economy and affecting all of our lives (and despite their long and ridiculous claims that the Affordable Care Act was “rammed through” Congress, when in fact it was debated for an entire year and was the subject of dozens of hearings and endless public discussion). We might talk about how every major stakeholder group — the American Medical Association, the American Hospital Association, the AARP, the American Cancer Society Cancer Action Network, the American Heart Association, and on and on — all oppose the bill.

All that matters. But the real problem is what’s in the bill itself. Here are some of the things it does:

  • Takes health insurance away from at least 24 million Americans; that was the number the CBO estimated for a previous version of the bill, and the number for this one is probably higher.
  • Revokes the Affordable Care Act’s expansion of Medicaid, which provided no-cost health coverage to millions of low-income Americans.
  • Turns Medicaid into a block grant, enabling states to kick otherwise-eligible people off their coverage and cut benefits if they so choose.
  • Slashes Medicaid overall by $880 billion over 10 years.
  • Removes the subsidies that the ACA provided to help middle-income people afford health insurance, replacing them with far more meager tax credits pegged not to people’s income but to their age. Poorer people would get less than they do now, while richer people would get more; even Bill Gates would get a tax credit.
  • Allows insurers to charge dramatically higher premiums to older patients.
  • Allows insurers to impose yearly and lifetime caps on coverage, which were outlawed by the ACA. This also, it was revealed today, may threaten the coverage of the majority of non-elderly Americans who get insurance through their employers.
  • Allows states to seek waivers from the ACA’s requirement that insurance plans include essential benefits for things such as emergency services, hospitalization, mental health care, preventive care, maternity care, and substance abuse treatment.
  • Provides hundreds of billions of dollars in tax cuts for families making over $250,000 a year.
  • Produces higher deductibles for patients.
  • Allows states to try to waive the ACA’s requirement that insurers must charge people the same rates regardless of their medical history. This effectively eviscerates the ban on denials for preexisting conditions, since insurers could charge you exorbitant premiums if you have a preexisting condition, effectively denying you coverage.
  • Shunts those with preexisting conditions into high-risk pools, which are absolutely the worst way to cover those patients; experience with them on the state level proves that they wind up underfunded, charge enormous premiums, provide inadequate benefits and can’t cover the population they’re meant for. Multiple analyses have shown that the money the bill provides for high-risk pools is laughably inadequate, which will inevitably leave huge numbers of the most vulnerable Americans without the ability to get insurance.
  • Brings back medical underwriting, meaning that just like in the bad old days, when you apply for insurance you’ll have to document every condition or ailment you’ve ever had.

It is no exaggeration to say that if it were to become law, this bill would kill significant numbers of Americans.

Crucial Vote on Healthcare Today

The ACHA, once thought dead, got revived yesterday.  The big change? 8 billion for states that choose to create high risk pools for people with pre-existing conditions.  Of course, the fact that this 8 billion boondoggle (which goes to insurance companies) exists only highlights the lie that “no changes are being made with respect to pre-existing conditions”.  And 8 billion, by the way, is nowhere near enough.

Here’s a table of key differences:

Terrible.

Chaitspeaks:

The heart of the bill is the same one that was polling at under 20 percent and failed two months ago: a near-trillion dollar tax cut for wealthy investors, financed by cuts to insurance subsidies for the poor and middle class. They have added a series of hazily defined changes: waivers for states to allow insurers to charge higher rates to people with preexisting conditions and to avoid covering essential health benefits, and a pitifully small amount of money to finance high-risk pools for sick patients.

The implications of these changes are vast. The Brookings Institution notes that if a single state eliminated the cap on lifetime benefits for a single employee, then employers in every state could actually follow suit, thus bringing back a horrid feature of the pre-Obamacare system, in which people who get hit with expensive treatment suddenly discover that their insurer will no longer pay for their care. This would affect not only those getting insurance through Medicaid or the state exchanges, but also through their job.

The ambiguity of the details is the strategy. Republican leaders have been “assuring centrists that the Senate would make changes to allay their concerns and insisting that few states would actually use the waivers allowing higher premiums for pre-existing conditions,” reports The Wall Street Journal. Sean Spicer says it would be “literally impossible … to do an analysis of any level of factual basis.” Representative Fred Upton told reporters that if the Congressional Budget Office says the bill is underfunded he will push for more money — after it passes his chamber.

They are rushing through a chamber of Congress a bill reorganizing one-fifth of the economy, without even cursory attempts to gauge its impact. Its budgetary impact is as yet unknown. The same is true of its social impact, though the broad strokes are clear enough: Millions of Americans will lose access to medical care, and tens of thousands of them will die, and Congress is eager to hasten these results without knowing them more precisely. Their haste and secrecy are a way of distancing the House Republicans from the immorality of their actions.

There’s simply no way that this can be considered “better”.  The White House argument is that it is necessary to keep Obamacare from imploding.

It would be nice to have CBO scoring on this, but that is not going to happen.  That is very telling.

Two things not mentioned above:

(1)  Congress and its staff are exempt from these changes.  Some GOP congresscritters have suggested that the issue of their exemption be taken up in a separate piece of legislation, but I’m not holding my breath.  (Why not do it now?)

(2)  People like me who get insurance through their employer are not necessarily protected.  If your employer is a multi-state employer, it can pick the state which has the crappiest (cheapest) benefits and provide that to ALL employers.

The vote is scheduled for 1:00 pm today.  I will update as the day goes on.

23 “No” Republicans will kill the bill in the House.  Right now, it doesn’t seem like we are there.

UPDATE 11:40am –

Going the wrong direction (wonder why CNN dropped off the list)

UPDATE 1:14pm –

Voting should start in a half hour or so…

Not sure why WaPo went down…

UPDATE 2:00pm –

They are voting to exempt themselves from Obamacare or whatever else comes up.  Democrats AND Republicans.

….and it passes with zero Nays.

UPDATE 2:13pm –  Voting started on Health Care passage.  Five minutes.

And The House PASSED H.R. 1628 – American Health Care Act 217 to 213

Singing “Na na na na hey hey hey goodbye” — Is it Democrats or Republicans?

I wouldn’t want to be a House Republican in a district Clinton won.  Here they are:

TrumpCare 3.0 (4.0?) Is Dead Pretty Much

The Hill reports:

House Republicans have an updated bill to repeal and replace ObamaCare, and The Hill has a new whip list.

The updated bill includes an amendment that would allow states to opt out of key ObamaCare rules, including on minimum coverage requirements and allowing insurers to charge more based on individuals’ health.

Those changes are designed to win over conservatives, and the new legislation has been backed by the House Freedom Caucus and outside groups including the Club for Growth and FreedomWorks.

The question is whether GOP centrists can back it.

A mix of centrists and conservatives objected to the earlier ObamaCare bill, forcing GOP leaders to call off a planned vote.

No Democrats are expected to vote for the measure, meaning Republicans can only afford 22 defections.

And they kept an updated list of “No’s”, which just hit the 22 mark.

NO (22)

Rep. Mark Amodei (Nev.) — Amodei told ABC on Thursday he is still a no.

Rep. Andy Biggs (Ariz.) — “The MacArthur amendment is an effort to make the AHCA better, but it does not meet my constituents’ threshold for repeal,” the Freedom Caucus member said. Biggs was a no on the first bill.

Rep. Mike Coffman (Colo.) — Coffman told Politico he is currently a no.

Rep. Barbara Comstock (Va.) — The centrist Republican told The Hill she is still a no. Comstock is one of Democrats’ top targets in 2018.

Rep. Ryan Costello (Pa.) — Costello told reporters Thursday he was a no.

Rep. Jeff Denham (Calif.) — Denham told The Hill he was a no on Wednesday.

Rep. Charlie Dent (Pa.) — The co-chairman of the centrist Tuesday Group is still a no.

Rep. Dan Donovan (N.Y.) — The freshman lawmaker told The Hill on Wednesday he still plans to vote no.

Rep. Brian Fitzpatrick (Pa.) — A centrist, Fitzpatrick is still a no.

Rep. Jaime Herrera Beutler (Wash.) — Herrera Beutler, a member of the Tuesday Group, is a no, CNN reported.

Rep. Walter Jones (N.C.) — Jones, who has bucked GOP leaders on a number of occasions, is still a no.

Rep. John Katko (N.Y.) — Katko is still a no. “To me, it doesn’t move the needle enough,” he told Syracuse.com. Democratic presidential nominee Hillary Clinton won Katko’s district in November.

Rep. Leonard Lance (N.J.) — Lance is still a no.

Rep. Frank LoBiondo (N.J.) — LoBiondo is still voting no despite potential changes.

Rep. Billy Long (Mo.) — Long told The Hill he is a no on the revised bill.

Rep. Thomas Massie (Ky.) — Massie, a conservative who is not in the Freedom Caucus, said he is still a no.

Rep. Patrick Meehan (Pa.) — Meehan said the revised bill would raise premiums for those with pre-existing conditions and older Americans.

Rep. Ileana Ros-Lehtinen (Fla.) — The centrist Republican from south Florida said she is still a no even with the amendment. Clinton won Ros-Lehtinen’s district by nearly 20 points in 2016, but the longtime GOP lawmaker said she will not seek reelection in 2018.

Rep. Chris Smith (N.J.) — Smith told ABC he is still a no. The New Jersey lawmaker is meeting with leaders Thursday.

Rep. Michael Turner (Ohio) — Turner on Thursday told CNN he is still a no.

Rep. Daniel Webster (Fla.) — Webster is still a no. The Florida lawmaker wants changes that provide more Medicaid funding for nursing homes.

Rep. David Young (Iowa) — Young told reporters he is still a no. A Paul Ryan-aligned super PAC pulled their support for him after his decision not to back the initial bill in March.

It should be noted that NBC’s whip count shows 20 Republicans firmly against the bill. Another dozen are undecided.

The New ACHA Is Even Worse

I could talk about how terrible the revised Republican repeal of Obamacare plan is, but the best evidence is that the Republicans themselves decided to exempt Members of Congress from living under it. In other words, THEY (and their families) get to keep Obamacare, while their proposed new law takes it away from everyone else.

Here, read this.

How Is AHCA Doing?

Depending on which news organization you look at, if the Republicans lose 22 or 23 votes, the AHCA is dead in the House. The voting is taking place today, and the bill is changing with little giftees for certain districts.  Here is a wrap-up of where we are so far on the vote count, but pay close attention to the times below.  This is a VERY fluid thing.

And this just got tweeted:

I went to bed thinking they would make deals and get the votes.  But they failed to satisfy the Freedom Caucus last night, and I’ve seen a few confirmed no’s this morning.

On the other hand, there’s still more hours ahead. The Freedom Caucus is meeting with the President at 11:30 am today.

Ohhhhh…. if I had to guess, I would say it won’t pass the House.

UPDATE: Earlier today, the Freedom Caucus left the White House unmoved to change their NO vote.  And just now… this:

Speed Read: The House Obamacare Replacement Bill

From Axios:

The House Republican Obamacare replacement package is finally out, and the two main health care committees — Ways and Means, and Energy and Commerce — are scheduled to start working on the bills on Wednesday. Here’s your speed read on what’s in them — summaries are available here and here:

In:

  • Pre-existing condition coverage
  • Continuous coverage — 30 percent penalty if people don’t keep themselves insured
  • Special fund to help states set up “high-risk” pools, fix their insurance markets, or help low-income patients
  • Enrollment in expanded Medicaid will be frozen
  • Current enrollees can stay until 2020, and keep getting extra federal funds, until they leave the program on their own
  • Medicaid will change to “per capita caps” (funding limits for each person) in fiscal year 2020
  • A new, refundable tax credit will be available in 2020 to help people buy health insurance
  • Covers five age groups — starts at $2,000 for people in their 20s, increases to $4,000 for people in their 60s
  • It’s not means tested, but phased out for upper-income people (starting at $75,000 for individuals, $150,000 for families)
  • Insurers can charge older customers five times as much as young adults

Out:

  • All Obamacare taxes
  • All Obamacare subsidies, including its premium tax credit
  • Individual, employer mandate penalties
  • “Cadillac tax” (until 2025)
  • No longer will limit the tax break for employer-sponsored health coverage
  • No payments to insurers for cost-sharing reductions
  • Selling insurance across state lines (can’t be done in the “reconciliation” bill)
  • Medical malpractice reform (can’t be done in the “reconciliation” bill)

There’s also a little sugar in there for insurance company CEOs. Under Obamacare, insurance companies could not deduct an employee’s pay that exceeded $500,000 per year.  This limited incentives to give excessive salaries to CEOs and officers.  That limitation is gone now.

Look, if this is complicated for you (and no shame in that — it’s hard stuff) consider this: the House did not send this to the Congressional Budget Office for “scoring”. In other words, we would normally get an estimate as to (1) how much this will cost or save (will it add to the deficit?); (2) how many people will get lose coverage; and (3) how much insurance costs will go up (or down) as a result for the average consumer.  The House did not get the bill “scored” because — let’s face it — they didn’t think the numbers would look good.

AND they are trying to get this passed without debate.

My prediction? Even if they succeed in passing the bill, it is DOA in the Senate.

Draft Republican Plan Leaked

Politico has obtained a draft bill from House Republicans for Obamacare repeal. The draft closely follows proposals put forward by House Speaker Paul Ryan and the proposal Tom Price introduced last year. He’s now popular vote loser Donald Trump’s Secretary of Health and Human Services. It defunds Planned Parenthood completely. For everybody. No matter what they visit PP for. But more than that, it scraps Medicaid expansion and by allowing insurance companies to charge older people much more for insurance.

The Republican plan would also eliminate Obamacare’s Medicaid expansion in 2020. States could still cover those people if they chose but they’d get a lot less federal money to do so. And instead of the current open-ended federal entitlement, states would get capped payments to states based on the number of Medicaid enrollees.

Capped payments is basically the same idea as a block grant. The state would get a set amount of money—less than currently under Obamacare’s Medicaid expansion—depending on the current Medicaid population size. If for some reason the Medicaid-eligible population increased in a state, it would have to do that thing Republicans falsely screamed bloody murder about with Obamacare: ration care. It would have to decide whether to keep covering children, or the disabled, or the elderly in long-term care. Which means, fewer people covered.

The draft bill is two weeks old, so maybe there have been changes, but if this is the end result, GOPCare will suck.  And they will get an earful.

NOW They Are Asking What Would Happen If Obamacare Is Repealed

Winning is easy; governing is hard.

It is easy to get people – especially Republicans — to hate Obamacare.  For one thing, it has the name of the 44th President attached to it.  That alone gets many people to dislike it.

On top of that, it DOES have many problems.  Rates this past year jumped bigly, and many plans now have high deductibles.  (To be fair, the health-care premium increased 31% from 2006-2011, pre-Obamacare, and only 20% with Obamacare over the 5 year period of 2011-2016 — but some states have been hit hard.)

Also, in many counties now, there is only one choice of healthcare plan.

