Thoughts on a Sabbatical: My Last Day in Webster

Today was my last day in Webster. It was a quiet day, mostly annual physicals with patients I have known for many years. All are very excited to hear that I am going to Washington, most have somewhat overblown ideas about what I am going to do, all are proud that "their" doctor was selected to go and many are sad that I won't be there to hear where they are going to college. Sad, and yet wonderful, to think that I have been privileged to be part of the lives of so many children and families for the last 18 years. If any of my Webster folks are reading this, I just want to thank you for making me a better doctor.

As I said earlier, I intend to keep the blog going, at least for a while, so I wanted to mention one last thing about the CBHI. One of the last families I saw were sisters, 10 and 18, members of the family who meeting I missed last week. I asked the mother how she was liking the work with the CSA so far, and she was incredibly effusive in her praise:

• "They focus on the whole situation, the whole family, not just the child in front of you".
• "They have be really helpful in sorting out the services that my sons need"
• "For single mothers especially those without much of an outside support system, they are wonderful"

The mother works in the early childhood capacity, and she told me that her Center was planning to screen for kids with behavior problems.

Progress. Keep it up, CSAs.

I'll blog again after we get to DC.

"How's Clare?" Why this work is important.

The U-Haul is coming on Tuesday, and my house is a mess, and the news is all about Health Reform and the Ted Kennedy. Then there is work: Thursday was frustrating. A 13 year old patient of ours had his Daytrana denied by MassHealth. Daytrana is a patch form of Ritalin, one that is quite expensive, and MassHealth rightfully wants us to us it after we have tried other things first. This kid had tried Methylphenidate and Concerta, without much success; Daytrana worked for the last 1.5 years and, as best I can tell, was paid for by MassHealth without a problem. Suddenly, it's a problem. Apparently, there is a written, but not publicly available policy that says that you have to have failed 3 forms of long acting stimulant before you can get Daytrana.

The family is one of the "working poor", with MassHealth as a supplement to private insurance. Their private insurance would pay 50% of the cost of the medication, leaving them with a $179/month out of pocket to stay on the medication. It had been paid for over the past 1.5 years out of their "spend down", which has something to do with their being employed. But $179 per month? They can't afford it. So, on the day before the kid starts 8th grade, I have to switch a marginal student off of the medication that works to a new medication that may not work to "try it out"- if he fails Adderall and Focalin, THEN we can get him back on the medicine that works.

The family sighed, and agreed to the change, but I was frustrated: if we had known of the problem in June, we could have done the required "trials" over the summer and not disrupted school. The needs of the system were served, but it is hardly personal. And mental illness is nothing if not personal.

In pondering the meaning of this incident, I came across this about the Senator in the Globe, and thought is appropriate to quote here at length. Although the Wellstone-Domenici bill was Patrick Kennedy's baby, the Senator's fingerprints were all over it. This is from an article by Kevin Cullen, that was in the Globe:

About 20 years ago, Senator Pete Domenici, a Republican from New Mexico, found out that his daughter Clare was schizophrenic. Domenici and his wife, Nancy, struggled to get help for Clare, and Domenici became an advocate for families of children and adults with mental illness.

Thirteen years ago, Domenici and Paul Wellstone, the liberal senator from Minnesota, teamed up to sponsor a mental health parity bill, so that people with a mental illness would be treated the same as those with a physical illness. After Wellstone was killed in a plane crash, Domenici asked Kennedy to step in as the bill’s cosponsor. Because of his sister Rosemary’s condition, Kennedy was always empathetic to those with mental disabilities, and he quickly agreed.

As the legislation’s progress waxed and waned, whenever Ted Kennedy saw Pete Domenici, he would ask one question: “How’s Clare?’’ And then they would talk about getting the bill through. Last year, when President Bush signed the bill into law, Ted Kennedy called his old friend Pete Domenici. Kennedy was in Hyannis Port, four months after being diagnosed with brain cancer, and Domenici was in Washington, about to retire from the Senate because he has a progressive form of brain disease.

The two old senators reminisced a bit and thanked each other for getting the law passed, and then Ted Kennedy said, almost apologetically because he had almost forgotten: “How’s Clare?’’

In the end, that's what the work is all about- building a system so that when you ask people "How's Clare?", they have something good to say about it. Connecting the policy to the personal is hard; Kennedy was the master at it, and we need to get better at it.

