RUTHFULLY YOURS

When it returns in June, house leadership has indicated it may take up a mental-health bill originally proposed by Representative Tim Murphy (R., Penn.), the Helping Families in Mental Health Crisis Act (H.R. 2646) as rewritten by Representative Fred Upton (R., Michigan). The well-intentioned Upton rewrite keeps some important provisions of the original bill, but it ignores the core finding of Murphy’s multi-year investigation of the mental-health system. Murphy found that we do not need to spend more money to cut the practice of incarcerating 365,000 seriously mentally ill, or to help the 140,000 seriously mentally ill who today go homeless. What’s required is for Congress to focus already-existing funding streams on treating adults known to have serious mental illness instead of using them to improve mental wellness in all others. It is the most seriously ill — not the worried well — who are most likely to become homeless or incarcerated or violent.

While some think more money is the only answer, the federal government already spends $130 billion annually on mental-health services, yet homelessness, arrest, incarceration, and violence related to untreated serious mental illness are all rising. That’s because the two agencies government charged with setting mental health policy — the Substance Abuse and Mental Health Administration (SAMHSA) and the Center for Mental Health Services (CMHS)­­ — moved away from a science-based system that spent mental-health dollars on delivering treatment to adults who were the most seriously mentally ill and who most needed treatment. Tragically, the system today largely ignores science and the seriously ill. Instead it works to improve the “sense of wellness” in the highest functioning. Under this new rubric, anything that makes you feel sad is now a mental illness.

National Review, the Wall Street Journal, and leading experts such as Dr. Sally Satel at the American Enterprise Institute, Dr. E. Fuller Torrey of the Treatment Advocacy Center, as well as my own organization Mental Illness Policy Org have extensively documented how SAMHSA and CMHS drive federal dollars away from the core mission of helping the most seriously ill. SAMHSA promotes prevention in spite of the fact that there is no known way to prevent serious mental illnesses such as schizophrenia and depression. “Preventing mental illness” is a great sound bite but lousy science. They use funds to address “trauma.” But everyone loses a parent and many people experience a trauma at some point. That is not a mental illness. It is part of life. Because SAMHSA and CMHS have no doctors at the top — or even on staff — they certify ineffective programs as being evidence-based. Virtually the only people who support SAMHSA or CMHS are those who receive SAMHSA and CMHS funds. That is not who Upton should listen to.

Was it only eight years ago that a newly elected president assured an adoring hometown crowd that crime and injustice would wilt before his enlightened moral authority? As the chalked outlines on too many sidewalks attest, it was another false promise
Every May I head to Chicago for a week (a long story, over a drink perhaps…). Great city. Lovely setting beside Lake Michigan. Wonderful architecture. Sensational shopping. Fantastic museums. Pleasant parks along the lakeshore. Easy to get around, but who would want to, who would dare to, anymore?

This year the murder rate in Chicago is up almost 80% on last year. Yes, 80%. No misprint. And that’s compounding on a rise of 20% from the year before — a trend heading towards a total that may well exceed 800 by the time this year is done. Sure, Chicago has seen years with more murders: 970 in 1974 and 943 in 1992. But this time there’s a remarkable difference to the crime statistics: the clear-up rate for murders has plummeted. Some 70% of murders were solved back in the early 1990s. But last year it was just over 30%. Put it another way: Two out of three Chicago murderers now get away with it. Scot free. Permanently.

All this is happening on Barack Obama’s home turf, just around the corner from where he used to live in the South Side’s Hyde Park, in the second term of his supposedly “transformative” presidency. And in the city where Barack’s buddy and former right-hand man, Rahm Emanuel, is current mayor.

These killings are not mass murders perpetrated by isolated, unhinged loners. This is gang violence writ large, with retribution after retribution after retribution. It is tearing apart the mainly black suburban communities that make up the South and the West of Chicago. But more recently shootings have spread into other areas of Chicago.

Chicago’s police, fearing they will get shot (or videoed shooting someone who later turns out to be unarmed — are intervening less and less, it seems. Instead, they come by later to stretch out the tape, mark out the corpses, pick up the cartridges, photograph stray bullet-holes, and hope that a witness dares to come forward. If Crime Scene Investigation is your buzz, then the Windy City is a sure bet for a long, steady career.

The American people have become familiar with ObamaCare’s failings: higher premiums, fewer choices and a more powerful federal health bureaucracy. Yet another important piece of health-care legislation, signed into law last year, has gone almost unnoticed.

The Medicare Access and CHIP Reauthorization Act, known simply as Macra, was enacted to replace the outdated and dysfunctional system for paying doctors under Medicare. The old system, based on the universally despised sustainable-growth rate formula, perennially threatened to impose unsustainable cuts in physicians’ fees. Macra passed Congress with bipartisan support and President Obama quickly signed it. Unfortunately, the law empowers the federal bureaucracy at the expense of the doctor-patient relationship, putting the quality of American health care at risk.

In an effort to secure broad support, Congress wrote into the law general guidance but left important details of implementation to the executive branch. What happened next was predictable: In April the administration presented a 962-page regulatory behemoth. This new set of rules uses the power of Medicare to put the federal government in charge of almost every aspect of physician care in the U.S.

Macra adopts the same theory of cost control embedded in ObamaCare. It assumes that the federal government has the knowledge and wherewithal to engineer better health care through “delivery system reforms,” forgetting the utter failure of the bureaucracy’s previous effort. ObamaCare and now Macra use Medicare’s payment regulations to force hospitals and physicians to change how they care for their patients. The administration’s regulations will force doctors to comply with scores of new reporting requirements and intrusions into their practices. Physicians who refuse to bend will see their Medicare fees cut.

Macra and the new regulations force physicians to pick between a “merit-based incentive payment system” or an “alternative-payment model.” Doctors who choose the former will get paid fee-for-service, but they will receive meager annual increases of only 0.25% starting in 2019. Some doctors could earn “bonus payments” but only if the federal bureaucracy approves of their performance. CONTINUE AT SITE