But the Affordable Care Act (see, it’s not Obamacare now!) is not the “total disaster” that Trump says it is. About 16.6 million people now have health insurance — people who wouldn’t have it otherwise.  Denial of insurance because of pre-existing conditions is a thing of the past.

The ACA also allows states to expand Medicaid eligibility, with the federal government paying most of the cost for new beneficiaries.

Finally, the ACA also prohibits insurers from charging different premiums to individuals based on their health. Everyone is in one big insurance pool, sharing in the average cost. Tax credits to help people buy private insurance.

The problems hit because more sick people enrolled than insurers expected when they initially set their premiums in 2014. That’s a big reason why premiums are rising more quickly for 2017 — with benchmarks increasing 22% on average nationally and 8% in California. Some insurers have exited the market, and Obamacare consumers face fewer choices. But the hope is that these higher premiums represent a one-time market correction rather than a sign of worsening trends to come.

But Republicans want to repeal.  They think it is what the people want.  Even some of the people think it is what they want.  It’s the most unpopular popular law.

The problem is, what happens when the GOP tries to change the ACA?

That, of course, depends on HOW they do it, and what they replace it with.  All indications are that they want to keep the popular parts of the ACA (the ban on pre-existing conditions, and the part where you can be on your parents’ plan if under age 26), but remove other parts (the individual mandate which penalizes people who don’t buy health insurance).

And how will they do this? It looks like they may use a budget maneuver known as a reconciliation bill, and through this, repeal parts of the ACA. The advantage of such a bill is that it cannot be filibustered in the Senate, meaning it can be passed with 51 votes instead of 60. The disadvantage is that it can be used only to make changes that have a direct effect on federal spending or taxes. So, for example, a reconciliation bill cannot repeal the ACA’s insurance market regulations, including protections for people with pre-existing conditions. But it can repeal the law’s premium subsidies and the individual mandate.

Unfortunately, this is going to wreak havoc and produce a death spiral in the individual health insurance market. With guaranteed insurance for people with pre-existing conditions but no subsidies or individual mandate, premiums could skyrocket. Or, more likely, insurers simply would exit the market. Why risk losses when the whole law is getting repealed anyway? The upshot would be canceled coverage with no other options for people buying in the ACA’s marketplaces (like healthcare.gov or Covered California), as well as those buying directly from insurers, where the same rules apply.

So what Republicans MUST do is hold off on the reconciliation bill until they have a replacement in mind for the ACA.  That presents a political problem though, because repealing Obamacare was designated a first priority.

In short, here’s the dilemma for Republicans: YOU HAVE TO HAVE THE INDIVIDUAL MANDATE IF YOU WANT TO KEEP THE BAN ON PRE-EXISTING CONDITIONS.  Period.  It’s that simple.  If you don’t, then premiums will go through the roof, since people will drop their insurance and insurance companies won’t have the money to cover all the people with pre-existing conditions.

The only other alternative?  Single payer.  But the GOP won’t touch that.

So the GOP is in a bit of a bind.  Maybe that’s why this happened:

In a Tuesday letter to congressional leaders, the American Medical Association (AMA) came out against plans floated by Republicans to quickly repeal Obamacare but delay fully replacing the law.

The AMA told congressional leaders that they must reveal their plans to replace the Affordable Care Act before repealing the legislation.

“[W]e believe that before any action is taken through reconciliation or other means that would potentially alter coverage, policymakers should lay out for the American people, in reasonable detail, what will replace current policies. Patients and other stakeholders should be able to clearly compare current policy to new proposals so they can make informed decisions about whether it represents a step forward in the ongoing process of health reform,” James L. Madara, the CEO of the AMA wrote in the letter.

The GOP, no doubt, wants to dismantle Obamacare but doesn’t want to get the blame.  The ball is definitely in their court.  They’re like the dog that caught the bus by the bumper — not sure what to do.

But it ain’t looking good for the dog.

Rape Survivor Jailed

Lovely:

A bipolar rape survivor was jailed for nearly a month in Houston after she broke down while testifying against her rapist. In jail, she was allegedly abused and mistaken as a sex offender. Now she’s suing the prosecutor who sent her to jail, a jail guard who allegedly hit her, and others.

The 25-year-old woman, known as Jane Doe, was the key witness in the trial of serial rapist Keith Hendricks, who received two life sentences for raping multiple women. In court last December, she broke down during questioning and ran from the courtroom, screaming that she’d never return.

She was hospitalized and then jailed because court officials feared she would not return to finish her testimony. Doe’s mom had been told her daughter would be treated in a mental health facility, but instead she was imprisoned for 28 days at Houston’s Harris County Jail, where she stayed in the general living quarters.

The woman’s lawyer, Sean Buckley, said a jail guard punched her in the face after she hit the guard (assault charges filed against her were later dropped) and that another inmate gave her a black eye. The complaint states an inmate “repeatedly slammed her head into the concrete floor” and she “was forced to drink from a spigot attached to a dirty metal toilet,”according to the Washington Post. Some jail staff mistakenly thought she was an offender from her jail record, which wrongly listed her charges as “Arrested for aggravated sexual assault,” according to local station KPRC’s investigation. After the woman testified against Hendricks again in January, she had to wait three more days in jail before she was released on January 14, in case she was asked to give more testimony.

Prosecutors had petitioned a judge for a “witness bond,” which by Texas state law allows a witness to be held without bail to make sure they arrive in court to testify. But a former Harris County prosecutor, a legal analyst, and other attorneys told local station KPRC they’d never heard of a witness bond being used to hold a rape victim.

Buckley filed the woman’s lawsuit against Harris County, the sheriff, the jail guard who hit her, and the prosecutor who asked her to be jailed. In a statement, District Attorney Devon Anderson supported the prosecutor’s decision, though as Jezebel noted, it seemed to suggest the woman’s family agreed to the witness bond while mistakenly thinking she would receive care in a proper facility. Anderson said:

Because the DA’s Office has been notified that a lawsuit is imminent, we cannot go into details about this case… However, witness bonds are a common tool used by prosecutors and defense attorneys when the lawyer has reason to believe that the witness will be unavailable or make him or herself unavailable for trial. A judge must approve a witness bond. In this case the judge and family agreed with the decision to obtain a witness bond.

KPRC’s legal analyst Brian Wice noted perhaps the most tragic result of this case: “At the end of the day she received less due process, less protection than the rapist did.”

This country, and particularly law enforcement and the courts, needs one long seminar on how to treat people who have suffered traumatic emotional injury, whether they be soldiers or rape victims.

SCOTUS Strikes Down Oppressive Abortion Restrictions

This morning, the Supreme Court struck down parts of a restrictive Texas law that could have reduced the number of abortion clinics in the state to about 10 from what was once a high of roughly 40.

The 5-to-3 decision was the court’s most sweeping statement on abortion rights since Planned Parenthood v. Casey in 1992. It applied a skeptical and exacting version of that decision’s “undue burden” standard to find that the restrictions in Texas went too far.

The decision on Monday means that similar restrictions in other states are most likely also unconstitutional, and it imperils many other kinds of restrictions on abortion.

Justice Stephen G. Breyer wrote the majority opinion, joined by Justices Anthony M. Kennedy, Ruth Bader Ginsburg, Sonia Sotomayor and Elena Kagan. Chief Justice John G. Roberts Jr. and Justices Clarence Thomas and Samuel A. Alito Jr. dissented.

The decision concerned two parts of a Texas law that imposed strict requirements on abortion providers. It was passed by the Republican-dominated Texas Legislature and signed into law in July 2013 by Rick Perry, the governor at the time.

One part of the law requires all clinics in the state to meet the standards for ambulatory surgical centers, including regulations concerning buildings, equipment and staffing. The other requires doctors performing abortions to have admitting privileges at a nearby hospital.

“We conclude,” Justice Breyer wrote, “that neither of these provisions offers medical benefits sufficient to justify the burdens upon access that each imposes. Each places a substantial obstacle in the path of women seeking a previability abortion, each constitutes an undue burden on abortion access, and each violates the federal Constitution.”

I’m not surprised by the outcome, nor am I surprised by swing justice Kennedy joining the “liberals” on the court.  Frankly, the Texas restrictions were NOT intended to support women’s health.  If you saw who proposed those restrictions (longtime Texas anti-abortion legislators) and listened to their rhetoric, “health of women” was a sham rationale.  Their real objective was to make abortion clinics so regulated that they could not afford to make the required changes, and eventually close down.  In fact, to date, twenty abortion clinics have closed down under those regulations.

So, yes, a victory, and it would have been a victory even if Scalia was alive and on the court.  But it does underscore the importance of the election and who gets to pick the next justices.

Lady Dynamite: A Review

I have had a girlfriend with bipolar issues, and another who has since developed identity diffusion disorder* (formally known as multiple personality disorder).  I’ve worked with informal counselling of families and friends of people stricken with mental illness.  Because of that, I can attest to the fact that it is no picnic to be in their shoes, or anywhere near their shoes (especially when they are not taking care of themselves).

This is why I am so enamored of Maria Bamford who not only handles her affliction head on, but turns it into a comedy both VERY funny and VERY personal.  Her illness is played for laughs.  It’s not the first to do this (“Orange Is The New Black” does this too), but Bamford goes the extra mile by letting the audience know that her mind, while humorous from a distance, is actually pretty scary too.  And she seems to make the audience understand that mania, while enthralling and objectively empowering, actually is dangerous to the point of being life-threatening.  Watching her, you know that Bamford has worked to maintain her stability, knowing what is good for her and what isn’t, but you also know that it is work (and pills and therapy and….) that never ends.

So here’s a review of the show from Slate:

In a scene toward the end of the first season of Lady Dynamite, the Netflix comedy starring Maria Bamford, Maria shares her concern about her lack of friends with her life coach, Karen (played with perfectly vapid sincerity by Jenny Slate).  At first, Karen answers with well-worn therapy jargon, telling Maria, “The only friendship you need to be concerned with is the one with the gal in the mirror.” Maria presses her, saying, “I’m just worried, because the only two friends I have left who will still be friends with me are Dagmar and Larissa”—to which Karen cheerfully responds, “Yeah, because you’re bipolar and you’re incredibly hard to stay friends with. I mean, people are really just going to fall by the wayside. And that’s life … for you.”

What’s remarkable about this exchange is not Karen’s apparent callousness in the face of her client’s troubles. In fact, by the episode’s end, Maria abandons her goal of “no friend left behind,” realizing that not all friendships are worth the sacrifices required to keep them. What makes this scene, and Lady Dynamite as a whole, so refreshing, is that Karen is exactly right. Maria isn’t an easy person to be friends with. She is thoughtful and eager to please, but her good intentions don’t always make up for her bad decisions.  And her desire to help those around her can’t prevent her brain from turning stress into mania, or stop the destructive behavior mania incites.

Maria’s life coach is just one of the many voices of harsh truth throughout the show’s 12-episode season. Some of these truth-tellers are more tactful than others. In the blue-tinted scenes representing Maria’s time in Duluth, MN, taking part in psychiatric outpatient therapy after a severe manic episode, her parents are shown to be kind and patient, but also matter-of-fact about her illness. When her mom scolds her dad for going out just as Maria arrives home, he replies to them both, “I thought we weren’t going to treat her differently just because her frontal lobe went on the fritz.” Her obnoxious best friend from childhood adds her own insight, musing: “Isn’t that funny, all the fame and fortune of Hollywood can’t save ya, if your brain done broke.”

Many of the tone-deaf comments Maria hears regarding her life with Bipolar Disorder (“Actually, I’m Bipolar II,” she tells her life coach, to which her life coach replies, “Right, which means you’re twice as hard to stay friends with.”) are played for laughs. But the humor is that much sharper for its proximity to truth. One of the major themes of the season, and one of the most sincere and affecting elements of Maria’s character, is her struggle to honestly state her own feelings, especially when they are unpleasant or scary. Whether she’s agreeing to act in ad campaigns of increasing absurdity (the most memorable of the bunch being the Bamford Pepper Stepper Pepper-Bot, a backpack-sized robot that feeds whole bell peppers to the jogger wearing it) or buying a nicer house than she needs to please her childhood friend’s aggressive real estate agent (a convincingly intimidating June Diane Raphael), Maria’s inability to say what she really thinks threatens to destroy not only her career, but also her closest friendships and romantic relationships.

While the desire to avoid conflict clearly isn’t new for a TV character (pick almost any sitcom of the last several decades and you’ll clearly find plenty of storylines set into motion by one character withholding information from another), Maria’s fear of sharing her thoughts is based on more than a simple desire to be liked. The character of Maria, like the real Maria Bamford, has good reason to fear how other people might react to her true thoughts., She perceives the world through a lens that is hers alone. This unique view is what makes her such a great comic, and what has earned her such a respected perch within L.A.’s alternative comedy scene. Her albums and specials are full of jokes that range from absurdly hilarious to disturbingly dark, often told in a number of different voices (outside of stand-up, Bamford’s greatest success has been in doing voice work for commercials and animated programs). She is physically small and outwardly cheerful, which highlights by contrast her frequently grim comedic observations. This apparent contradiction is what makes Maria the character, and Lady Dynamite the series, feel so refreshing amid a wide range of half-hour shows featuring stand-up comedians. And it is also what singles out Lady Dynamite’s depiction of mental illness from every other show on television.

Depictions of mental illness on TV have generally grown increasingly nuanced and considered in recent decades, with prestige dramas from The Sopranos to Homeland, treating mentally ill protagonists with seriousness and respect. In the past year, comedies like You’re the Worst, and Crazy Ex Girlfriend have presented characters who are highly functional, frequently charming, and relatively successful, despite living with ongoing symptoms. But Lady Dynamite goes even further. Instead of treating mental illness as an obstacle for a character to overcome, or a device to explain otherwise nonsensical actions, Lady Dynamite builds it into the very fabric of its world. It mines tragedy for comedy, showing us a character who is herself struggling to find the humor within her own terrible pain. It’s the rare comedy that shows us that the reality of mental illness is that darkness can coexist with creativity and fun and hope.

Like Type 1 Diabetes, Crohn’s Disease, or fibromyalgia, Maria’s mental illness will never go away completely. Even after months of psychiatric care, Maria returns to Los Angeles knowing the risk of a manic episode or a suicidal depression isn’t entirely behind her. She actively tries to do the things she knows will help her stay healthy, but the dark realities have not changed, and neither has her desire to make people like her. (When her mother tells her not to look to others for approval, Maria replies, “But that’s literally what standup is, looking for approval from strangers.”).

The wisest advice Maria receives over the course of the first season comes from another comically blunt therapist. While taking part in an art-therapy group at the Duluth psych ward, Maria tries to stop two other patients who are arguing over the magazine cut-outs for their vision boards. Maria says, “Hey, we’re all here to get along.” Without missing a beat, the group therapist corrects her, saying, “No, Maria, we are not. We are all here to better ourselves and sometimes that means expressing your negative emotions in a constructive way.” Trying to set an example, the therapist goes on to tell her patients that they stress her out so much that she sometimes contemplates taking “all the pills” in her desk. She laughs as she says this, patting another patient on the shoulder.