CBHI is a Process: Thoughts on a Systems of Care Meeting

Building the CBHI is a process, and the key to that process is the collaboration that will happen in the Systems of Care Committee meetings (times and dates for Worcester County are listed to the right)

Please note that this is my take on this meeting, and I bring my own biases and thoughts to this process. If you were there, and thought that I got something wrong, let me know and I will change it.

I went to a Systems of Care Committee meeting today. It was crowded in the Conference Room, with people from Worcester, Southbridge, Webster and Milford congregated in a room, to see how the South Central CSA is doing. It is a big district, stretching from Ware to Franklin across Massachusetts’ southern border with Eastern Connecticut and Rhode Island, and it is great that they were able to get this many people in one place. We introduced each other; there were parents, providers and even a school district represented at the table. Then we got down to business.

Initially, it was mundane; time and place of meeting, can we get phone access to the meeting, who else do we need to be here? The group is in the “forming” stage and we were all trying to understand what each of us are trying to do. The programs are in place, both emergency mobile services and intensive care coordination and family partners are up and running. Several community agencies (schools, practices, parents) expressed confusion about when to call the different types of services and asked for more guidance in organizing themselves to address the services. We also spoke of the upcoming “change in initials” for programs like FST, which is morphing into In-home behavioral health therapy. Change is hard, and at least part of it is that it is new.

The group was very interested in the process, and people had concrete suggestions for ways in which this can work. First was getting the information out: Make the literature more clear. Create multiple ways of disseminating the message. Clarify the roles that all of the players are clear as to their names, agencies and roles. Then was communication: There are overlapping roles with DCF, DMH, the school, the FST program have sometimes created logjams, with parents confused as to who is involved in various specific cases. All of this is complicated by the need for releases from the family to allow inter agency communication.

The South Central CSA got 60 referrals in the first month; they reported fewer referrals in August to date. Some of this reflected the level of staffing; the CSA is hiring the people and it is hard to find folks with the right skill set who are willing to travel as much as is required in this area. Some of this, however, reflects the culture of the area. Folk down here don’t like to air their family problems in public, and they don’t trust outsiders in their homes. It will take time to build trust, that this program is really going to be responsive to their needs and not to the needs of DCF or some other government agency. Finally, some of this reflects the newness of the program- people are going to need to hear about this program over and over again before the implications actually sink in.

So what is our vision? Collaborative care, creating a system that families can understand? We kicked it around for a while, but it came down to struggling with the central question of the CBHI: How do we fit this model of wraparound into the culture of South Worcester County? This group is actively engaged in that process. I hope that the other meetings are going as well.

Statement from The Kennedy Family

Hyannisport, August 26, 2009

"Edward M. Kennedy -- the husband, father, grandfather, brother and uncle we loved so deeply -- died late Tuesday night at home in Hyannis Port.

"We've lost the irreplaceable center of our family and joyous light in our lives, but the inspiration of his faith, optimism, and perseverance will live on in our hearts forever.

"We thank everyone who gave him care and support over this last year, and everyone who stood with him for so many years in his tireless march for progress toward justice, fairness and opportunity for all.

"He loved this country and devoted his life to serving it.

"He always believed that our best days were still ahead, but it's hard to imagine any of them without him."

Hard to add anything to this. All of those dedicated to improving the health care system are in mourning. Of course, we need to keep doing the next thing, in his memory.

MCPAP Needs Our Help (and our Stories)

Adapted from a recent e-mail blast:

The various MCPAP programs need help to negotiate with the medical insurers who provide behavioral health and medical coverage to your patients. In the State’s FY 2010 budget, the MCPAP received a 20% cut in funding with the State’s intention of having the private insurers make up this shortfall. Presently all of the money supporting MCPAP comes fully from state dollars. This is in spite of the fact that more than half of the calls and families evaluated by MCPAP have private insurance with a behavioral health benefit. It will be difficult for any program to take a 20% cut in support without decreasing services.

MCPAP is asking our involved primary care clinicians to write a brief letter describing the value of MCPAP to your practice and the patients you treat. If appropriate, you could note your understanding of the limited access that you have to mental health services in the community. MCPAP will use these letters in our negotiations with the private insurers to both demonstrate the value of our state-wide service as well as to show the important (albeit invisible) role we play in the insurer’s delivery system, filling some of the gaps that we know are there.

If you are willing to write a letter, you use the MCPAP “Tell Us Your Story” link here, which may result in your comments being published on the MCPAP website . We are hoping to receive supporting letters by early September.

