REP. BURKE: OHIO’S MENTAL HEALTH SYSTEM FACES A CRISIS

Will introduce bill to identify cost-savings, structural improvements

COLUMBUS—In order to improve the efficiency and effectiveness of Ohio’s mental health services, State Representative Dave Burke (R-Marysville) intends to propose legislation that calls for a review of Ohio’s behavioral health system. The goal of this legislation will be to identify potential reforms and cost-containment opportunities within the system, which will not only improve state health services but also rein in costs.

“The current system is crumbling and fragmented,” said Burke, who serves as chairman of the Health and Human Services Subcommittee of the Finance and Appropriations Committee. “There is no transparency with regard to costs, and oftentimes there is no coordination of services. With numerous tragic events that have happened over the last few years that have involved behavioral health system issues, it is important that Ohio make a comprehensive review of the system.”

More than 340,000 Ohioans received community mental health treatment during fiscal year 2009. Starting in 2014, the Ohio Medicaid program expects that more than 550,000 new enrollees will be added to the system, about one-third of whom will require mental health treatment. However, the current system leaves significant gaps in coverage for individuals who need behavioral services, which in fiscal year 2009 left more than 22,000 mental health patients without Medicaid coverage.

According to Burke, a lack of coordination between departments often leads to inflated costs or flawed patient care, which not only strains the state budget but also puts vulnerable Ohioans at risk. Many mentally ill Ohioans end up institutionalized in prisons and nursing homes, when in reality, a number of these individuals require more intensive behavioral treatment.

“It is extremely important that we don’t let Ohioans who depend on state services fall through the cracks or be subjected to inadequate treatment,” said Burke. “We will soon have an opportunity to improve Ohio’s mental health system while at the same time reduce inefficiency. This is a standard of excellence that we owe to those who elected us to lead this state.”

More notes from the editor:

Personally, I think the public mental health system is so broken in Ohio that it should be totally eliminated if it doesn’t get fixed. Taxpayer dollars spent on public mental health would be well worth it if the public mental health system in Ohio actually worked. It doesn’t. What would happen to the lives that are crumbling right now if the system was eliminated? Not a whole lot worse than what already happens. What about public safety if the system was eliminated? Wouldn’t it be dangerous? The public safety is already jeopardized, but perhaps you weren’t aware of it. If you’re reading this, you are now aware of it. Be careful out there.

Beyond the Medicaid issues (both eligibility and spend-down requirements), the lack of mental health parity with physical health in terms of medical coverage, the destitute who might not qualify for Medicaid but still have no money to access the system, and the co-pays (a co-pay for the psychiatrist at least once every three months, a co-pay for each of the quite frequent counseling sessions with a psychotherapist, a co-pay for the case management, and a co-pay for the medication) even if there is some medical coverage, the service delivery stinks.

Access is a huge issue.  Actually, in the public mental health system, you might have to wait two months to even get an intake appointment. Then you have to wait for maybe another two months before you see the psychiatrist, which means no medication until then. You can get in to see the counselor sooner–maybe within the same month of your intake, maybe not–which means no case management until after your first session of therapy. Once you are in the system, you might get to see the case manager each week, you might get to see the counselor twice a month, but don’t bet on seeing the psychiatrist once every three months, even if you scheduled an appointment three months out. You’re likely to get a call from the receptionist that all appointments are canceled that day due to an emergency that called the psychiatrist away to the hospital. That’s what it’s like. Because of a scarcity of preventive care in the public system, the otherwise manageable cases become emergencies, land people in the hospital, and that’s when they get to see the psychiatrist.

If you are a stakeholder in someone’s mental health case, perhaps by assisting a family member or by being a patient yourself, watch out for the snafus of the office staff, too. They may lose paperwork which may require a destitute person to reapply for financial assistance from the county ADAMH board each time the person makes a visit. However, the office staff won’t tell the person that the application for assistance went missing. Instead, the staff will not bill ADAMH, so the medical billing company will then mail a hefty bill to the person’s house for the followup visit–a bill that will scare the patient into not ever scheduling again because they are made to believe they can’t afford it. Watch for the multiple billings, too. An account number isn’t assigned to a patient. Instead, an account number is assigned to a visit, thus one patient will have to track down multiple account numbers if that patient wants to question the billing with the office staff. A patient might get two or three duplicate invoices in the mail for the same visit, and if it’s happening to the patient, Medicare or some other medical coverage provider might be getting invoiced just as often (defrauding the Medicare system and the patient, both). If there are questions to resolve about invoices and payments, a patient should be made aware that the billing has been outsourced to some other company hundreds of miles away whose only address is a post office box. The person in the office that provides that information to the outsourced medical billing company (the patient may see 20 staffers behind that receptionist counter, but only one knows anything about the account balances) may be out to lunch or otherwise out of the office. Once the patient manages to meet that staffer, the patient will have to correct the staffer’s math, because they added and subtracted the $$ amounts wrong.