Maria is generally realistic, but she is also an optimist. She believes that happiness, healthy relationships and basic human kindness are not only worth striving for, but are achievable. Her challenge, and the challenge of Lady Dynamite, is balancing that hope and desire for good with the realities of her suffering. The entire show is an exercise in following the art-therapy teacher’s advice: finding a way to use the fear and pain of mental illness to construct something that ultimately brings joy. Just as in life, the truth can be painful, but it can also be incredibly funny.

* No “You sure can pick ’em” comments please.

Two Million Pregnant Women At Risk For Zika Virus

So far, the GOP-controlled House has offered a mere $622 million in Zika funding — far less than what will be needed to meaningfully combat the virus. It’s unclear when Congress may reach an agreement on this issue before its long summer recess. And according to an analysis by the Center For American Progress, this delay could be putting about 2 million pregnant American women at risk.

Using data from the Centers for Disease Control and Prevention (CDC), here’s the think tank’s prediction for the number of pregnant women who might be affected by Zika this summer and fall, broken down by state:

Zika-webtable-620x804

We’ve known for months that Zika, which has been ravaging our neighbors to the south, was headed for the United States as warmer weather approached. In fact, it’s already here — there are currently 472 confirmed cases of Zika in the continental US, though so far they are all travel-related. Including U.S. territories such as Puerto Rico, which is already being overwhelmed by the virus, so far 279 pregnant women have tested positive for the virus.

These new numbers, however, show just how great the risk is if the United States hits mosquito season unprepared. Preparation takes funding — which is necessary for basic research on the virus, to help develop a vaccine, and take preventative measures like providing mosquito nets and education campaigns about how to avoid getting bitten. Yet despite the clear and present danger, conservatives on Capitol Hill have dragged their feet, haggling over the finances.

Josh Earnest, White House Press Secretary, said, “The House of Representatives is three months late and more than a billion short of doing what’s necessary to protect the American people.”

This is typical of a Republican-led Congress.  They fail to do enough until it is too late, and then things get really expensive.

Spot-On Review of Maria Bamford

Forget Amy Schumer.  Yes Amy is funny, but she’s becoming a bit of a Johnny One-Note. (Yes, we get it, Amy — you are beautiful even if you’re not a size 4, but how many times do we have to applaud your body and being “brave” about it?).

But for my money, the real edge-y woman of comedy is Mario Bamford.

Which is why I am pleased she is finally getting some credit with her new show:

There’s a great song in the musical “[title of show]” that asserts, “I’d rather be nine people’s favorite thing / Than a hundred people’s ninth favorite thing.” For two decades, that’s been Maria Bamford’s brand. She’s played small roles on sitcoms; she was the spokeswoman for Target. But the purest Bamford essence could always be found in her dreamy, destabilizing standup routines, which dealt head on with time spent in mental institutions, struggling with a bipolar II diagnosis and an assortment of crippling O.C.D.-ish compulsions. In her YouTube series “The Maria Bamford Show,” which was set in Duluth, Minnesota, where she’d retreated after a breakdown, Bamford played not only herself but various family members, frenemies, and dates—while crooning to her psychiatrist, “If I keep the ice-cube trays filled, then no one will dieeeeeeeee.” In her self-distributed show, “Special Special Special,” she performed in her living room, with only her parents as an audience.

When I first heard about “Lady Dynamite,” Bamford’s new Netflix series, I felt apprehensive, having been burned, in recent months, by too many floppy, over-extended dramedies produced by streaming neworks, such as “Love” and “Casual.” These shows, like “Lady Dynamite,” often dealt with dysfunctional, single Los Angelenos, often on the fringes of the entertainment world, unable to commit to love. But then I watched the first “Lady Dynamite,” and the second, and the third, and soon the weekend was gone and I had to start watching the show all over again, from scratch. Like “Arrested Development,” whose creator, Mitch Hurwitz, co-produced “Lady Dynamite” with Pam Brady (a longtime collaborator with Matt Stone and Trey Parker), the series is not a dramedy but a true comedy. Despite (or because of) the show’s serious themes, it’s stuffed with jokes, visual and verbal, to the point that it’s like a tottery Jenga game. The pilot leans a bit heavily on the meta-comedy—it features a debate between Bamford and Patton Oswalt about how to structure the series—but after that it becomes a real joyride. In certain ways, “Lady Dynamite” shares ground with the terrific “BoJack Horseman,” another comedy about the difficulty of distinguishing ordinary Hollywood misery from genuine mental illness. But it has a distinct vibe, somehow at once celebratory and melancholic, with a hallucinogenic edge. It performs a small miracle by expanding Bamford’s story just enough to make it feel sitcom-like while still maintaining her voice.

The central plot of “Lady Dynamite” tracks Bamford’s Pilgrim’s Progress toward a balanced life in Hollywood, braiding together three separate timelines, each filmed in a slightly different style. There’s “Past,” a bright-neon era from before her nervous breakdown, when Bamford was doing that high-paying gig for Target (satirized, scathingly, as the union-busting Checkmark) but was also careening through bad friendships and awful relationships, ascending toward full-blown hypomania. There’s the gray-blue “Duluth,” set after Bamford moved back in with her Midwestern parents, having been institutionalized for suicidal depression. And there is “Present,” in which Bamford is medicated, gamely trying to restart her Hollywood career, and dating again, while struggling not to repeat the choices she’s made in the past. Each episode ends with a plaintive strain of Dean Martin, with the resonant lyrics, “I don’t know what I’m doing / More than half of the tiiiime.” As with H.B.O.’s “Enlightened,” “Lady Dynamite” is a show that frequently satirizes New Age and therapy speak but that nonetheless has faith in their bedrock ideals.

None of this complicated blend would work without Bamford’s fascinating, hard-to-describe, explosively brittle performance style. A tiny, tense figure in her forties, Bamford has scared-looking eyes and a pointy nose and straw-like (or, sometimes, crazily permed) blond hair, and she holds her shoulders hunched as if in eternal apology; she’s a bit like a comedic Cindy Sherman, using her unthreatening Hollywood-blonde blankness as a screen to project something that’s far stranger and more out of control. She’s fragile, but her jokes are hard. She’s also a skilled shape-shifter who can perform multiple voices—a sexy rich lady, a shrieking cartoon character—who nonetheless seems trapped in her own spasming physicality. In the tradition of performers like Andy Kaufman and Paul Reubens, she’s constantly wincing and screaming and contorting her face, yet she’s also quite sweet, almost deceptively so. One of the smartest things about “Lady Dynamite” is that it doesn’t rely on a self-pitying portrait of Bamford as a pure victim of those around her. Yes, she is a people-pleaser who gets bullied by false friends and crazy agents. Sure, she gets engaged to a newly divorced stuntman with bad credit. But she is also pathologically passive-aggressive in response to any sign of conflict—during one relationship, she hides in the shower and stuffs a sponge into her mouth so that she can scream after every phony, awful interaction. As the episodes elapse, the show builds a fascinating and nuanced portrait of a woman whose magical gifts aren’t all that inseparable from what makes her a little bit impossible.

Maria simply is a pleasure to watch, simply because of her shape-shifting face.  And while she is upfront and honest about her bipolar disorder (bipolar two, she would stress), she doesn’t beat it over the head with the audience.  It is a thing she has; it is a thing she deals with.  Every day.  And she does it with humor and grace and, uh, stress.

Looking forward to season two.

And if you don’t know Maria and her style of comedy, here’s a 2 minute sample:

A Reminder

May is Mental Health Awareness Month.

If you — or someone you know — need help, please call 1-800-273-8255 for the National Suicide Prevention Lifeline. If you are outside of the U.S., please visit the International Association for Suicide Prevention for a database of international resources.

Prevalence of Mental Illness

  • Approximately 1 in 5 adults in the U.S.—43.8 million, or 18.5%—experiences mental illness in a given year.
  • Approximately 1 in 25 adults in the U.S.—10 million, or 4.2%—experiences a serious mental illness in a given year that substantially interferes with or limits one or more major life activities.2
  • Approximately 1 in 5 youth aged 13–18 (21.4%) experiences a severe mental disorder at some point during their life. For children aged 8–15, the estimate is 13%.3
  • 1.1% of adults in the U.S. live with schizophrenia.4
  • 2.6% of adults in the U.S. live with bipolar disorder.5
  • 6.9% of adults in the U.S.—16 million—had at least one major depressive episode in the past year.6
  • 18.1% of adults in the U.S. experienced an anxiety disorder such as posttraumatic stress disorder, obsessive-compulsive disorder and specific phobias.7
  • Among the 20.2 million adults in the U.S. who experienced a substance use disorder, 50.5%—10.2 million adults—had a co-occurring mental illness.8

Social Stats

  • An estimated 26% of homeless adults staying in shelters live with serious mental illness and an estimated 46% live with severe mental illness and/or substance use disorders.9
  • Approximately 20% of state prisoners and 21% of local jail prisoners have “a recent history” of a mental health condition.10
  • 70% of youth in juvenile justice systems have at least one mental health condition and at least 20% live with a serious mental illness.11
  • Only 41% of adults in the U.S. with a mental health condition received mental health services in the past year. Among adults with a serious mental illness, 62.9% received mental health services in the past year.8
  • Just over half (50.6%) of children aged 8-15 received mental health services in the previous year.12
  • African Americans and Hispanic Americans used mental health services at about one-half the rate of Caucasian Americans in the past year and Asian Americans at about one-third the rate.13
  • Half of all chronic mental illness begins by age 14; three-quarters by age 24. Despite effective treatment, there are long delays—sometimes decades—between the first appearance of symptoms and when people get help.14

Consequences of Lack of Treatment

  • Serious mental illness costs America $193.2 billion in lost earnings per year.15
  • Mood disorders, including major depression, dysthymic disorder and bipolar disorder, are the third most common cause of hospitalization in the U.S. for both youth and adults aged 18–44.16
  • Individuals living with serious mental illness face an increased risk of having chronic medical conditions.17 Adults in the U.S. living with serious mental illness die on average 25 years earlier than others, largely due to treatable medical conditions.18
  • Over one-third (37%) of students with a mental health condition age 14­–21 and older who are served by special education drop out—the highest dropout rate of any disability group.19
  • Suicide is the 10th leading cause of death in the U.S.,20 the 3rd leading cause of death for people aged 10–2421 and the 2nd leading cause of death for people aged 15–24.22
  • More than 90% of children who die by suicide have a mental health condition.23
  • Each day an estimated 18-22 veterans die by suicide.24

Citations

  1. Any Mental Illness (AMI) Among Adults. (n.d.). Retrieved October 23, 2015, from http://www.nimh.nih.gov/health/statistics/prevalence/any-mental-illness-ami-among-adults.shtml
  2. Serious Mental Illness (SMI) Among Adults. (n.d.). Retrieved October 23, 2015, from http://www.nimh.nih.gov/health/statistics/prevalence/serious-mental-illness-smi-among-us-adults.shtml
  3. Any Disorder Among Children. (n.d.) Retrieved January 16, 2015, from http://www.nimh.nih.gov/health/statistics/prevalence/any-disorder-among-children.shtml
  1. Schizophrenia. (n.d.). Retrieved January 16, 2015, from http://www.nimh.nih.gov/health/statistics/prevalence/schizophrenia.shtml
  2. Bipolar Disorder Among Adults. (n.d.). Retrieved January 16, 2015, from http://www.nimh.nih.gov/health/statistics/prevalence/bipolar-disorder-among-adults.shtml
  3. Major Depression Among Adults. (n.d.). Retrieved January 16, 2015, from http://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adults.shtml
  4. Any Anxiety Disorder Among Adults. (n.d.). Retrieved January 16, 2015, from http://www.nimh.nih.gov/health/statistics/prevalence/any-anxiety-disorder-among-adults.shtml
  5. Substance Abuse and Mental Health Services Administration, Results from the 2014 National Survey on Drug Use and Health: Mental Health Findings, NSDUH Series H-50, HHS Publication No. (SMA) 15-4927. Rockville, MD: Substance Abuse and Mental Health Services Administration. (2015). Retrieved October 27, 2015 from http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf
  6. U.S. Department of Housing and Urban Development, Office of Community Planning and Development. (2011). The 2010 Annual Homeless Assessment Report to Congress. Retrieved January 16, 2015, from https://www.hudexchange.info/resources/documents/2010HomelessAssessmentReport.pdf
  7. Glaze, L.E. & James, D.J. (2006). Mental Health Problems of Prison and Jail Inmates. Bureau of Justice Statistics Special Report. U.S. Department of Justice, Office of Justice Programs Washington, D.C. Retrieved March 5, 2013, from http://bjs.ojp.usdoj.gov/content/pub/pdf/mhppji.pdf
  8. National Center for Mental Health and Juvenile Justice. (2007). Blueprint for Change: A Comprehensive Model for the Identification and Treatment of Youth with Mental Health Needs in Contact with the Juvenile Justice System. Delmar, N.Y: Skowyra, K.R. & Cocozza, J.J. Retrieved January 16, 2015, from http://www.ncmhjj.com/wp-content/uploads/2013/07/2007_Blueprint-for-Change-Full-Report.pdf
  9. Use of Mental Health Services and Treatment Among Children. (n.d.). Retrieved January 16, 2015, from http://www.nimh.nih.gov/health/statistics/prevalence/use-of-mental-health-services-and-treatment-among-children.shtml
  10. Agency for Healthcare Research and Quality. (2010). 2010 National Healthcare Disparities Report. Agency for Healthcare Research and Quality, Rockville, MD. Retrieved January 2013, from http://www.ahrq.gov/research/findings/nhqrdr/nhdr10/index.html.
  11. Kessler, R.C., et al. (2005). Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbitity Survey Replication. Archives of General Psychiatry, 62(6), 593–602. Retrieved January 16, 2015, from http://archpsyc.jamanetwork.com/article.aspx?articleid=208671
  12. Insel, T.R. (2008). Assessing the Economic Costs of Serious Mental Illness. The American Journal of Psychiatry. 165(6), 663-665
  13. Agency for Healthcare Research and Quality, The Department of Health & Human Services. (2009). HCUP Facts and Figures: Statistics on Hospital-based Care in the United States, 2009. Retrieved January 16, 2015, from http://www.hcup-us.ahrq.gov/reports/factsandfigures/2009/pdfs/FF_report_2009.pdf
  14. Colton, C.W. & Manderscheid, R.W. (2006). Congruencies in Increased Mortality Rates, Years of Potential Life Lost, and Causes of Death Among Public Mental Health Clients in Eight States. Preventing Chronic Disease: Public Health Research, Practice and Policy, 3(2), 1–14. Retrieved January 16, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1563985/
  15. National Association of State Mental Health Program Directors Council. (2006). Morbidity and Mortality in People with Serious Mental Illness. Alexandria, VA: Parks, J., et al. Retrieved January 16, 2015 from http://www.nasmhpd.org/docs/publications/MDCdocs/Mortality%20and%20Morbidity%20Final%20Report%208.18.08.pdf
  16. U.S. Department of Education. (2014). 35th Annual Report to Congress on the Implementation of the Individuals with Disabilities Education Act, 2013. Washington, DC: U.S. Department of Education. Retrieved January 16, 2015, from http://www2.ed.gov/about/reports/annual/osep/2013/parts-b-c/35th-idea-arc.pdf
  17. Suicide Facts at a Glance 2015 (n.d.). Retrieved October 23, 2015, from http://www.cdc.gov/violenceprevention/pdf/suicide-datasheet-a.pdf
  18. Suicide Prevention. (2014, January 9). Retrieved March 24, 2015, from http://www.cdc.gov/violenceprevention/pub/youth_suicide.html
  19. U.S.A. Suicide: 2013 Official Final Data. (2015, January 22). Retrieved March 24, 2015, from http://www.suicidology.org/Portals/14/docs/Resources/FactSheets/2013datapgsv2alt.pdf
  20. U.S. Department of Health and Human Services. (1999). Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institute of Mental Health. Retrieved January 16, 2015, from http://profiles.nlm.nih.gov/ps/access/NNBBJC.pdf
  21. U.S. Department of Veteran Affairs Mental Health Services Suicide Prevention Program. (2012). Suicide Data Report, 2012. Kemp, J. & Bossarte, R. Retrieved January 16, 2015, from http://www.va.gov/opa/docs/Suicide-Data-Report-2012-final.pdf

– See more at: https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers#sthash.vnHwqtTp.dpuf

RIP Patty Duke

Another 69 year old dies.