From the Maternal and Child Health Bureau

PAPER DELINEATES BENEFITS OF AN INTEGRATED APPROACH TO SUPPORT CHILDREN'S EMOTIONAL WELL-BEING

Strategies to Support the Integration of Mental Health into Pediatric Primary Care provides an overview of research advances and policy trends that support integration of mental health into primary care and explores strategies that can be employed by primary care health professionals, with support of health plans, to achieve coordinated and integrated mental health care in the pediatric primary care setting. The issue paper was published by the National Institute for Health Care Management with support from the Maternal and Child Health Bureau. Topics include the prevalence of and risk and protective factors for children's mental health problems; the current state of mental health in pediatric primary care, including the relationships between primary care and mental health services; public and private sector financing of mental health services for children and the implications for integrative approaches; federal, organizational, and foundation initiatives supporting integrative care; and considerations and strategies for health professionals and health plans to improve the delivery of mental health care in pediatric primary care.

Conclusions and selected resources on children's mental health care are provided. The paper is available at http://nihcm.org/pdf/PediatricMH-FINAL.pdf.

A thought from a reader

It is nice to know that folks are still reading this blog; being in the office, packing up my office and furnishing an apartment in DC has cut into my blogging time.

Hi David,

I was just catching up on your blog and saw that you are leaving for DC in less than 2 weeks. Last time I talked to you, you were awaiting a "call" on whether you were keeping your blog. So what happened with that?

I am really glad you are commenting on CBHI. I am realizing more and more that there is very little critical observation and even less advocacy (except for rates). At times like these, I really miss Walter!

At any rate, I am wondering about the blog and want to wish you well on your sojourn in DC. Please stay in touch!!! We wade in on national health policy stuff from time to time (as you might guess).

Best,

***********

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In case you were wondering, authors LOVE it when someone asks them to keep writing. This sort of e-mail just makes me want to get out there and write more. Thanks, **********. This means a lot. Let me try to answer as best I can.

1) I will try to keep this blog both alive and focused on the Children's Mental Health Reform process on which we have spent so much time and energy. That may be tricky, as I will no longer have direct contact with my patients, who have always been my best source of information about the CBHI, and the mental health system in general. But I will try.

2) Over the next few months, I will be undergoing a training process in Washington, organized through the Institute of Medicine, that will give me access to many of the folks setting the policies that drive what we do. I mostly can't talk about that, especially on an open blog. By January 1, I will be an aide in a Congressional or Senatorial office. At that point, I may or may not be able to blog at all. So, stay tuned.

But what of the CBHI in the lazy days of summer? I actually had two folks from the Worcester CSA (their new name escapes me at present) join me in discussing the CBHI process with our Housestaff at UMass Medical Center last week. They told us that they have enrolled the first 90 or so families in the program and that they are working on the second hundred now, doing CANS, hiring staff, convening meetings (like the one I couldn't make last week) and the like. They were surprise at how few of their referrals are coming from pediatricians and other primary care providers. I wasn't. Traditionally, there has been so little communication between primary care and behavioral health providers that I would have been surprised if they were contacting the CSA themselves. Most of us give parents a list of counselors and agencies and have them get to it. So the CSA would likely not know that the primary care doc had sent the patient.

So it is churning, and movement is happening. If I can make it to the next community meeting in Webster, I will have much more to say on that.

Anyone else got any stories? Put them in a comment, send them in an e-mail. It is out there, percolating now. Look at CBHI on Google News here.

On a personal note, I still can't believe that in 8 days I'll be on my way to Washington. It is simply too cool to be real.

Pictures from a Town Hall Meeting.

I went to the Town Hall (literally) in Warwick on Wednesday night to try to hear Representative Langevin speak on the prospects of health reform, and instead found a wild group of LaRouchites (with Obama as Hitler posters), "Government can't do anything" folks, Democrats, Union supporters, medical students and the odd pediatrician standing around, outside the Hall, trying to convince the the media of their importance. It was an interesting scene; I met few there who had not yet already made up their minds and many who enjoyed shouting and chanting. As a singer, I sort of get that- their is value in the human cameraderie that goes along with a good chant. In this case, however, it made it difficult to engage in a meaningful discussion with the folks who had serious doubts about the legislation, which is why I was there. But I tried.