The professional counselors and psychiatrists hate their jobs because of all the crazy paperwork required by both government bureaucracy and insurance bureaucracy. If they could go into private practice in an office that only accepts cash, to be paid at the time of service, and line up enough customers to fill the schedule, they’d jump at it. On a cash-only basis, where no insurance, no Medicaid, and no Medicare are accepted for payment, and the staff will not even process paperwork for reimbursement from coverage providers, the only billing info they need on hand is the duplicate copy of the hand-written receipt given to the customer when cash is received at the time of the visit. Most patients would assume that going to a cash-only office would be too expensive, but, actually, with the lower overhead, the charges for service might be no more expensive than the co-pays in the public mental health system. Though cash-only patients can get much better access to the private-practice mental health care professionals at a reasonable price, what’s unreasonably expensive are the prescription drugs, which can cost hundreds of dollars each month. So, if a patient can’t pay for prescriptions out of pocket, then, to get insurance coverage or government assistance, one either goes to a private practitioner with much more overhead expenses (in which case, it’s much more expensive for psychotherapy there), or one goes to public mental health (which, if you add the cost of psychotherapy and the cost of drugs together, is the lowest cost alternative).

If you’re rich and can afford all the medications and psychotherapy out of pocket, go to the cash-only private practitioners.

Case managers in public mental health also don’t like their jobs. Not only are they swamped with more cases than they can manage, they also know that those who they’re assigned to help aren’t getting effective treatment in such a broken system. Therefore, the case managers feel a dread that they are risking danger whenever they meet up with clients.

The grumpy professionals in the public mental health system will tell you the scarcity of care is due to government cutbacks.  The truth is, even if their budgets were bigger, they’d still hate their jobs, which makes recruiting staff problematic.  Furthermore, the professionals and staffers, perhaps from feeling burnt out or overwhelmed by the backlog, don’t really work that much.  They may spend as much time socializing with each other as they spend on-task.  So the backlog is not just a product of supply and demand, not just a product of government budgets, not just a product of not enough professionals and staff, not just a product of having to put out fires instead of preventing them in the first place, not just a product of mountains of paperwork, but it’s also a product of lack of productivity due to lack of a work ethic.  I’m sure staffers and professionals would protest and act appalled at the allegations I’m making, but when one spends hours in a waiting room, one has plenty of opportunity to observe the staff with one’s own eyeballs.

These horror stories of public mental health don’t just take place in Ohio’s urban areas. They take place in small towns, like Sandusky, Norwalk, and Tiffin, too.

If Ohioans want the mentally ill to have access to treatment, then state rep David Burke is right. The system must be fixed, and the broken system is costing taxpayers too much money for such unacceptable treatment outcomes.  A word of warning:  Truly fixing the system may take much more effort than the state rep ever imagined.

Having been diagnosed with both ADHD and bipolar disorder, I have firsthand knowledge of such service delivery dysfunction. Been there, done that.

Also making news were groups of detractors widely known as the Tea Party.

I’m trying to remember, way back then, how you characterized the negative feedback that garnered media coverage . . .

Correct me if I’m wrong, but, didn’t you say it was mere astroturf?

I think you did.  I think you said it was nothing but astroturf.

I wonder if you would care to elaborate further on that observation in light of the most recent election results.  Do you still think it’s astroturf?

BEHIND ENEMY LINES

It’s not every day the President of the United States comes into town.  In fact, it’s such an unusual event that even I succumbed to curiosity.  OK, so my wife was the one that wanted to go . . . but since I had never been able to say that I had seen a sitting President (or any President for that matter) in person, I went along.  I will confess that at first I wanted to shout “vote for Sharron Angle,” but I restrained myself and I’m glad I did . .  not worth taking the chance of being pummeled  . . .

On this occasion, the President was in town to rally support for the endangered Senate majority leader.  (I may add that this was my first time seeing a Senator in person, as well.)  Interestingly enough, I found that if you didn’t get caught up in the shouts and chanting it was really difficult to tell who exactly he was talking about.

