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Mental health coverage and the Uvalde school shooting
Friday Pulse Check
Good morning and welcome to the Friday Pulse Check. This week, I want to spend a few moments talking about mental health, particularly in the aftermath of the Uvalde, Texas school shooting this week.
But first, the news:
I am personally shocked that I missed this. Ron and I have spent at least some portion of the last few podcast episodes discussing Senator Bernie Sander’s Medicare for All proposals. When I looked for a news article this morning, all I could find was this op-ed by Mr. Sanders on FOX News. He lamented his usual laments including the average cost of healthcare per person (which is $12,350), forgetting that about five percent of people use most of the healthcare in this country. He also criticized high drug costs and an on average lower life expectancy compared to Germany. He wraps admitting Medicare for All is expensive, but that its less expensive than our current system because “it would eliminate an enormous amount of the bureaucracy, profiteering, administrative costs and misplaced priorities inherent in our current for-profit system.” Didn’t some former heads of the Veterans Affairs hospitals go to jail for something like that?
Keep checking FLATLINING.net over the next few weeks as we explain why Medicare for All is not just bad for patients, but for doctors as well.
Do you remember a Super Bowl ad this year with Gal Gadot voicing a strange white box that was advertised as working well with your smart home? If you’re still pondering what this device was, it is a high-tech, at-home, COVID-19 test. The Cue device worked like your drive-through PCR testing stations; you take a nasal swab and stick it in the box. Then the box would send the results, via Bluetooth, to an app on your phone. The problem is, that the device is $249 and $195 for a pack of three tests. They tried to hop on the subscription model, but that didn’t work out too well either. Read more about Cue and how its stock price plummeted since its debut on FLATLINING.net.
Nearly three in ten women who are pregnant believe at least one item of misinformation about COVID-19 vaccines and pregnancy
That is the latest polling data from the Kaiser Family Foundation’s COVID-19 Vaccine Monitor. It also found that seven in ten people were confident in the safety of COVID-19 vaccines, but that number drops to five in ten when asked about safety in pregnant women.
Very quickly before I get into mental health, I wanted to make sure I plug this week’s podcast. Ron and I spent the entire show talking about a recent premier debate in Ontario, Canada. Steven Del Duca (ON Liberal Party), Andrea Horwarth (ON New Democratic Party), and incumbent Premier Doug Ford (ON Progressive Conservative Party) had it out on healthcare and of course, we took notice. Senator Bernie Sanders has said previously that he wants the US to have a Medicare system like Canada’s (even though his current Medicare for All proposal does not look like Canada’s system except for the fact that it is single payor) and so Ron and I discussed what that actually looks like in Canada. Additionally, I think you will be surprised by the amount of debate and arguing they had about their own system. Clearly, even in Canada, there is no consensus about how to do healthcare. Take a listen.
If you hadn’t heard (I would be shocked if you hadn’t), a young man walked into an elementary school in Uvalde, Texas on Wednesday carrying an AR platform rifle. He killed nineteen children and two adults; he was shot and killed by law enforcement on the scene. I cannot begin to imagine the pain and sorrow of the grieving parents and families.
Almost immediately after the shooting, I saw fingers being pointed in two distinct directions. The first finger was pointed at guns and the second was pointed at mental health. I am going to leave the gun debate for another day. I am aware that the Biden Administration and Democrats have discussed gun violence as a public health issue, however, in this situation, gun violence and mental health seem to be presented as polar opposites depending on which side of the political equation you come down on.
Before I continue, I want to stress that I am not commenting on the shooter. Texas Governor Greg Abbot said on Wednesday that the shooter “had no known mental health history” and I’ll take him at his word until more information comes out. Today, I am simply commenting on the two emphasized platforms that arise after these horrible events (that is gun control and mental health).
Despite the statement about the lack of mental health history of the shooter, Texas officials placed the blame entirely on mental health. Mr. Abbott said, “The ability of an 18-year-old to buy a long gun has been in place in the state of Texas for more than 60 years. ... And why is it that for the majority of those 60 years we did not have school shootings. And why is it that we do now? The reality is I don't know the answer to that question,” he continued. “One thing that has substantially changed is the status of mental health in our communities.”
If the status of mental health has significantly changed over the last sixty years, why is it that our healthcare system has not seemed to catch up? I think, when we drill down to it, the foundation of that problem is two things: fear of cost and lack of education.
I want to start with the latter first because I think that, although it is one of the essential problems, it is easily fixable, and that Western society has been working to fix this problem for a while.
My age rides the borderline of the millennials and gen z and I have seen the shift in thinking from people older than me. There was a time when I was in school when depression was essentially ignored. I am a firsthand witness to see how this can affect someone’s ability to do schoolwork, participate in activities that they normally like, and significantly hinder someone’s social life. This all becomes worse and worse the more it is ignored.
By the time I was in college, I saw that shift in thinking. A school would be more willing to admit something was wrong and work with the parents and the student to seek help. In college, the school worked more with the student on their own.
Putting my views on the state of American education and the general quality of modern parenting aside, I think this is a good thing, even if it is only happening in the aftermath of a tragic shooting. It is like the curb effect; one thing meant to help a certain group of people helps everyone.
One closing thought on education. Mr. Abbott did seem to come to terms with the fact there was no mental healthcare facility in the area and said that there was a need for one in the area.
The second problem is the fear of cost. This is typical when talking about any sort of healthcare situation (mental health is part of healthcare). People worry that going to seek help or that getting a depression screening is going to cost them too much money. Fortunately, I think I can help calm some of those fears today.
Since 2008, health insurance provided in these situations is required to treat mental illness with the same cost-sharing methods (the fancy word is parity) as physical illness. This means that they cannot charge a $40 copay for mental health and only $20 for a specialist. They must charge the same in these situations:
Employee sponsored coverage for companies with fifty or more employees
Coverage purchased through the exchanges
The Children’s Health Insurance Program (commonly called CHIP)
Most state Medicaid programs (check locally)
Additionally, Medicare patients also have some mental health benefits. For Medicare Part B, these include:
One depression screening per year (done in a primary care office that can provide referrals)
Individual or group psychotherapy
If you are on Original Medicare, you pay nothing for your yearly depression screening as long as your doctor can do it and once you meet the Part B deductible, you only pay twenty percent for visits to the doctor to diagnose and treat.
Some Medicare Advantage plans can increase your benefits as well, including telehealth appointments if your primary care physician does not provide those.
The best advice we can give if you have more questions about cost is to look at your benefits booklet for your health insurance plan. If you have questions about mental health, talk to your doctor; they are more than happy to help you (after all, that’s kinda what they’re there for).
For more information about parity laws and Medicare’s mental health coverage, check out these resources:
To wrap up this rather lengthy Friday Pulse Check, the World Health Organization passed a motion on Thursday condemning the regional health emergency triggered by Russia’s invasion of Ukraine. With that same vote, they also rejected an alternative proposal from Moscow that made no mention of Russia’s role in the crisis. The proposal, however, stops short of suspending Russia’s voting rights in the UN health agency. The resolutions came alongside a report from WHO Director General Dr. Tedros Adhanom Ghebreyesus which detailed 235 attacks on healthcare facilities and disruptions to health services. Moscow is continuing to call its actions a “special military operation.”
Have a good weekend.
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