I would say that the folks who were present broke down

into three groups. First were the supporters of reform; largely professionals, Obama supporters and union folk. Tended to be younger, tended to be less loud- these folks were often single-payor supporters, and were very much in favor of the inclusion of the public plan in the mix of things to come out of this process. In talking to them, I was concerned that they were too focused on the public plan; for many, the loss of the public plan would mean that we had failed in our effort, even if more people were covered and the insurance industry is dragged into a process other than ruthless competition to fund the care that people need. You all have probably guessed that I think that this process is essential; the "free" market as currently structured is likely to oscillate and collapse unless we are able to realign the structure in which it operates. Kind of like the stock market, except this bubble really does kill people directly. So "our side" needs to convince its own people that 3/4 of a loaf is an acceptable outcome.

Second were the ideologues, the folks who think that the government is simultaneously incompetent and unable to accomplish anything AND evil, conspiratorial and able to focus in and ruin their lives in a really personal way. It is interesting to talk to them; the arguments tend to be circular and to focus back on personal attributes of the one that they are trying to convince. I was asked over and over again, "Have you read the bill?" Well, yes, but, unless you are an attorney, reading the bill doesn't really tell you very much. The language is there, but the meaning of the language is steeped in prior legislation, numerous Court decisions and the policies and procedures of the Department of Health and Human Services. We are all, in many ways, dependent on our colleagues in the legal professions to tell us what this bloody thing means, and sometimes they don't even know until it is passed. Smart people think that this thing will get more people covered, support the move to quality improvement and allow me to take care of children without worrying about their coverage all of the time- that is actually good enough for me. The bill is hundreds of pages long (double spaced, though), and is worth a look through.

The biggie for me is that it extends EPSDT to children on the Children's Medical Security Plan- that is a huge boon to families of children with special needs and I am absolutely for it.

Third were the critics with ideas, and there were a lot of them. People who think that things need to change, but that this bill (the House Bill being the only one on the table at the present time), is not good enough. I spoke with one IT guy who was worried that the system would be too permeated with politics- he favored removing this from the political process. Another person was a hospice worker, concerned that they would mess up the regulation of the transition from treatment to end of life care. A couple with seven kids gets their health care through a Christian health cooperative- they were concerned that they wouldn't be able to continue in this form of insurance that worked so well for them. These are folks that we can talk to- they may never support the reform, but they won't blow up the country to keep it from happening.

The one thing that was clear that evening was that people on all sides of this debate care deeply about how this thing happens- inside the room, the session went on for several hours, and we stood out there without a speaker, talking and yelling and arguing and waving signs and engaging in the political process that makes us who we are: Americans. My side has not yet closed the deal on this thing, but neither has the opposition run it off of the cliff. It is time, though, for all of us to weigh in and figure out which side we are on.

A Busy Day: I missed my chance to see the Team in Action

Got this from the CBHI today:

August 18, 2009
Over 1,000 Families Enrolled in ICC Services!
On June 30th, Community Service Agencies (CSAs), the organizations that deliver Intensive Care Coordination and Family Support and Training, began providing services to children, youth and their families. Since that time, the MassHealth Health Plans have reported over 1,000 families are in the beginning stages of working with Intensive Care Coordination services. During the beginning “engagement” phase of this service, families work with Care Coordinators and Family Partners to complete a “strengths and needs” discovery and start building their child’s ICC Team. In the experience of Wraparound programs nationally, as well as CFFC and MHSPY in Massachusetts, some number of families will decide during this process that ICC is not for their family. CBHI will begin to have data in September on the number of families that enroll beyond the engagement phase. Intensive Care Coordination (ICC) is a care-coordination service for children and youths with serious emotional disturbance (SED). Children, teens and young people most likely to benefit from ICC services may include: those with complex needs involving many providers or state agencies; families of children or youth who have frequent behavioral health crises; and children or youth in families that have been “difficult to engage” in other services.

I know this to be true- as I mentioned last week, I got invited to one of those meetings myself. During the day. When I had patients. So I couldn't go.
Mental health figured prominently into today's patients: a young man with ADHD and an untreated substance abuse problem heading off to college; we had a long talk about weed and apathy and the possibilities of drinking and drugs in teh big city (I won't say which one!). Another youth, repeating 9th grade, whose ADHD is unresponsive to medication because it doesn't work ("I don't feel any different") or because he doesn't take it very often (last Rx was in December, although he claims to be on the stuff). Neither of them is seeing a therapist; both have one parent in MA and one in CT, making it tricky to sort out which mental health system to access. These kids are hard to manage, and I truly look forward to having a CSA with whom to work.