President Obama said he wanted to break away from old style politics:  A Washington without partisan bickering, politics where the candidate with the most money and cynicism doesn’t always win.  He called for the parties to work together in a bipartisan way for the good of the people.  Who were you talking to Mr. President?  Look in the mirror when you make such statements.

Another interesting statement was that neither he nor Harry Reid was born with a silver spoon in their mouth.  Then he lauded Reid for being a common man saying that he had humble beginnings and remembers what it is like to have to work for a living and struggle to make ends meet.  Who are you trying to fool?  I never went to a private school while growing up (OK, I technically went to a private college, but BYU tuition was less than Ohio State for me), nor was I privileged enough to have an Ivy League education.  As for Reid, yes, he may remember what it is like to be a common man, but that’s just it:  he has to remember.  I’ll bet he has to think about it a long time to remember, though, because that is now ancient history . . .

Obama also decried campaign smear ads by Republicans and fear mongering ads by groups that aren’t even affiliated with the candidate, groups with funny names that have donors that can’t be identified.  Funny, when my brother (none other than the Buckeye RINO) was here helping me move in, he saw such an ad campaigning against Sharron Angle . . . It was in Spanish, but he noted that the endorsement by Reid was missing (“I’m Harry Reid, and I approved this message”).  I have since heard that ad and many others attacking Sharon Angle that don’t have Harry Reid’s endorsement at the end.  Most of them use very negative pathos suggesting that Angle is not only radical but dangerous based on sound bites from some of the things that she has said that don’t sound very good on the surface but aren’t really all that scary.  (Remember that Angle is a novice.  Reid has had lots of practice speaking in public about sensitive issues, Angle has not.)  I live here in Las Vegas, NV now and I can say that I have heard more of this type of attack ads directed at Angle than I have directed at Reid…  Who are you talking to Mr. President?

When the rhetoric turned to bragging about accomplishments, Obama and Reid both touted their health care reform.  Obama claimed that health care reform is making health care more affordable for consumers.  Oh really?  Then why am I faced with a 100% increase in the health insurance premium portion that I pay, plus why is the company I work for paying an additional 25% for 2011? To be fair, the dollar amounts are roughly equal, because the company I work for pays a much larger portion of the premium than I do, but combining them both represents roughly a 30% increase.   So how is a 30% increase more affordable?  Have we changed the rules of mathematics?  If so, could you explain to me the new rules so I can understand them too?

Obama said that we should move forward and not backwards, that we needed new thinking.  So when Reid bragged that the high speed rail line to California and the I-15 corridor work would bring thousands of jobs to the area in response to the economic downturn, was that a fresh idea?  Is that new thought?  Wait a minute, I seem to remember another time when we had a major economic fallout and the government started a mega-project in southern Nevada . . . Oh, yes!  The great depression and the Hoover Dam . . .  Original thinking there, Mr. Obama and Mr. Reid.  Glad you are here to come up with all these new ideas.  So what happens if it doesn’t improve the unemployment in Nevada?  Will you then say “It would have been worse if we hadn’t”, or will you blame the Republicans for ruining it?

Well if you want some really new ideas Mr. President, some radical ones, I have a few.  How about agreeing to allow use of our national parks by the native Americans as part of restoring trust after years of abuse and land grabs?  How about returning power to the states by eliminating federal agencies and programs that are better handled on a local level, like education and welfare?  If you are so anti-imperial, how about starting right here at home?  In order to compete in the world economy, why not negotiate with the rest of the Americas to adopt the US dollar the way the European Union has? (This has already worked well in Ecuador.)  Why not take it one step further and open the door to allow the states of Mexico to join our Union?  Maybe then we could keep illegal immigration at bay once conditions inside the country improve and they are no longer drawn northward.  (Of course you would have to cut off federal entitlement programs for that to work.)  Maybe then we could get the gang wars under control if we could send in our military instead of theirs.  Maybe then we could keep our retirees, that flee southward trying to keep themselves financially afloat, so that they retire inside the boundaries of the expanded US?  That’s radical thinking.  This is something no politician is even talking about, a new idea.  Re-creating the New Deal under a different name is not a new idea.

After another year, and after we are ready for the next campaign, we’ll check in, Mr. President, and see if you are having any luck with that original thought.  If you haven’t by then, we can help you out . . .

If you’ve missed some opportunities to show your true genius in designing your own homemade protest signs and banners, January 22, 2010 (this Friday) might be a fortuitous occasion.  Who knows?  Perhaps someone in the Presidential motorcade might even spot your sign.