As a teen, she won an Oscar for The Miracle Worker.  Duke became best known in later life as an advocate for mental health issues, after she was diagnosed with bipolar disorder in 1982

Her last two tweets:

Emotional President Moves On Gun Control

White House insiders have long said that the worst day of Obama’s presidency was the day of the shooting at Sandy Hook Elementary School in Newtown, Connecticut.

What should have been a 9/11 moment for the whole nation turned out to be nothing — as in nothing changed.  Congress voted against reasonable laws like universal background checks.

It is clear that Obama, facing his last year as president, is not going to rest on his laurels.  Gun violence has killed 146 people in the United States this year.  And it is only January 5.  The Republican controlled Congress has passed nothing relating to gun control. Today he made a moving, and largely extemporaneous (in parts), speech announcing his intentions.

Here’s what the Obama administration plans to do:

  • The federal government will issue guidance that will narrow who can sell guns without a federal license, based on an evaluation of the circumstances surrounding individual gun sales. The idea is to reduce the number of for-profit dealers — as opposed to collectors or people who only give or sell guns to family members or friends — who avoid background checks, whether they’re at a store, at a gun show, on the internet, or anywhere else.
  • The FBI will hire more than 230 more people to help run background checks — an increase of more than 50 percent to the current staff. Lynch said this was in part needed to keep up with rising demand. “We’re looking to improve the efficiency and response time of the system,” she said.
  • The government will also require background checks for people who try to buy restricted firearms through a legal entity, such as a corporation or trust. People were able to avoid background checks in the past through these entities.
  • The Department of Health and Human Services will finalize a rule regarding health record privacy laws to remove barriers to states providing mental health records to the background check system.
  • The administration will enforce tighter rules for reporting guns that are lost or stolen on their way to the buyer to make it easier for law enforcement to track down missing firearms.
  • Federal agencies will encourage and fund more research into technologies that can make guns safer, largely to reduce the risk of accidents.

In addition to these measures, the administration will continue pushing Congress to pass tighter gun control laws, and to direct more funds to enforcing existing gun laws and to mental health treatment.

This last part is particularly good, because it addresses one aspect of gun control that is rarely discussed — suicides:

The reaction from the right and the NRA is predictable.  What Digby said:

As of this writing the proposal has not been formally announced but it’s reported that he will issue executive orders to close the “private seller” loophole, which would require everyone who sells a gun as a business transaction to submit a background check. (As it is now, only licensed dealers have to do this.) It’s also expected that he’ll issue an order requiring that licensed dealers report lost or stolen guns to the authorities. It’s hard for me to believe that these slight reinterpretations of the law are even controversial but apparently making gun ownership subject to any sort of oversight is tantamount to a coup.

There is little doubt the administration anticipated the furious reaction, so one assumes they are happy to draw attention to the issue. After all, polling shows that the vast majority of Americans — and gun owners — are in favor of such commonsense gun safety regulations. Nonetheless, this will likely end up in court with a number of legal issues at stake and the gun lobby dedicated to filling its coffers on the backs of gun owners who don’t actually need to worry about any of these very mild restrictions.

In today’s White House press conference, President Obama teared up as he spoke about the victims of gun violence, especially the children massacred at Newtown.

Many conservatives took this opportunity to show themselves once again as utterly heartless sociopaths.  Some are suggesting that Obama’s tears are fake.

Not just tears, but FASCIST tears.

The full Obama speech in below the fold.

Disease Of The Week

It’s called dementia with Lewy’s Bodies, and Robin Williams.  So says his widow, citing the cause of his suicide.  It wasn’t depression that caused the suicide, so much as the dementia with Lewy’s Bodies which caused the depressions which caused the suicide.

I have to be honest here: Is attribution to a physical illness merely a way to make a mental illness more palatable?  Given the stigma against mental illness (which includes depression), you have to wonder if the family is trying to revive some honor to Mr. Williams.

Uninsured State By State

From tomorrow’s New York Times, this remarkable map shows the percent uninsured in each state under Obamacare.  The states which elected to expand Medicare coverage are outlined in bold, and you can see the difference.  Compare, say, Arkansas in 2015 to its southern neighbors which did not expand Medicare coverage.

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First Human Trials On An HIV Vaccine Start Today

Researchers may be one step closer to creating an HIV vaccine.

This month, the Institute for Human Virology at the University of Maryland School of Medicine in Baltimore launched the first phase of clinical trials for a new treatment. The immunogen, known as the Full-Length Single Chain (FLSR), could potentially induce protective antibody responses to HIV-1 strains, going where previous trial vaccines have fallen short.

And it only took three decades and millions of deaths.

Florida Can No Longer Lock Mentally Disabled People And Forget About Them

Fifteen years ago, J.R. — an intellectually disabled man who “functions as a seven-year old.” — was charged with sexual battery, but he was never tried because a court found him incompetent to stand trial. Instead, J.R. was involuntarily committed to a residential mental facility by a court order that contains no end date.

End of story.  You see, under Florida law, the only entity that can order people like J.R. to be released is the court that originally ordered those people to be committed. And those courts have no obligation to conduct periodic reviews of whether institutionalized people.belong in a mental institution.

J.R. for example did not get a hearing since 2005.

I think the gravity of that needs to sink in.  Obviously, there was a competency hearing of some kind, so J.R. received “due process” under the Constitution.  Yet, he is in effect incarcerated indefinitely, even though he was never convicted of a crime.  And that’s a huge constitutional problem.

Fortunately, in a decision handed down by the Eleventh Circuit federal appeals court yesterday, this is no longer permissible.

“A state must release a person who is involuntarily committed if the grounds for his commitment cease to exist,” Judge Beverly Martin explained in her opinion on behalf of a two-judge panel. That constitutional requirement, however, “is toothless if a state does not periodically review whether the grounds for commitment are met.”

Specifically, Judge Martin notes, J.R. was committed under a law that permits the institutionalization of people who lack “‘basic survival and self-care skills to such a degree that close supervision and habilitation in a residential setting is necessary and, if not provided, would result in a real and present threat of substantial harm to the person’s well-being’ or would leave the person ‘likely to physically injure others if allowed to remain at liberty.’” J.R. may very well have presented a danger to others at the time of his confinement, but he has now lived more than a decade in a facility where he could learn coping and socialization skills that may eliminate that danger. He’s also been convicted of no crime.

At the very least, Martin’s opinion establishes, he should not remain confined forever because no one has bothered to look into whether his commitment can still be justified.

It’s some small progress in the law recognizing the rights of the mentally ill.

John Oliver On Mental Health

Mental health is in the news again, but only because of another mass shooting.  Mental health is a problem even without the ease of access to guns.  All the politicians agree that the mental health care system in this country is abysmal, but they rarely do anything about it.  Obamacare, to its credit, was a good first (albeit small) step in treating mental illness in the same way that we treat physical illness, at least as far as insurance is concerned.  But that’s it.

What John Oliver says is worth your time, and he knows he’s only scratching the surface.

The Clinton Gun Plan And The Mental Health Factor Of Gun Control

I was going to write a post about mental health and gun control, but I see that Hillary Clinton just came out with a plan, so I’m going to talk about that as well.  First, the Clinton plan:

Fight for comprehensive background checks.

  • Advocate for comprehensive federal background check legislation.
  • Close the “Charleston Loophole.”
  • Tighten the gun show and Internet sales loophole if Congress won’t.

The first bullet point is meaningless.

The second is concrete and is common-sensical.  The “Charleston loophole” is what made the Charleston shooter able to obtain a gun legally.  He had a federal criminal record, but the background check was not completed in three days.  If that happens, you get the keep the gun.  Which is stupid.  Close the loophole and make it a law that you can’t get the gun until the background check is complete.  (It seems to me this is smart from a homeland security standpoint as well).

The third also is sensical.  Require background checks when the gun is bought on the internet or at gun shows.  Clinton’s wording seems to suggest that this can be done without Congressional approval.  If that is so, I think it would have been done by now.

Hold dealers and manufacturers fully accountable if they endanger Americans.

  • Repeal the gun industry’s unique immunity protection.
  • Revoke the licenses of bad-actor dealers.

The NRA lobbied Congress to pass the so-called “Protection of Lawful Commerce in Arms Act,” a law which prevents victims of gun violence from holding negligent manufacturers and dealers accountable for violence perpetrated with their guns.  It is very odd.  If we can hold cigarette manufacturers responsible, why not gun manufacturers?  This isn’t a second amendment issue either.  It is not a ban.  Having the right to make guns does not mean you are immune from the legal consequences.

Presumably, we all already revoking the licenses of bad-actor dealers.  Clinton says we need to be more vigilant.  Fine.

Keep guns out of the hands of domestic abusers, other violent criminals, and the severely mentally ill.

  • Support legislation to prohibit all domestic abusers from buying and possessing guns.
  • Make straw purchasing a federal crime.
  • Improve existing law prohibiting persons suffering from severe mental illness from purchasing or possessing a gun.
  • Keep military-style weapons off our streets.

More obvious solutions, although somewhat vague in the third bullet point, which is what I wanted to address.

I think we’re talking about a reductionist link between mental health and mass shootings that is too simplistic. Most mentally ill persons are more likely to be victims of crime, not perpetrators. The common post-shooting cry that more resources should go toward dealing with mental illness misses the point. So many factors seem to go into mass shootings—age, alcohol and drug use, social isolation, the availability of guns, whether the shooter knows the victims (usually they do) and mental illness—that the problem needs to be addressed in its totality.

In fact, if I were to guess, I think social isolation and age (and certainly gender) are more relevant factors than mental illness. And I’m not sure what mental illness MEANS in this context.

Mental retardation, sure.  Mental illness which manifests itself with violent tendencies and a history of assaultive behavior, sure.  Those are obvious.  But I don’t think that net is big enough to have captured the Oregon shooter, the Charleston shooter, or the Columbine shooters, to name a few.

So do you cast a wider net?  Do you include people with schizophrenia?  Bipolar disorder?  Other major mental and emotional illnesses, even if they don’t include violence?

Maybe, but sometimes people with those kinds of mental illness can control them with drugs and behavioral therapy.  What do you do, for example, with someone who was diagnosed as schizophrenic in his teens, but is now in his 60s and has gone 5 decades without any incident?

What about depression?  Social anxiety?  These are mental illnesses found in the DSM-V, that are often temporal in nature.  Are you going to deny guns to ANYONE who has EVER been depressed?  What about PTSD which happens to crime victims and one-third of all soldiers who served in combat (try taking guns away from THAT group)?

And how do you find out about peoples’ mental and emotional illnesses anyway?  Will private medical and psychiatric records be made available to the government?

In other words, other than the most obvious examples (people committed to long-term mental hospitals), a “mental illness” approach to reducing gun deaths and suicides is not only impractical, but ineffective.  Violent tendencies (as shown by domestic abuse complaints, and violent crimes) are a better predictor, and our focus should be on that.

In the end, however, Nick Kristof isn’t saying anything new, but he’s saying it correctly:

First, we need to comprehend the scale of the problem: It’s not just occasional mass shootings like the one at an Oregon college on Thursday, but a continuous deluge of gun deaths, an average of 92 every day in America. Since 1970, more Americans have died from guns than died in all U.S. wars going back to the American Revolution.

When I reported a similar figure in the past, gun lobbyists insisted that it couldn’t possibly be true. But the numbers are unarguable: fewer than 1.4 million war deaths since 1775, more than half in the Civil War, versus about 1.45 million gun deathssince 1970 (including suicides, murders and accidents).

If that doesn’t make you flinch, consider this: In America, more preschoolers are shot dead each year (82 in 2013) than police officers are in the line of duty (27 in 2013), according to figures from the Centers for Disease Control and Prevention and the FBI.

More than 60 percent of gun deaths are suicides, and most of the rest are homicides. Gun enthusiasts scoff at including suicides, saying that without guns people would kill themselves by other means. In many cases, though, that’s not true.

In Great Britain, people used to kill themselves by putting their heads in the oven and asphyxiating themselves with coal gas. This accounted for almost half of British suicides in the late 1950s, but Britain then began switching from coal gas to natural gas, which is much less lethal. Sticking one’s head in the oven was no longer a reliable way to kill oneself — and there was surprisingly little substitution of other methods. Suicide rates dropped, and they stayed at a lower level.

The British didn’t ban ovens, but they made them safer. We need to do the same with guns.

When I tweeted about the need to address gun violence after college shooting in the Roseburg, Ore., a man named Bob pushed back. “Check out car accident deaths,” he tweeted sarcastically. “Guess we should ban cars.”

Actually, cars exemplify the public health approach we need to apply to guns. We don’t ban cars, but we do require driver’s licenses, seatbelts, airbags, padded dashboards, safety glass and collapsible steering columns. And we’ve reduced the auto fatality rate by 95 percent.

One problem is that the gun lobby has largely blocked research on making guns safer. Between 1973 and 2012, the National Institutes of Health awarded 89 grants for the study of rabies and 212 for cholera — and only three for firearms injuries.

Daniel Webster, a public health expert at Johns Hopkins University, notes that in 1999, the government listed the gun stores that had sold the most weapons later linked to crimes. The gun store at the top of the list was so embarrassed that it voluntarily took measures to reduce its use by criminals — and the rate at which new guns from the store were diverted to crime dropped 77 percent.