Back from the Mountains: The Cost of Children's Health

I saw patients today, 9 physicals with negative behavioral health screens, a bunch of kids with acute medical problems, a few behavioral/mental health follow-ups and no contact with the CBHI. It is really odd to think that I will be leaving the practice in a mere 14 days, and that I only have 6 more days of clinical pediatrics before I descend into the maelstrom of Washington politics.

One of the reasons that children are often absent from the discussion of health reform is that, in general, child health is a small percentage of the cost of health care (some colleagues refer to the cost of "child health" as a rounding area when compared to the cost of care for the elderly). My AAP News today, however, suggested that we should be looking at this in a different way. According to a recent study by AHRQ, $98.8 billion was spent on children's medical care in 2006. Please note that this is in the context of $2 - $3 trillion of total expenditure on health care, so that is a mere 5% of the healthcare pie. 5 conditions account for 30 % of that spending, and mental health costs led the way in terms of expected outlay. As the same time, it turns out that the insurers have managed to turn this one into a massive cost shifting to the consumers. When one looks at the percentage of that cost that is paid out of pocket by parents, 21% of the bills are shouldered by parents, in the context of a system that most would consider to be woefully inadequate, compared to 11 % of the bills in the case of infectious disease. These data confirm what we already knew- that a substantial part of the problem of access to health care for children is access to mental health services, and that the system is designed to restrict access as a means of cost control. Clearly, for children, this message needs to be heard in the discussion on Capital Hill.

Of Interest: From the National Institute of Health Care Management

FROM MY COUNCIL ON COMMUNITY PEDIATRICS NEWSLETTER:

Report - Strategies to Support the Integration of Mental Health into Pediatric Primary Care

The National Institute for Health Care Management (NIHCM) Foundation is pleased to release an issue paper, Strategies to Support the Integration of Mental Health into Pediatric Primary Care, examining the landscape for mental health service delivery to children, including a discussion of the role of federal and state agencies, as well as public and private insurance. With the aim of informing and facilitating discussions on how mental health care can be fully integrated into pediatric primary care, the issue brief reviews information on mental health programs, practices and guidelines and discusses strategies health plans can utilize to improve early identification and treatment for children in primary care. To view the report visit here.

Mountains are great, but there is work to be done

There is nothing like three days in the White Mountains to give one perspective on life. The Whites are crowded, meaning that, while hiking on a popular trail, you will run into someone every 20 minutes or so. The Whites are treacherous, meaning when you see the thunderhead on the horizon, you have about 20 minutes to get off the Ridgeline or you will become a intimate acquaintance of the lightning. The Whites are magnificent, because when you are sitting on top of Mount Lafayette (5260 ft- not quite a mile high), you can not hear the roads in the valleys below. The silence is deafening (and the ascent does good things for your leg muscles). It is worth breaking from the internet to hear that silence.

*******************

My inbox is full of Health Insurance Reform, with little to offer in the area of Children's Mental Health. I will direct you all to MCPAP website today; it is a useful place, and they ran an article that I wrote about the CBHI that you might find useful. I'm visiting some Congressional and Senatorial offices over the next few days, working this Insurance reform plan through Congress. I'll keep you posted on how that is going.

Off for a Walk in the Woods

So, I'm heading off for 3 day walk on the Appalachian Trail with my family and a few friends- more on that later. I have just finished a solid week of primary care with little time to blog; mostly well child visits for boys in early and late adolescence. My screens have mostly been negative; several young men have needed referral for standard mental health services (counseling for outbursts or depression). I've had one family that I sent to the CSA for care coordination. The family from last week (the boy who was acting out here) had two kids in for a well child check- the CSA seems to be working out pretty well for them.

And I got this e-mail:

David,
Kim RXXXXX-SXXXX - a clinician from Counseling and Assessment Clinic of Worcester called regarding XXXXXXX. Meeting is on August XXth at XX:30 - location at their office which is at 51 Union Street, Suite 104, Worcester, MA (over by Maxwell Silverman's). Work Cell # : XX-XXX-XXXX.

My first invitation to an CSA Meeting to coordinate care. I can't go, of course- patients are scheduled, and, if I still had a care coordinator, I would send her in my stead. But I was invited!!

It's a start.