But in 2003, Congress barred the government from publishing such information.

Why is Congress enabling pipelines of guns to criminals?

Public health experts cite many ways we could live more safely with guns, and many of them have broad popular support.

A poll this year found that majorities even of gun-owners favor universal background checks; tighter regulation of gun dealers; safe storage requirements in homes; and a 10-year prohibition on possessing guns for anyone convicted of domestic violence, assault or similar offenses.

We should also be investing in “smart gun” technology, such as weapons that fire only with a PIN or fingerprint. We should adopt microstamping that allows a bullet casing to be traced back to a particular gun. We can require liability insurance for guns, as we do for cars.

It’s not clear that these steps would have prevented the Oregon shooting. But Professor Webster argues that smarter gun policies could reduce murder rates by up to 50 percent — and that’s thousands of lives a year. Right now, the passivity of politicians is simply enabling shooters.

The gun lobby argues that the problem isn’t firearms; it’s crazy people. Yes, America’s mental health system is a disgrace. But to me, it seems that we’re all crazy if we as a country can’t take modest steps to reduce the carnage that leaves America resembling a battlefield.

Tales Of The One Percenters

Honestly.  What is it going to take for the people and/or the government to throw these rich bastards in jail?  No, not for being rich, but for, you know, breaking laws and regulations that effect the lives of actual people…. when?!?

Case Study Number One:

Volkswagen chief executive Martin Winterkorn resigned Wednesday as a growing scandal over falsified emissions tests rocked the world’s biggest carmaker.

“I am doing this in the interests of the company even though I am not aware of any wrongdoing on my part,” Winterkorn said after an emergency meeting with Volkswagen directors.

Winterkorn, 68, was Volkswagen (VLKAY) CEO for eight years. The German company, which also owns the Audi and Porsche brands, had just achieved his long-standing goal of overtaking Toyota (TM) to become the biggest automaker three years ahead of target.

But his position had looked increasingly precarious since the scandal broke Friday, when U.S. regulators said the company had deliberately programmed some 500,000 diesel-powered vehicles to emit lower levels of harmful gases in official tests than on the roads.

The crisis escalated Tuesday when Volkswagen revealed it had found significant emissions discrepancies in 11 million diesel vehicles worldwide.

Winterkorn, an engineer and former head of Audi, said he was stunned by the scale of the misconduct, and was accepting responsibility to clear the way for a “fresh start” for the company.

Stunned, my ass.  You don’t intentionally program an entire line of cars to “cheat” emissions tests without the CEO knowing about it.  So this guy straps on a golden parachute, and leaves Volkswagon.  But people die when these things are avoided:

Volkswagen has admitted that 11 million of its cars worldwide were designed to cheat emissions testing, in an escalating scandal that has loaded pressure on the wider motor industry.

Campaigners have long claimed engine emissions figures under laboratory tests are far exceeded in real-life conditions, and experts have said thousands of premature deaths could be averted by ensuring cars meet their legal limits.

Emphasis mine.

Case Study Number Two:

Hedge fund manager Martin Shkreli is 32 years old but he’s acting half that age on Twitter today after news broke that his company, Turing Pharmaceuticals, had raised the price of the life-saving drug Daraprim from $13.50 to $750 per pill.

That’s not a typo — $13.50 to $750.00 per pill.

Daraprim is used to treat toxoplasmosis, a condition caused by a parasite that exists in nearly a quarter of the U.S. population over age 12, but which can prove deadly for the unborn children of pregnant women and for immunocompromised individuals like AIDS patients. These vulnerable populations will now have to pay over 5,000 percent more for their treatment.

Due to the sudden price hike, Shkreli, whose company only acquired Daraprim last month, has already dethroned the dentist who killed Cecil the Lion as the most-hated man in America.

***

Shkreli did a news show circuit as well, beginning with Bloomberg, where he attempted to argue that Daraprim had been underpriced before Turing swept in.

“The price per course of treatment to save your life was only $1,000 and we know these days, [with] modern pharmaceuticals, cancer drugs can cost $100,000 or more, rare-disease drugs can cost half a million dollars,” Shkreli said, as if it should be shocking that cheap, life-saving medicine could cost less than a laptop.

When confronted by the reporter with the low cost of producing Daraprim—about $1 per pill by her estimate—Shkreli claimed that the price hike was necessary for Turing Pharmaceuticals to increase revenue, and that some of the profits would be funneled into research and development costs for a Daraprim alternative. But as Emory University infectious disease professor Dr. Wendy Armstrong told RawStory, “I certainly don’t think this is one of those diseases where we have been clamoring for better therapies.”

Why do one percenters get away with this?  Because they can:

But as reprehensible as Shkreli’s actions might appear, what is even more harrowing is that they are not illegal. With his social media swagger, Shkreli makes an easy target for a problem that extends far beyond the confines of his ego: the rampant overpricing of life-saving medicine. As USA Today reported, many new cancer drugs cost over $100,000 per year—a fact that Shkreli, ironically, sees as justification for raising the cost of Daraprim. And technically, there’s no way to stop him.

As a spokesperson for the Food and Drug Administration told The Daily Beast’s Ben Collins on Twitter in response to Shkreli’s actions, their power in this situation is, well, nonexistent.

An FAQ page on the FDA’s website asks, “What can the FDA do about the cost of drugs?” and the answer is, essentially, nothing: “We understand that drug prices have a direct impact on the ability of people to cope with their illnesses as well as meet other expenses. However, FDA has no legal authority to investigate or control the prices charged for marketed drugs.”

Martin_Shkreli__3449094bThis is true, but states have laws against gouging.  An industrious state Attorney General could make a name for himself on this.

In any event, Shkreli’s media blitz cast him in an even worse light — he came off as slimy and greasy as a used car salesman.  Just .look at his picture.  The latest news today is that Shkreli has agreed to reduce the price, although he will not say by how much.

He’s not the first person to corner the market on a drug and hike the price.  But he’s one of the most frequent offenders.  Fortunately, Bernie Sanders and Hillary Clinton have weighed in, and this could become a political hot potato.  Any chance for reform?  We’ll see.

 

Planned Parenthood, the Abortion Debate, and 2016 Elections

There is very little to recommend being over the age of 50, but one of the nice things is that it gives perspective and wisdom — the kind of experience that can’t be taught, but can only come from having lived several decades.

There is one thing I have learned – abortion rights are not going away.

notdifficultThat wasn’t always a certainty.  Roe v Wade was seriously challenged in the 1980s and 1990s, not only in the political arena, but also in the courts.  But that nadir of the conservative anti-abortion movement came in 1992, with the case of Casey vs. Planned Parenthood.  The Supreme Court was, like today, leaning conservative.  You had Scalia, you had Thomas, you had Alito, you had Rehnquist for crying out loud.  And they were handed, on a silver platter, a case in which Roe v Wade could have been overturned, or at least seriously curtailed.  The result was 5-4, with the conservatives losing.  The Casey case actually strengthened abortion rights.

Having lost in the legal arena, the anti-choice forces spent the next two decades challenging abortion in the political arena.  They have had some success there.  There was the Hyde Amendment, a legislative provision barring the use of certain federal funds to pay for abortion unless the pregnancy arises from incest, rape, or to save the life of the mother.  That was signed into law by Bill Clinton in 1993.  At the state and local levels, a hodgepodge of laws have restricted access to abortion through laws requiring waiting periods, mandatory ultrasounds, and over-regulation of abortion clinics (like requiring wide hallways).  But abortion itself remains legal.

The recent attempt to defund Planned Parenthood is probably the strongest national push against abortion since the Hyde Amendment.  It is quite obviously punitive in nature — since the Hyde Amendment already restricts federal funds to go to Planned Parenthood for abortions, the current legislative push seeks to defund Planned Parenthood of federal funds for everything else they do (cancer screening, etc.).  And why?  Because they sell “baby parts”, which of course is a crass and not-altogether-honest way of saying that Planned Parenthood provides fetal tissue to medical research facilities in the hopes of curing disease.  Conservatives want to kill Planned Parenthood (the largest abortion provider) even if it means killing women’s health.

Of course, this dovetails nicely into the “war on women” meme.  And Hillary Clinton is right to pound Republicans on this.  This issue was a gift to her — she was sagging in the polls and Bernie Sanders has been making a serious play for the nomination (coming within 8 points of Hillary in New Hampshire).  Now she can talk about women’s health, and the Republican efforts to kill it.

I am perplexed as to why Republicans want this debate.  They seems to care more about two-celled zygotes than million-celled actual women.  After they lost the 2012 Presidential elections, they performed an autopsy of their failures, which included statements like this:

When it comes to social issues, the Party must in fact and deed be inclusive and welcoming.

If we are not, we will limit our ability to attract young people and others, including many women, who agree with us on some but not all issues…

The RNC must improve its efforts to include female voters and promote women to leadership ranks within the committee. Additionally, when developing our Party’s message, women need to be part of this process to represent some of the unique concerns that female voters may have. There is growing unrest within the community of Republican women frustrated by the Party’s negative image among women, and the women who participated in our listening sessions contributed many constructive ideas of ways to improve our brand with women throughout the country and grow the ranks of influential female voices in the Republican Party.

But rather than do that, they seem to be doubling down on losing the women vote — going so far as to threaten a government shutdown.  At first I thought the talk of government shutdown was an empty threat, but maybe I am wrong.  Stan Collender at Forbes puts the odds of a government shutdown at 60% (up from his previous prediction of 40% ). Here’s his wonderfully descriptive way of saying what happened.

But the biggest change from last week in the odds of a government shutdown is because of the emergence of the one big thing that has been missing so far from the appropriations debate: a highly emotional, politically toxic and take-no-prisoners issue.

Even the front-runner in that contest right now – Donald Trump – declared his support for a government shutdown over Planned Parenthood. Any candidate who had doubts about whether or not a government shutdown would be good for their campaign will now have to weigh in with that in mind.  Also, we’ve already seen one example of a candidate making a mess of that when, in commenting about Planned Parenthood funding, Jeb Bush said yesterday that he was “not sure we need half a billion dollars for women’s health issues.” His campaign pretty immediately tried to walk that one back. Overall it’s very likely that, in order to win the GOP primary, these candidates will all wind up taking positions that their own autopsy suggested were one of the causes of their defeat in 2012.

The craziness of the high rhetoric of this 2016 election campaign is causing Republicans to shoot themselves in the face.  It is interesting to watch.

This Says It All

Obama Derangement Syndrome:

Atlanta resident Ted Souris, 62, describes himself as an “arch-conservative” who initially opposed the health law. He said he had mixed feelings about the ruling. He receives what he calls “a pretty hefty subsidy” to buy insurance — he gets $460 and pays $115 a month for insurance.

“I’m so against Obama, and I hate that he has any kind of victory,” Souris said, “but it’s nice that I don’t have to worry” about affording health coverage.

He said that he doesn’t like getting what he calls “a government handout” but that the law — and the subsidy — allowed him to retire early and still have coverage. “I am glad I have the Affordable Care Act, and I appreciate that I got the subsidy.”

These people just hate.  Hate Obama.  Even when Obama does things that are good for them.

I’m not saying it is racism, but whatever it is, it is a very strange pathology.

Obamacare Subsidies Upheld By SCOTUS

I’m actually not that surprised at the outcome.  The surprising thing was that the Supreme Court ever took this case in the first place.

But the US Supreme Court upheld the challenge to Obamacare.  The opinion is here.

In layman’s terms, the issue surrounded some (arguably) vague language in the Affordable Care Act relating to the federal government providing financial assistance to people who get Obamacare through their state exchange.  If you interpret the language one way, the federal government cannot provide financial assistance.  If you interpret it the way Congress intended it, then the federal government can provide financial assistance.  Without the federal government assistance, however, health insurance will become far too expensive for millions of people who buy it through their state exchange, and so they won’t buy it.  (In North Carolina, it would increase healthcare costs by over $300 per month).   In effect, it would end Obamacare.

So the question was actually quite simple…. did Congress intend to write a healthcare law that wouldn’t work?

Chief Justice Roberts wrote the opinion and the short answer to that question is….

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Chief Justice Roberts did note that the ACA was a badly written piece of legislation.  (There are, he notes, three separate Section 1563s).

Scalia’s dissent is pure Scalia.  It refers to “interpretive jiggery-pokery” and calls the majority opinion “pure applesauce”.

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Elsewhere, he writes: “Impossible possibility, thy name is an opinion on the Affordable Care Act!”

He writes that the court “rewrites the law to make tax credits available everywhere… We should start calling this law SCOTUScare.” (that’s the first time “SCOTUS” has ever been used in a SCOTUS opinion).

He says: “Under all the usual rules of interpretation, in short, the Government should lose this case. But normal rules of interpretation seem always to yield to the overriding principle of the present Court: The Affordable Care Act must be saved.”

And similarly: “[T]he cases will publish forever the discouraging truth that the Supreme Court of the United States favors some laws over others, and is prepared to do whatever it takes to uphold and assist its favorites.”

Talk about projection.  Scalia is the one with the obvious agenda and “favorites”.  That last comment is a pretty harsh attack on his colleagues, including the Chief Justice.

We should remember that Scalia didn’t give a rat’s ass about the clear language OR the legislative intent of the Voting Rights Act when he and his conservative colleagues gutted it, deciding unilaterally that it didn’t apply to today’s world, now that there isn’t racism any longer.

Roberts, by the way, took Scalia’s own dissent from the last major Obamacare case, and used it against Scalia.  It was buried in a footnote and amounted to a small dart lobbed Scalia’s way.  To defend making the subsidies available to consumers everywhere, Roberts cited a line the dissent to the 2012 decision in favor of Obamacare, in which Scalia said, “Without the federal subsidies . . . the exchanges would not operate as Congress intended and may not operate at all.”

Roberts used the line to argue that it “is implausible that Congress meant the Act to operate” in a manner to limit the subsidies only to those states with state-operated exchanges, as the challengers in King v. Burwell argued.

Other reax below the fold

Don’t Call ‘Em Crazy

I really have a problem with the second-day opinion that the Charleston shooter was “mentally ill” or “disturbed”. 99% of the time, the person offering that assessment isn’t at all a qualified doctor, and 100% of the time, he hasn’t examined the shooter. There’s a ridiculous circular logic that the shooter’s actions explain his mental state, and his mental state explains the shooting. “Of course he is mentally ill; he killed those people”, you hear. Oddly, however, that psychiatric diagnosis is rarely applied to, say, the 9/11 hijackers or WWII Nazis or the Boston Marathon bombers or Muslim suicide bombers. Only white people with guns.

There are a couple of problems with calling the shooter “mentally ill” (aside from the fact that it is pure conjecture). One problem is, by calling him crazy, people (politicians and pundits, etc.) can then dismiss the larger, more relevant discussion, whether it be gun laws or racism or whatever. I hear it all the time in every gun control debate — “Well, the (Aurora/Sandy Hook/Charleston) shooter was crazy, and you can’t legislate against crazy.” Can we open ourselves up to the possibility that some people are simply, you know, evil? Again, we seem to have no problem when it comes to Muslim shooters or bombers. We don’t crawl into their head and give them a psychiatric evaluation.

Secondly, I bet there is not a person reading this who has not experienced mental illness. Technically, even temporary depression or anxiety are forms of mental illness. When you hear the phrase “mentally ill” (or any synonym), think “physically ill”. Everybody gets physically ill at some point (often many times) in their lives. And some people have (or develop) chronic physical illnesses. It’s just the same with mental illness. Therefore, having a mental illness, whether chronic or temporary, doesn’t make you Charles Manson or a horrible killer. It doesn’t necessarily foreclose the possibility that you might (also) simply be a horrible person or (I hasten  to add) a wonderful person.  It’s just something you have.

So let’s show some respect for the concept of “mental illness” and not use that as a label to avoid the harder conversations of racism and gun control. It is disrespectful to those who suffer from mental illness, as well as those who suffer from racism or the effects of a gun-crazy society.

The worst culprits of this sin lie on the right side of the political spectrum.  If they are not dismissing the Charleston shooter as “disturbed”, then they are “baffled” by why he might do this.

Again, the right wing just doesn’t want to acknowledge a race problem. So they’ll wear blinders so they can avoid the news reports about what the shooter said:

And just this morning:

(CNN) Dylann Roof admits he did it, two law enforcement officials said — shooting and killing nine people he’d sat with for Bible study at a historically black church in Charleston, South Carolina.

But why? To start a race war, Roof told investigators, according to one of the officials.

Aside from calling the shooter “mentally ill”, they have a couple other tactics to avoid discussing the race or gun issue.  Tell me if you’ve heard any of these lately:

(1)  Now is not the time….. we should think of the victims and pray.  (And then move on)

(2)  We should not politicize this horrible event.  Out of respect for the victims, we should think of them (and then move on).  Any attempt to change laws, or prevent this from happening again, will divide the nation and create more trouble like what happened.

(3)  It’s about religious freedom.


But returning to mental health, why the “crazy” argument?  Well, it’s a way to dismiss the issue.  To give yourself authority that you know (or can’t know, because it is baffling) the true root cause of something.  Don’t listen to the Charleston shooter, the right wing says.  He’s nuts!!!

But we should listen to Dylann Roof.  He’s telling us why he did it.

UPDATE – Salon says the same thing as me…. and adds:

We’ve successfully created a world so topsy-turvy that seeking medical help for depression or anxiety is apparently stronger evidence of violent tendencies than going out and purchasing a weapon whose only purpose is committing acts of violence. We’ve got a narrative going where doing the former is something we’re OK with stigmatizing but not the latter. God bless America.

Yup.

RELATED:  Jon Stewart not being funny is amazing:

“What blows my mind is the disparity of response between when we think people that are foreign are going to kill us and us killing ourselves.”

Will America’s Uninsured Rate Go To Single Digits?

No major survey has ever found that the uninsured rate in America has hit single digits.  Ever.

But a new survey from the Urban Institute’s Health Reform Monitoring Survey, a quarterly survey of non-elderly Americans, says that 10.0% of nonelderly adults were uninsured.  That’s down from 17.8% in September 2013, before the Affordable Care Act’s insurance exchanges first launched.

And in fact, that data is only as recent as March 2015, so we are probably in the single digits now.

Let’s hope SCOTUS doesn’t screw things up now.

Shooting The Mentally Ill

I’ve written about this before — the propensity of the police to open fire on people they know to be mentally ill.  Like their current problem with minorities, members of law enforcement seem to have a problem with showing restraint when it comes to the mentally ill.

Earlier this week, the US Supreme Court had occasion to address this issue, and sadly, the results were not what mental health advocates were hoping for.

Teresa Sheehan suffered from a mental illness and lived in a San Francisco group home. After Sheehan threatened her social worker when he attempted to perform a welfare check, he became concerned that she was a danger to herself or others and summoned the police for help transporting her to a mental health facility for a 72-hour involuntary commitment. When the police officers arrived, they entered Sheehan’s room without a warrant to take her into custody. Sheehan grabbed a knife and threatened to kill the officers. They were forced to withdraw outside her room and call for backup, but instead of waiting for the backup to arrive, they drew their weapons and forced their way back into her room. When Sheehan again threatened the officers with a knife, they shot her several times.

Sheehan sued the officers and the city for violations of her Fourth Amendment right to be free from warrantless searches and seizures as well as violations of the Americans with Disabilities Act.

The district court granted summary judgment in favor of the defendants, and Sheehan appealed. The U.S. Court of Appeals for the Ninth Circuit held that there were triable issues of material fact regarding whether the officers’ second entry into Sheehan’s room was reasonable under the circumstances and whether the officers failed to reasonably accommodate Sheehan’s disability as required by the Americans with Disabilities Act.

The US Supreme Court was asked to determine two things:

(1) Did the officers violate a clearly established right under the Fourth Amendment when they forced entry into Sheehan’s room the second time?

(2) Does the Americans with Disabilities Act require law enforcement officers to provide accommodations to an armed, violent and mentally ill suspect when attempting to take that suspect into custody?

The Supreme Court ruled “no” to the first question and didn’t reach the second one.  The ruling was 6-2, with Scalia and Kagen dissenting on procedural grounds (that is, even though they dissented, they still didn’t agree with the Sheehan’s claim).

My opinion: when you read the facts of the case, you see that the police were in a precarious position.  Obviously, they had to do something, and the longer they waited, the more this woman was a risk to herself and others.  I just have an issue with shooting her.

And the problem isn’t a legal one or a political — the solution lies with proper police training.

As I have written before, police need to adopt what is known as the Crisis Intervention Training (CIT) model of dealing with the mentally ill.  It is a 40-hour curriculum — one of the most comprehensive police officer mental health training program in the country. According to Laura Usher, CIT program manager at NAMI headquarters in Arlington, Virginia, there are crisis intervention training programs in 45 states as well as the District of Columbia. (States without programs are Delaware, West Virginia, Alabama, Arkansas, and Rhode Island.)

While there are multiple CIT programs within some counties, many states are barely on the map in terms of the number of counties within each state that have programs. Most states only have CIT programs in only one or two counties.

Most law enforcement agencies can’t afford to train everyone.  They’d have to pay someone else overtime, and that can be a big expense.  As a result, many police departments prefer to train only a few specialized officers to deal with crisis issues, rather than making mental health training mandatory.

You can read more about it here.  The Supreme Court opinion is below the fold….

I Feel Bad For The Guy, But….

There are many angles about the story I am about to convey.

One might say it is a story about a guy out on his luck.  Another might say it is a story about the crappy healthcare system we have.  Or maybe it is about how Republicans talk about personal responsibility but then complain when they don’t get government handouts when they want it.  For me though, this is a story about a guy so entrenched in his Obama hatred that he screwed himself over (and yet he still blames Obama).  Anyway, you be the judge. From the Charlotte Observer:

Lang, a 49-year-old resident of Fort Mill, S.C., has bleeding in his eyes and a partially detached retina caused by diabetes.

“He will lose his eyesight if he doesn’t get care. He will go blind,” said Dr. Malcolm Edwards, the Lancaster, S.C., ophthalmologist who examined Lang.

Lang is a self-employed handyman who works with banks and the federal government on maintaining foreclosed properties. He has done well enough that his wife, Mary, hasn’t had to work. They live in a 3,300-square-foot home in the Legacy Park subdivision valued at more than $300,000.

But he has never bought insurance. Instead, he says, he prided himself on paying his own medical bills.

That worked while he and his wife were relatively healthy. But after 10 days of an unrelenting headache, Lang went to the emergency room on Feb. 25. He says he was told he’d suffered several mini-strokes. He ran up $9,000 in bills and exhausted his savings. Meanwhile, his vision worsened and he can’t work, he says.

That’s when he turned to the Affordable Care Act exchange. Lang learned two things: First, 2015 enrollment had closed earlier that month. And second, because his income has dried up, he earns too little to get a federal subsidy to buy a private policy.

Lang, a Republican, says he knew the act required him to get coverage but he chose not to do so. But he thought help would be available in an emergency. He and his wife blame President Obama and Congressional Democrats for passing a complex and flawed bill.

Since Lang now has no income, he should be eligible for the ACA’s expanded Medicaid coverage, for which the federal government picks up tab. But Lang lives in Fort Mill, South Carolina. And South Carolina refused to accept Medicaid expansion. So he’s out of luck on that front too.

He now has a gofundme page to help raise some money for his medical expenses.

Okay.

That’s the story.  Now, he and his wife have decided to lay blame at ACA’s feet, so let’s play the blame game:

Let’s go through this point by point:

(1) Lang broke the law by refusing to get health insurance coverage because he prided himself on being able to pay his bills out of pocket.  ACA’s fault?  Verdict: No.

(2) He lost the health lottery and got sick.  That’s when he realized he actually had too little savings to cover even relatively small health care bills.  ACA’s fault?  Verdict: No

(3) By now open enrollment has closed. But he figured he’d be able to buy in if he got in a jam or wait till he got sick to buy coverage. Luckily the ACA’s Medicaid expansion covers him regardless. But the state of South Carolina refused to accept Medicaid expansion even though the federal government would pay for it. ACA’s fault?  Verdict: No (The US Supreme Court ruled that it could not be made compulsory on states to accept the Medicaid expansion, i.e., states had to opt in.  Most states did choose to opt in but the Republican legislature and governor of South Carolina said “no”.).

When all is said and done, Lang is left in precisely the situation that would exist if the ACA (aka Obamacare) had never been passed. So he blames… Obama?  It takes quite a lot of chutzpah to blame the Affordable Care Act for not covering him when he disdains government programs and never carried health insurance in the first place. If he thinks he should be covered now then he’s really asking for single payer, which he would probably call “socialist”.  Lang’s case shows the exceptional power of myths reinforced by Fox News-like partisanship and ideology.

Lead Paint And Inner City Violence

I’m just going to point to this comprehensive and insightful Washington Post article which talks about Freddie Gray (whose death while in Baltimore police hands sparked the recent riots there) and lead paint.  Like many inner city kids, Gray lived in sub-standard housing with peeling lead paint, and in his case, it specifically was blamed for ADHD and other problems.

It wasn’t long after that he was given the first of many blood tests, court records show. The test came in May of 1990, when the family was living in a home on Fulton Avenue in West Baltimore. Even at such a young age, his blood contained more than 10 micrograms of lead per deciliter of blood — double the level at which the Center for Disease Control urges additional testing. Three months later, his blood had nearly 30 micrograms. In June 1991, when Gray was 22 months old, his blood carried 37 micrograms.

“Jesus,” Dan Levy, an assistant professor of pediatrics at Johns Hopkins University who has studied the effects of lead poisoning on youths, gasped when told of Gray’s levels. “The fact that Mr. Gray had these high levels of lead in all likelihood affected his ability to think and to self-regulate and profoundly affected his cognitive ability to process information.”

Levy added, “And the real tragedy of lead is that the damage it does is irreparable.”

This isn’t unusual, and any discussion of violence in the inner cities needs to consider this as a factor.

CIA to Carrie Matheson: “Good Riddance”

So, this happened:

That’s an official tweet from the official Central Intelligence Agency to a fictional character — Carrie Mathison of the Showtime series, Homeland.  Next season, Carrie will no longer be working for the CIA.  The CIA tweet references a Sunday New York Times op-ed by Maureen Dowd which declared that Carrie’s “real-life counterparts” were thrilled that Claire Danes’ character would be no longer an agent:

The C.I.A. sisterhood is fed up with the flock of fictional C.I.A. women in movies and on TV who guzzle alcohol as they bed hop and drone drop, acting crazed and emotional, sleeping with terrorists and seducing assets.

Dowd quotes a number of women in the CIA, including Gina Bennett, who has been an analyst in the Counterterrorism Center for 25 years. Characters like Carrie “can leave a very distinct understanding of women at the agency — how we function, how we relate to men, how we engage in national security — that is pretty off.”

The agents’ personal anecdotes are fascinating: they describe briefing Condolezza Rice while in labor (“I’d tell her about the global jihad and then I would turn away and breathe”) and balancing post-9/11 anti-terror operations with parenting a teenager.

Certainly the women mentioned in the Dowd article are entitled to their opinion.  But I think they are missing the larger point.  Sure, Carrie Mathison doesn’t accurately portray a female CIA agent and sure, this portrayal is demeaning or unflattering– but she is not meant to mirror the typical female CIA agent.  Carrie Mathison is bipolar, compulsively sexual, occasionally predatory. She had a brief, horrifying fantasy about drowning her own baby in a bathtub. She should get to be all of these complicated, unlikeable, screwed-up things.  It makes for interesting drama.

The issue is that in a sea of cop shows, FBI shows, CIA shows, etc., there simply aren’t enough female characters, period.  If there were, then Carrie Mathison would be just one eccentric female character in a wide range of strong cop-like female characters.  And then, her eccentricities would not stand out so harshly.  The problem for Carrie, and female characters on television more broadly, isn’t misrepresentation. It’s under-representation.  Carrie Mathison is held accountable in this disproportionate way because she’s standing in for everyone.

Men don’t have this problem. This is why you don’t hear male high school science teachers fuming about how Walter White is a meth-cooking sociopath. This is why male homicide detectives didn’t get themselves into a tizzy over the drunk, dishonest practices of Rust and Marty on True Detective. This is why men who worked in advertising in the 1960s aren’t up in arms about Don Draper’s adulterous, alcoholic ways.  There are enough men in lead roles to counterbalance these “bad eggs”.

To be sure, there are some female characters who are competent and possess real power onscreen. Parks and Recreation’s Leslie Knope and Empire’s Cookie Lyon come to mind.  And even Carrie Mathison, in spite of her emotional malady.  But most women, even the so-called successful ones, spend an awful lot of time being sexualized, or at least reinforcing the stereotype that their success comes from sex.  The female reporters on House of Cards for example.  (And even Carrie Mathison uses sex in furtherance of her mission).

So, yes.  This is yet another post and yet another plea for better-written and more female characters.  This is the second golden age of television, they say, and this is still a problem.

NAMI On the Germanwings Air Crash

Reprinted in full:

NAMI shares the grief of the rest of the world over the crash of Germanwings Flight 9525.  We extend our condolences to the families of those who lost their lives in this senseless tragedy.

As often happens in tragedies, information emerges first through an immediate frenzy of reporting in news media and then through more careful analysis. It is always best not to speculate on causes, but to wait until all facts are confirmed and assessed.

In this case, as news cycles have progressed, we’ve been told that the co-pilot who crashed the plane had some history of depression. Most recently, a German prosecutor has reported that he had “received psychotherapy for an extended period of time, during which suicidal tendencies had been noted,” while the airline has reported in 2009 he had disclosed to them a previous episode of severe depression. Treatment apparently occurred before he received his pilot’s license.