See you after we get back from the mountains.

The Center Can Hold, If We Let It

Check out today's post on Health Care for All's blog. This is an appropriate response, folks. Let's get out there and do it.

Hello From Niki Tsongas’ Community Meeting at the Chelmsford Town Hall. The meeting was scheduled to begin at 10 a.m. but the place was packed to capacity at 9:30 a.m. Hundreds of people were in the overflow of the parking lot, with signs, songs and slogans, and a good dose of respect-filled conversation. The radicals from the right handed out some very scary materials, and there were a smattering of single payer advocates, and an equal number holding signs in favor of reform, but mostly there were people in the middle interested in telling their stories and learning more about what health reform will mean for them. These were the folks asking questions, and very disappointed not to be in the auditorium. At the very beginning I thought that the majority of the crowd opposed reform, but eventually, by about 10:15 the sides were even, and groups were beginning to congregate together, mostly with their backs to the hateful signs and chanting. I talked to plenty of national reform opponents who did not want to be associated with the sad fringe.

From the Center for Public Representation: Progress is Being Made

Court Holds Status Conference on New Services

On July 28, 2009, the Court held another periodic conference to review the status of implementation. Prior to the hearing, the defendants filed a detailed semi-annual report on the status of all of their activities under the Judgment. The plaintiffs submitted their status report, which included comments on the accomplishments and challenges of the implementation process and which identified several pending disputes concerning care coordinator caseload limits, authorization procedures by managed care entities (MCEs), inclusion of children in Medicaid expansion populations, and the availability of a meaningful appeal process for families. The parties discussed their respective views on the status of implementation, and the Court asked many questions concerning screening, assessments, the new Community Service Agencies (CSAs), the new remedial services, and the approval process for these services.

I Know it is not Mental Health, but....

I should stay focused on children's mental health, but it is hard not be excited about this:

FOR IMMEDIATE RELEASE

Contact:

Aug. 5, 2009

Quentin Young, M.D., (312) 782-6006, info@pnhp.org

Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org

David Lerner or Karmen Ross, Riptide Communications,

(212) 260-5000

House vote on single payer will be historic first, doctors' group says

Physicians call on lawmakers to 'do the right thing' on health reform

Hailing last week's pledge by House Speaker Nancy Pelosi to hold a floor debate and vote on single-payer health reform this fall, a group of 16,000 physicians is launching an intensified campaign to educate lawmakers about the urgency of a "Medicare-for-All" solution to the nation's health care crisis.

Leaders of Physicians for a National Health Program (PNHP) say their campaign includes a stepped-up program of visits by doctors to House members in their home districts during the August recess.

Last Friday's commitment by Pelosi (D-Calif.) to Rep. Anthony Weiner (D-N.Y.) to put his single-payer amendment to H.R. 3200, the House leadership's health reform bill, to an up-or-down vote before the full House has set the stage for first-ever floor vote of its kind. The House debate on the amendment could begin as early as September.

"Single payer has gone from being 'off the table' to 'on the floor,'" said Dr. Quentin Young, national coordinator of PNHP. "This dramatic turn of events is a striking indicator of our success. It shows the House leadership recognizes the strong public support - including among doctors - for removing the wasteful insurance company middlemen from our health system and redirecting the resultant savings into care."

Weiner's amendment would delete most of the language of in the House bill and instead substitute language from H.R. 676, the single-payer bill introduced by Reps. John Conyers Jr. (D-Mich.) and Dennis Kucinich (D-Ohio).

The Weiner amendment, unlike the House leadership's bill, assures universal, comprehensive, and high-quality coverage, free choice of doctor and hospital, and no co-pays or deductibles through a publicly financed system similar to Medicare. Young said that because of massive savings on private insurance overhead and paperwork, the amendment would entail no increase in U.S. health spending, in contrast to the House bill's $1 trillion price tag over 10 years.

"By recapturing the administrative waste associated with our present multi-payer, for-profit private insurance system, estimated to be $400 billion annually, a single-payer program would have more than enough resources to cover everyone who lacks insurance now and to upgrade everyone else's," he said.

"A single-payer system would also possess strong cost-control tools like bulk purchasing of drugs, negotiation of fees and global budgeting, controls that are notably absent in the House bill," he said.

Young says many union, civic and faith-based groups will be watching how lawmakers vote with an eye to the 2010 election cycle. "Lawmakers now have a golden opportunity to stand up for the best interests of their constituents, to rebuff the private, for-profit health insurance industry, and assure the health of our nation," he said.