He also apparently was being seen for one or more other medical issues. How relevant those factors actually are remains to be seen.

We know that by crashing the plane, the co-pilot killed himself, along with 149 other people.

We know that most suicides involve mental illness.

In the United States, approximately 40,000 people die from suicide each year.  Obviously, we are falling far too short in suicide prevention.

Typically, suicide involves a struggle between a person and his or her own psychological problem. Murder-suicides are very rare. Murder-suicides conducted by commercial airline pilots are even rarer—extremely rare—although that of course is no consolation to the victims of Flight 9525, their families and friends.

People living with mental illness are rarely violent. Usually, mental illness is only one factor, among several, if not many, that set the stage for violent tragedies.

In the case of Flight 9252’s co-pilot, the fact is that we don’t know his full history yet. We may never know every relevant fact. His precise history of depression, whatever it may have been, may ultimately be seen as unimportant compared to other issues in his life.

Please keep that point in mind as the global conversation now turns to whether anyone who experiences mental illness should be allowed to serve in certain occupations or professions. Mental illness is treatable. People do recover.

Senseless tragedies must not be allowed to resurrect or perpetuate stigmatizing stereotypes that associate anyone with a history of mental illness with a propensity to violence. It will be an additional tragedy if the crash of Flight 9525 leads to “witch hunts” in which people who have sought help for mental illness become unfairly discriminated against.

Sixteen million American adults—almost 7 percent of the population—had at least one major depressive episode in the past year.  When depressive symptoms occur, people need to see a doctor for a comprehensive examination. Underlying medical issues that can mimic a depressive episode, side effects from medications or any other medical causes must first be ruled out, before a treatment plan is chosen.

As a society, we need to create a cultural environment in which people are encouraged to seek help when they need it—regardless of whether it is a mental illness or any other illness.  No one should have to hide out of fear of negative consequences or reprisals such as loss of employment or social ridicule.

We want a society that affirms the worth of every individual—the same kind of affirmation that causes us to mourn the loss of so many precious lives on Flight 9525.

Today Is World Bipolar Day

wbdAccording to the World Health Organization (WHO), there are 450 million people globally with mental illness; of that number, 5 percent are labeled bipolar, which is three times all cases of diabetes and 10 times all the cases of cancer. Bipolar is the sixth leading cause of disability, according to WHO.

“Bipolar Disorder is a mental illness that represents a significant challenge to patients, health care workers, family members and our communities,” according to a press release from World Bipolar Day organizers. “While growing acceptance of bipolar disorder as a medical condition, like diabetes and heart disease, has taken hold in some parts of the world, unfortunately the stigma associated with the illness is a barrier to care and continues to impede early diagnosis and effective treatment.”

So how do we break down barriers and dispel myths and mistruths? Enter World Bipolar Day.

March 30 is the birthday of Vincent Van Gogh, the famous painter who cut off his own ear and was posthumously diagnosed with probable bipolar disorder, also known as manic depression. Dr. Pichet Udomratn, a member of the Asian Network of Bipolar Disorder (ANBD) who worked with with International Bipolar Foundation (IBPF) and International Society for Bipolar Disorders (ISBD) to create World Bipolar Day, thought March 30 would be a fitting day to bring the world information about a highly stigmatized and feared mental illness.

For more information on World Bipolar Day and how you can get involved, visit the cause’s Facebook page or follow the event on Twitter @WorldBipolarDay.

Don’t Blame Depression

This is in Forbes, so I don’t have to write it:

You saw a depressed person today. Probably dozens or hundreds of them.

They drive cars. They perform surgery.

They fly planes — and safely land them.

Of course, that’s been frequently forgotten since last week’s devastating Germanwings tragedy.

Many pundits quickly blamed the horrific plane crash on depression, noting that co-pilot Andreas Lubitz — who took control of the Germanwings airliner and steadily, deliberately flew it and his 149 fellow passengers into the Alps — was reportedly treated for depression and possessed a supply of antidepressants.

The argument came from know-nothing pundits like Piers Morgan. “Depressed pilots on medication for mental illness should not be flying passenger planes,” he declared. If they’re not pulled from the skies, he added, “it could be any one of us next.”

The supposed link was blared across European newspaper headlines, too.

Even the experts weren’t sure.

“Should a depressed pilot be allowed to fly?” wrote Dr. John Grohol, the founder & CEO of Psych Central.

“I’m not sure someone who has a lot of responsibility should be going into work on days where they’re dealing with this kind of emotional upset or sadness.”

On one count, Grohol’s right: there do need to be some basic protections. (That’s a key reason why the FAA has been incredibly restrictive when letting pilots return from treatment for depression, as Forbes writer David Kroll notes.)

And there is a possible link between depression and violence, at least in some cases.

For example, a recent Oxford University study reviewed 50,000 Swedish citizens diagnosed with depression, concluding that people who were diagnosed with depression tended to commit more violent crimes too.

“Our findings suggest that the odds of violent crime are elevated two to three fold after adjustment for familial, socioeconomic, and individual factors,” the researchers wrote in TheLancet Psychiatry in February.

But blaming a person’s depression for his evil acts is ridiculous.

For instance, the Oxford researchers noted that when accounting for other factors — like a previous history of violence, substance abuse, or psychosis — the elevated rate of violence among depressed was notably smaller. And it’s possible that “depression” was over-diagnosed in these people, too.

Mental health experts further stress: Depressed people may be suicidal, but almost never homicidal. The suicide rate in the United States is roughly double that of the homicide rate.

That’s why one of the most important public health efforts of the past few decades has been the effort to de-stigmatize depression — especially because it’s so widespread. Depression strikes up to 20% of Americans across their lifetimes, the Anxiety Disorders Association of America has found.

For the moment, depression is seen as a debilitating, but not disabling condition. “Depression made me do it” isn’t an acceptable excuse for doing a poor job at work, and can’t get you out of a legal bind.

And it doesn’t explain what happened in the case of Germanwings, as Lubitz horribly plunged a plane of screaming passengers into the Alps, acting with chilling evil.

If you believe the tale told by an alleged ex-girlfriend, the plane crash was chillingly planned for months; Lubitz supposedly wanted the world to know his name.

“I don’t know what that is,” psychiatrist Anne Skomorowsky wrote at Slate, “but it’s not depression.”

Ask one of the 10 million-plus Americans who are seriously depressed at any given time. The bravest among them will admit: Depression is devastating. It makes you self-loathing, and lays you low.

But it doesn’t make you a murderer.

See also: “Would We Be ‘Blaming’ Cancer for the Deaths of Those People Who Perished in the Alps?” at HuffPo

I would add that we shouldn’t blame bipolar disorder either.  That is being bandied about as the culprit because he was prescribed strong SSRIs and anti-psychotic medicine.

Don’t get me wrong… I think it is clear that he suffered from some mental illness.  He may have had bipolar disorder or depression, but these would only explain the suicide, not the 149 homicides.  Some have suggested narcissistic personality disorder, which is characterized by (among other things) indifference toward others and grandiosity (Lubitz reportedly said he wanted to “change the system”).  Perhaps that is true.

But the danger here is linking his illness to the tragedy.  I know people who have struggle with depression.  I know people who have been diagnosed bipolar.  And people who have NPD/borderline.  None of them are likely to become homicidal.  This tragic event, like some school shootings, could become a good teaching moment for mental illness — to explain both the frequency and severity and the wide range of problems it causes (homicide being extremely rare)  But instead, the media focus will merely add to the already-existing stigma of mental illness, causing fewer people to seek treatment, or deny their illness altogether.  And that would add to the tragedy.

Stigmatization Of Mental Illness Begins

It’s an explanation, not an excuse.

By the way, it bears mentioning that if there were no stigmatization of mental illness, the copilot would not have felt the need to hide his condition, and could have gotten the help he needed, thus saving 150 lives. But you can bet the media won’t take that angle.

The Cheap Wine You’ve Been Drinking May Contain Too Much Arsenic

That’s the allegation in a lawsuit (read the complaint here — PDF) filed in California this week.  The origins of the lawsuit draw back to Kevin Hicks, a former wine distributor who started BeverageGrades, a Denver-based lab that analyzes wine. The lab tested 1,300 bottles of California wine, and found that about a quarter of them had higher levels of arsenic than the maximum limit that the Environmental Protection Agency allows in water.

Now, it is important to keep in mind that this is a lawsuit, and it is entirely possible that this is essentially a nuisance lawsuit — one contrived by ambulance-chasing lawyers in order to get a quick shakedown of the wine companies involved, hoping that the companies would rather see this go away quickly than have to put up with years of bad publicity (even if they are vindicated in the end).  So take that into account. But in the meantime, below the fold is a list of wines that are included in the lawsuit. (Note: Any wines without a specific year listed mean that the grapes don’t come from a single year.)

Taking Anti-Vaxxing To The Next Level

It’s one thing to say that measles vaccinations are harmful (they’re not), but it is entirely different to say that measles don’t exist at all.  Yet, one German pseudoscientist did, going so far as to put his money on it.  He lost:

This is something I thought would probably never happen – a science denier, in this case German virologist Stefan Lanka, was ordered by a court to pay 100,000 Euros to German doctor David Barden for meeting his challenge to prove that the measles virus exists.

Lanka is clearly, in my opinion, a crank, which is a specific flavor of pseudoscientist who makes sophisticated arguments to support a hilariously wrong conclusion. There is some major malfunction in their scientific reasoning. Typically, in my experience, they have an oversized ego and think they know better than the rest of the scientific community. For some reason an extreme narrative gets stuck in their brain, and they spend their career marshaling evidence and arguments to support a nonsensical idea. I find cranks endlessly fascinating because I think they are extreme cases that reveal major weaknesses in the operation of the human brain.

One favorite tactic of cranks and deniers is to issue an open challenge to prove what they deny exists. I think this strategy is inspired by the Randi Million Dollar Challenge, which is a legitimate challenge for anyone to prove a paranormal phenomenon. Randi has a specific process spelled out, with concrete criteria for success.

Hoax challenges are pure publicity stunts – they sound grandiose but typically are framed in such a way that the one issuing the challenge can wiggle out of ever having to pay. They are rigged from the beginning, mainly by not spelling out what kind of evidence would meet the challenge.

I guess Lanka got a little sloppy. He issued a 100,000 Euro challenge to anyone who could prove the measles virus exists. That’s right – the measles virus. Lanka is an HIV denier from back in the 1990s (and still denying HIV). HIV denial is the claim that AIDS does not exist as a discrete medical illness, or at least is not caused by a specific virus, and in fact the human immunodeficiency virus does not really exist.

***

That a court has now demanded that Lanka pay Barden the reward for meeting his challenge is an interesting twist. Barden pulled together published scientific evidence that together proves beyond a reasonable scientific doubt that measles is real. Lanka, of course, denied the evidence. That is what he does. You will never meet his burden of evidence to prove the thing that he denies, which is what makes such challenges from deniers a hoax.

However, Barden went to the courts to settle their dispute. The court, unlike Lanka, has apparently applied a reasonable standard for scientific proof and determined that Barden did indeed meet the burden of proof to demonstrate that measles is real. Lanka, of course, will appeal, and there is always the possibility that he will wiggle out of the judgment on legal grounds (rather than the merits of the case).

Study: Selfish Anti-Vaxxing Parents Facilitated Measles Outbreak

L.A. Times:

Although epidemiologists have not yet identified the person who brought measles to Disneyland, a new analysis shows that the highly contagious disease has spread to seven states and two other countries thanks to parents who declined to vaccinate their children.

Using some simple math, a team of infectious disease experts calculated that the vaccination rate among people who were exposed to the measles during the outbreak was no higher than 86%, and it might have been as low as 50%.

In order to establish herd immunity, between 96% and 99% of the population must be vaccinated, experts say.

“Even the highest estimated vaccination rates from our model fall well below this threshold,” the researchers reported Monday in the journal JAMA Pediatrics.

… In other words, the only way to explain how the measles spread from a single person at Disneyland to 145 people in the U.S. and about a dozen others in Canada and Mexico is that a substantial number of parents have not had their children fully immunized with the measles, mumps and rubella vaccine.

“Clearly, MMR vaccination rates in many of the communities that have been affected by this outbreak fall well below the necessary threshold to sustain herd immunity, thus placing the greater population at risk as well,” the researchers concluded.

Fortunately, there are bills in the California legislature (and hopefully in other states as well) to make it harder for parents to “opt-out” their kids.

Why My Plans To Retire In Costa Rica Are Looking Better

Because of this:

Exactly five years ago this week, as the Congressional debate over the Affordable Care Act was coming to its eventual conclusion, Rush Limbaugh made a bold statement about his future as a resident of the United State of America.

Speaking to a caller who expressed concerns about the impact of Obamacare on the U.S. healthcare system, Limbaugh said, “If this passes and it’s five years from now and all that stuff gets implemented, I am leaving the country. I’ll go to Costa Rica.”

He’s still here in the U.S.  Maybe he was just saying stuff.

Whew!

Do We Have A Contender For Michelle Bachman’s Replacement?

MichelleFioreNevada Republican assemblywoman Michelle Fiore made a bit of name for herself when she was quoted in the New York Times saying that “hot little girls” on campus need guns to protect themselves against rapists.  She did not say what ugly large girls should carry.  This was all in connection with a bill she sponsored that would allow firearms onto college campuses (because what could possibly go wrong with that?)

Now she is telling her constituents that cancer is a fungus that can be flushed out with salt water and baking soda.

Yes, she really said that.

Gonna keep an eye on this one…..

P.S.  The more you know….

The Vaccination Debate Makes For An Interesting Political Wedge Issue

Of the potential 2016 presidential candidates on the GOP side, we have Christie and Rand Paul cuddling up with the anti-vaxxers (spouting “freedom” in their answers when asked about whether parents should vax)

And then we have one of the most conservative Christian candidates out there, Dr. Ben Carson, who seems to be the voice of reason on this issue:

“Although I strongly believe in individual rights and the rights of parents to raise their children as they see fit, I also recognize that public health and public safety are extremely important in our society,” Carson said in a statement to BuzzFeed News.

Carson said diseases of the past should not be allowed to return because of people avoiding vaccines on religious or philosophical grounds.

“Certain communicable diseases have been largely eradicated by immunization policies in this country and we should not allow those diseases to return by foregoing safe immunization programs, for philosophical, religious, or other reasons when we have the means to eradicate them,” Carson said in the statement.

Well, duh.

[UPDATE 2/4/15 — Looks like I gave Carson too much credit.  He stands by his statement, but he blames “undocumented people” for outbreaks (despite the fact that countries in Central and Southern America are better about vaccinations than we are.]

This isn’t a battle the Republicans want to have. This shouldn’t be one of those issues where you have to reflexively oppose whatever Obama or Clinton says, and the potential Republican candidates do this at their peril. The GOP is already thought of as the anti-science party. If Republican leaders are questioning the efficacy of vaccines, they’re going to double down on that label, alienating many of the moderates they need in 2016.

By the way, there is some interesting data on who supports/opposes vaccinations.  According to a YouGov survey, support for mandatory vaccinations for “childhood diseases like measles, mumps, whooping cough” is inversely correlated with age. Under-30s actually oppose it by a 42/43 margin, while those 30-44 support it 50/37; 45-64-year-olds support it 64/26, and seniors support it 73/21.

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I think the reason for this is quite simple: younger people are…. well, not stupid…. but ignorant.  They simply grew up in a time when these diseases had been eradicated for the most part.  They are going from their own blind lack of experience and firsthand knowledge.  They think of things like pro-choice and freedom, and apply it to this situation, without really knowing the history or facts.

The Problem With Libertarianism

Libertarianism (Latin: liber, “free”) is a political philosophy that upholds liberty as its principal objective. Libertarians seek to maximize autonomy and freedom of choice, emphasizing political freedom, voluntary association and the primacy of individual judgement.

For months, nay, years, I have been wanting to write about the shortfalls of libertarianism.  It’s been difficult because who in America, other than outright fascists, would argue with liberty and freedom of choice?

But finally FINALLY we have an illustrative example come to the fore.  And I’ve been blogging about it recently (a lot) and now I can make a simple tie-in without expending too many words.

Let’s go to the money quote from libertarian extraordinaire and 2012 Presidential candidate, Ron Paul:

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On Monday, Rand Paul, the son, hedged a little:

Paul was asked to weigh in on vaccines, after New Jersey Gov. Chris Christie (R), a likely rival for the GOP nomination in 2016, said Monday morning that there should be “some measure of choice” for parents leery of vaccinating their children.  “I’m not anti-vaccine at all, but most of them ought to be voluntary,” Paul, an ophthalmologist, said Monday on the “Laura Ingraham Show,” in a segment circulated by the Democratic National Committee along with criticism of Paul’s views.

UPDATE:  Later that day, Rand Paul was asked a follow-up, and said this with respect to vaccines:

I think they’re a good thing but I think the parent should have some input. The state doesn’t own your children; parents own the children and it is an issue of freedom.

Huh. So parents own their children (that’s libertarian?!?) and not only have the “freedom” to expose their property to deadly illnesses, they have the freedom to expose your kids to deadly illnesses.

The thing is — and I certainly can see why the anti-vaxxers hate this — IT TAKES A VILLAGE to get rid of some of these diseases.  All or most children had to be vaccinated before measles made its disappearance and the beginning of this century.  The same can be said for many more diseases.

The same holds true for other areas of human endeavor — the economy for example.  Libertarians think the self-interest and the invisible hand of Adam Smith will take care of everything.  Nope:

Neighborhoods, communities, villages, cities, societies — depending on the situation — can succeed and improve the quality of life where “individual freedom” cannot.  Does that mean socialism and communism is the way to go?  Of course not.  But libertarianism — the polar opposite of socialism and communism — is just as ineffectual for most things.

There is a balance between individual rights and the common good. This should be obvious, but hardcore libertarians seem to believe that the mere assertion of a right is sufficient to end a public argument. It is not, when the exercise of that right has unacceptable public consequences, or when the sum of likely choices is dangerous to a community.

Turning to the issue at hand, vaccines provide protection through two means.  The first is direct protection.  I get a shot for something and the probability of me getting that particular disease declines dramatically as my immune system now knows how to fight that type of invader.  The second is indirect protection via herd immunity.   If I get a shot, I go from being a possible vector and transmitter of a disease to another unvaccinated person to a very low probability of passing the disease along.  Herd immunity only works when the vast majority of the population already is immune to a disease as the probabilities of a current carrier bumping into a receptive individual is fairly low if the general population is overwhelmingly vaccinated.

So the point of vaccinations is to protect not merely ourselves, but the community. To not vaccinate is to threaten the array of trillions of antibodies and T cells that decades of vaccination have built up in our bodies/  We drape a web of germ-fighting agents not just in ourselves, but around our most vulnerable neighbors. To not vaccinate is to affirm an overweening individuality. It’s a form of selfishness.

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The best results come when everybody does what is best for themselves and for the group.  Adam Smith was wrong.  So are Ron and Rand Paul.  And the anti-vaxxers.

World’s Worst Doctor

There’s always one.  No matter what hair-brained position you take, you can always find an “expert” to add alleged credibility.

This time the “expert” is Jack Wolfson.  He’s being embraced by the loons because he’s a doctor AND an anti-vaxxer.  Here’s the thing to keep in mind — he’s a cardiologist.  That means he knows as much about vaccines as a proctologist knows about muscle degeneration.  Weigh his medical views against literally tens of thousands of academics and doctors who actually study and practice in this field.

Anyway, here’s a little of his drivel:

“Measles isn’t a big deal”, he said, though the CDC definitely disagrees. “This quote-unquote ‘outbreak’ has infected 70 people who are quote-unquote ‘infected,’ ” he said. “This is a country of 300 million people, and no one has died, and no one is sick as far as I know. We are all worried, and we are all getting crazy, and what we’re talking about is really just a fever and a rash.”

Uh, Mr. quote-unquote doctor?  It IS an outbreak. There have been over 80 102 people identified as of two days ago.  And what’s more, as the same article notes, that in YOUR state (Arizona), as many as 1,000 people, including 200 children, have potentially been exposed to the disease, and seven are infected.

No, it isn’t that black plague, but there was a point in history when there were only 80 people infected with the black plague.  That wasn’t a big deal at the time either.

What’s interesting/scary about the guy is that he doesn’t deny that vaccines prevent measles, mumps, rubella, chicken pox, etc.  He just thinks children have the “right” to contract these potentially life-threatening illnesses.  He says:

“I’m a big fan of what’s called paleo-nutrition, so our children eat foods that our ancestors have been eating for millions of years…. That’s the best way to protect.”

Except it is not.  It is just another fad diet, one that nutritionists reject.  In fact, in 2012, a panel of experts reviewed 36 different diets for their weight loss and health (nutrition) value.  Guess what came in last?  The paleo diet, mostly because it was unsafe.

But morons will be morons.  Even with a DR in front of their name.

*******

Also, this:

Video of Kristiana Coignard’s Summary Execution

As I posted a few days ago, police in Longview, Texas, tragically shot and killed a 17-year-old girl last week.  Her name was Kristiana Coignard.

In the newly released video, it’s clear that her shooting death was completely and totally avoidable.

After speaking with officers and roaming around the lobby of the police station for ten minutes, Kristiana, who was struggling with mental illness, was subdued by an officer in the lobby until two additional officers entered.

After Kristiana clumsily charges at the original officer, he shoots and kills her instantly.  We’ve been told she was “brandishing” a knife.  I don’t see it, but (for now) we’ll take the officers word on that.

Even then, a lot of questions come to mind: Why did he not handcuff her earlier in the minutes he had her subdued? Why did he not search her for weapons earlier? Why did he not Taser her with a stun gun? Why did he not use pepper spray? Why did he not simply grab her and subdue her again? Why did he not throw a chair at her, run from her, ANYTHING?

This cannot and should not be the best practice for police officers.  Firing your weapon should be the LAST RESORT.  I’m pretty sure it used to be. If this is all our officers are trained to do, it’s insufficient.

War On The Mentally Ill

As if having bipolar disorder isn’t difficult enough, you now risk being a target for overzealous cops.  Last Thursday, a 16 year old girl with a knife was shot by three cops in the lobby of the police station:

When Officers arrived they were confronted by a white female who threatened them. The suspect brandished a weapon, made threatening movements toward the officers and was shot. The suspect was transported to Good Shepherd Medical Center where she were pronounced dead by a Justice of the Peace. The Texas Rangers have been called in to investigate this shooting.

Coignard had been living with her aunt, Heather Robertson, who told ThinkProgress that the girl struggled with depression and bipolar disorder and had previously attempted suicide several times. “I think it was a cry for help,” said Robertson about her niece’s actions. “I think (police officers) could have done something. They are grown men. I think there is something they are not telling us.”

kristiana-coignard2Yes, there is undoubtedly something else they could have done. This was a mentally disturbed teen-age girl with a knife. They could have retreated, called for some help to try to talk her down or even used a taser if they really felt afraid for their lives. But why should they bother? This is easier.

Remember, these cops have very tough jobs. We can’t second guess their actions even when it might seem obvious to anyone with half a brain and the tiniest common sense that there might be other options besides opening fire on a disturbed teenage girl inside a police station.  (Not!)

Look, I get that mentally disturbed people can pose a serious threat to the public.  A 2013 joint report by the Treatment Advocacy Center and the National Sheriffs’ Association found that while no national data is officially collected on fatal police shootings of the mentally ill, “multiple informal studies and accounts support the conclusion that ‘at least half of the people shot and killed by police each year in this country have mental health problems’”

A third of “justifiable homicides”, the study found, could be characterized as “suicide-by-cop”, and many victims were not taking their medications nor under close supervision by mental health agencies.

But again, this was a girl with a knife.

For what its worth, the National Alliance on Mental Illness (NAMI) strives to increase awareness and understanding of the mentally ill through its partnership with the University of Memphis Crisis Intervention Training Program.

But within the law enforcement population, much is still to be done.

Crisis Intervention Training (CIT)—with a 40-hour curriculum—is the most comprehensive police officer mental health training program in the country. According to Laura Usher, CIT program manager at NAMI headquarters in Arlington, Virginia, there are crisis intervention training programs in 45 states as well as the District of Columbia. (States without programs are Delaware, West Virginia, Alabama, Arkansas, and Rhode Island.)

While there are multiple CIT programs within some counties, many states are barely on the map in terms of the number of counties within each state that have programs. Most states only have CIT programs in only one or two counties.

Most law enforcement agencies can’t afford to train everyone.  They’d have to pay someone else overtime, and that can be a big expense.  As a result, many police departments prefer to train only a few specialized officers to deal with crisis issues, rather than making mental health training mandatory.

And that’s how 16 year old girls who need help. end up getting shot by government employees.

UPDATE: The hacking group known as Anonymous, in a video posted on Saturday, cited Coignard’s death as the impetus for a new operation called Stop Lethal Force on Children.

“In 2014, we watched as police killed children and it started a army [sic] of angry Americans,” the group said. “This teen girl’s death just put fuel on that fire.”

A Transgender Suicide

A transgender teenage girl, Leelah Alcorn, died of suicide yesterday by jumping in front of a semi on I-71 near the South Lebanon, Ohio exit.  She left a note on her Tumblr:

leelahalcornIf you are reading this, it means that I have committed suicide and obviously failed to delete this post from my queue.

Please don’t be sad, it’s for the better. The life I would’ve lived isn’t worth living in … because I’m transgender. I could go into detail explaining why I feel that way, but this note is probably going to be lengthy enough as it is. To put it simply, I feel like a girl trapped in a boy’s body, and I’ve felt that way ever since I was 4. I never knew there was a word for that feeling, nor was it possible for a boy to become a girl, so I never told anyone and I just continued to do traditionally “boyish” things to try to fit in.

When I was 14, I learned what transgender meant and cried of happiness. After 10 years of confusion I finally understood who I was. I immediately told my mom, and she reacted extremely negatively, telling me that it was a phase, that I would never truly be a girl, that God doesn’t make mistakes, that I am wrong. If you are reading this, parents, please don’t tell this to your kids. Even if you are Christian or are against transgender people don’t ever say that to someone, especially your kid. That won’t do anything but make them hate them self. That’s exactly what it did to me.

My mom started taking me to a therapist, but would only take me to christian therapists, (who were all very biased) so I never actually got the therapy I needed to cure me of my depression. I only got more christians telling me that I was selfish and wrong and that I should look to God for help.

When I was 16 I realized that my parents would never come around, and that I would have to wait until I was 18 to start any sort of transitioning treatment, which absolutely broke my heart. The longer you wait, the harder it is to transition. I felt hopeless, that I was just going to look like a man in drag for the rest of my life. On my 16th birthday, when I didn’t receive consent from my parents to start transitioning, I cried myself to sleep. I formed a sort of a “fuck you” attitude towards my parents and came out as gay at school, thinking that maybe if I eased into coming out as trans it would be less of a shock. Although the reaction from my friends was positive, my parents were pissed. They felt like I was attacking their image, and that I was an embarrassment to them. They wanted me to be their perfect little straight christian boy, and that’s obviously not what I wanted. So they took me out of public school, took away my laptop and phone, and forbid me of getting on any sort of social media, completely isolating me from my friends. This was probably the part of my life when I was the most depressed, and I’m surprised I didn’t kill myself. I was completely alone for 5 months. No friends, no support, no love. Just my parent’s disappointment and the cruelty of loneliness.

At the end of the school year, my parents finally came around and gave me my phone and let me back on social media. I was excited, I finally had my friends back. They were extremely excited to see me and talk to me, but only at first. Eventually they realized they didn’t actually give a shit about me, and I felt even lonelier than I did before. The only friends I thought I had only liked me because they saw me five times a week.

After a summer of having almost no friends plus the weight of having to think about college, save money for moving out, keep my grades up, go to church each week and feel like shit because everyone there is against everything I live for, I have decided I’ve had enough. I’m never going to transition successfully, even when I move out. I’m never going to be happy with the way I look or sound. I’m never going to have enough friends to satisfy me. I’m never going to have enough love to satisfy me. I’m never going to find a man who loves me. I’m never going to be happy. Either I live the rest of my life as a lonely man who wishes he were a woman or I live my life as a lonelier woman who hates herself. There’s no winning. There’s no way out. I’m sad enough already, I don’t need my life to get any worse. People say “it gets better” but that isn’t true in my case. It gets worse. Each day I get worse.

That’s the gist of it, that’s why I feel like killing myself. Sorry if that’s not a good enough reason for you, it’s good enough for me. As for my will, I want 100% of the things that I legally own to be sold and the money (plus my money in the bank) to be given to trans civil rights movements and support groups, I don’t give a shit which one. The only way I will rest in peace is if one day transgender people aren’t treated the way I was, they’re treated like humans, with valid feelings and human rights. Gender needs to be taught about in schools, the earlier the better. My death needs to mean something. My death needs to be counted in the number of transgender people who commit suicide this year. I want someone to look at that number and say “that’s fucked up” and fix it. Fix society. Please.

Goodbye,
(Leelah) Josh Alcorn

First of all, way to go parents for trying Christian-based therapy which, apparently, made this kid feel worse about who she is.

Secondly, it could have been better.  She just never stuck around to find out.  You can never say things like “I’m never going to be happy. Either I live the rest of my life as a lonely man who wishes he were a woman or I live my life as a lonelier woman who hates herself. There’s no winning. There’s no way out. I’m sad enough already, I don’t need my life to get any worse. People say ‘it gets better’ but that isn’t true in my case. It gets worse. Each day I get worse.”.  Each one of those statements is false, if only because they predict the future and the future is unknowable.  But a depressed person, of course, they lose sight of that.

But she is right about society being broken, especially when it comes to people who are different.