He continued: "Many members of Congress - including Speaker Pelosi - have told constituents that they personally support a single-payer, Medicare-for-all approach, but claim they can't vote for it because it's not politically feasible. Yet polls that show they would have the public's support for such a stand. Now we'll be watching to see whether their votes match their words."

Single-payer bills have been introduced in Congress repeatedly over the past 60 years - starting with the Wagner-Murray-Dingell bill in the 1940s, and including the Kennedy-Griffiths bill of the 1970s and the Wellstone, McDermott and Russo bills of the 1990s - but none has ever reached the floor of the House or Senate.

It only seems fair; if the opposition wants to accuse us of creeping socialism, we might as well actual put something radical on the table. This isn't quite socialism, any more than arms procurement is socialism- just makes the Federal government as the sole purchaser, while allowing us all to compete to be the vender.

We do live in interesting times.

An Approach to Destroying Health Insurance Reform: If You Can't Win the Argument, Make It Impossible to Have One

I could not attend today's "Town Hall Meeting" in Worcester, in which our Congressman tried to lay out the case for health reform. My wife was there (and in the picture in the Telegram and Gazette); she was appalled by the tactics used to stifle discussion. There is a story about the tactics on the NPR blog that I commend to all to read here and another story in the NY Times here. Also, our friend and sometime poster Robbin Miller posted her thoughts:

I attended a Health Insurance Reform in Worcester today that was co-sponsored by Congressmen Neil and McGovern.

You can be my post at www.therapistsforchange.blogspot.com
I would be interested in hearing your comments.

Robbin Miller, LMHC
Facilitator
www.robbinmiller.vpweb.com

It is a little worrisome, but not unexpected, to find those opposed to health reform are using a bit of guerrilla theater. Logic dictates change- so to fight change, one must drown out logical thought. We will see how it plays in the rest of the world.

Meanwhile, the President visited a Children's Hospital today. Check out the speech here. Not a bad thing.

Guess It Is Official Now: RWJ Health Policy Fellowship Announcement

So, the word is officially out now. Check it out here. Sounds awesome, no?

RWJF Health Policy Fellows have unique opportunity to influence health reform

10 health professionals selected to participate in competitive fellowship

Princeton, N.J. — Ten exceptional health professionals have been selected as Robert Wood Johnson Foundation Health Policy Fellows for 2009-2010. The ten fellows will utilize their wide range of academic, public health, clinical and community-based experience to provide health policy leadership on Capitol Hill to improve health and health care.

Each year, fellows are selected through a competitive selection process. They leave their academic settings and professional practices to spend a year in the nation's capital. A three-month orientation program is followed by a nine-month assignment in which fellows work in a congressional office or the executive branch. Work assignments are supplemented throughout the year with health policy leadership development activities and media training.

"This is a particularly remarkable year to contribute much-needed practical knowledge of health and health care to Washington, D.C. Our fellows will have the chance to impact health reform directly," said Michael Painter, J.D., M.D., RWJF senior program officer and 2003-2004 Robert Wood Johnson Health Policy Fellow. "The 'hands-on' health and health care experience of our fellows provides a critical perspective to the reform debate."

In September, following the one-year experience, fellows can choose to extend their Washington stay past the fellowship period through the end of the legislative session. Once they've completed the program, fellows return to their respective institutions or take another appropriate position where they further develop their health policy leadership skills. They become part of a nationwide alumni network and typically return to Washington yearly to attend the Institute of Medicine's annual meeting and get an update on issues and trends in health and health care policy.

From the Children's Mental Health Campaign: Still Some Work to Do!

Action Needed: Blue Cross Foundation Provider Capacity Survey

The Blue Cross Blue Shield Foundation is conducting a survey to determine provider capacity in Massachusetts and potential barriers to children's behavioral health services.

Click here for information on how to participate in the survey.

Please forward this information to your networks.

State House Ops Committee Meeting: September 9 @ 11:30am

The next CMHC State House Operations Committee meeting will be on Wednesday, September 9 from 11:30am - 12:30pm at MSPCC (99 Summer Street, Boston).

At this meeting, we will discuss legislative advocacy work in support of passage of the Collateral Contacts legislation.

If you are planning to attend or to have your name added to the email distribution list for this group, please contact Nancy Scannell at nscannell@mspcc.org.