Lorain County Community College is on the outskirts of Elyria, and it’s a venue where President Obama will make an appearance on Friday, though I’m not sure of the exact time of the President’s appearance.

For the Tea Party, however, you’re welcome to stay the whole day.  You can pack food, if you like, but there are also plenty of fast food joints and other restaurants just down the road, to the north of the campus.  I have no idea what the weather forecast is, but be prepared for the outdoor conditions.

Mike Hellyar of the Lorain North Shore Patriots is designated as the organizer of the rally.  The plan for Tea Party attendees is to park at Elyria’s Hilltop Park Cobblestone.  It’s a little bit of a walk to the LCCC campus from there.  If by chance there’s no available parking at the park or at the campus, there is a shopping center called Cobblestone on the same road (State Route 301–also known as Abbe Road) as the campus.  State Route 301 is a heavily traveled thoroughfare, so as you walk along the way, plenty of motorists will have an opportunity to see your signs at virtually any time during daylight hours (just be careful not to get run over if you have to cross any intersections).

Driving-wise, LCCC is not that far from an interchange with I-90.  If traveling from Cleveland or other points east, you’d make a left off of the exit ramp onto State Route 254, and then make a right on State Route 301.  If traveling from Sandusky or other points west, you’d make a right off the exit ramp onto State Route 254 and then make a right on State Route 301.

You’ll see the Cobblestone shopping plaza on your right hand side fairly soon after turning on to SR 301 (Abbe Road).  The LCCC campus will be further south, along the left hand side of the road.  The sign at the entrance of campus is clearly visible.

I’ve always accessed Hilltop Park from Gulf Road (roughly parallel to Abbe, but further west), but it’s not the only access point, but the park stretches over to Abbe Road and up to Burns Road.  There is an intersection with Burns Road just south, beyond the LCCC campus, along Abbe Road.  Hilltop Park lies a little further south, just beyond that Abbe-Burns intersection, on the right hand side.

If you feel your clever banner didn’t get enough exposure to viewers during the Tea Party, you might consider sending me a photograph of it, snapped on the LCCC grounds, and I’ll consider posting it here on Buckeye RINO.

Let the President know what you REALLY think about the bailouts, cap and trade, and Obamacare.

[UPDATE 1/20/2010] Two more links to help you get there and know what’s going on:

Cleveland Tea Party Patriots

Lorain NorthShore Patriots

As you may recall, this past summer, when Obamacare opponents said that the proposed legislation hadn’t ruled out federal subsidies for abortions, Obamacare supporters said that such a charge was as fictitious as death panels and coverage for illegal immigrants.  “Stop telling lies!” was the mantra of the Obamacare supporters.  Obamacare opponents, of course, were not telling lies, and federal subsidies of abortion weren’t stricken from the Obamacare bill until Saturday, just an hour before the final Obamacare bill vote, when an amendment to the bill, the Stupak amendment, was passed.

Not until the final hour had abortions been ruled out of the bill.

Could Congress have saved themselves some headaches by ruling out abortions much earlier in the process?  I think so.  Speaker Pelosi, however, has been playing a game of brinksmanship, to squeak uber-leftist legislation through.  Moderate Democrats have been left in a bind.

Many moderate Democrats arrived in Congress on the heels of Republican scandals.  Other moderate Democrats won seats because Republican officeholders voted like liberal Democrats on key issues.  Moderate Democrats pledged that they would represent voters’ interests more faithfully than their Republican opponents, and that they’d be scandal-free.  Voters in many conservative-leaning districts took a big risk by electing Democrats instead of Republicans.

While the moderate Democrats may have remained true to the pledge that they would not embroil themselves in scandal, their voting records under Pelosi’s leadership have been quite liberal, as Pelosi hasn’t sought middle ground on any issue whatsoever.  Conservative-leaning districts are quickly learning that the Democrats they elected aren’t really championing voters’ interests.

Let’s recap how the Ohio delegation voted on the Stupak amendment and on the House’s finalized version of the Obamacare bill:

• Republicans Boehner, Turner, Latta, LaTourette, Tiberi, Jordan, Schmidt, and Austria all voted for the Stupak amendment (to rule out federal subsidization of abortion) and against the final Obamacare bill.
• Democrat Boccieri voted for the Stupak amendment and against the final Obamacare bill.
• Democrat Kucinich voted against the Stupak amendment and against the final Obamacare bill.
• Democrats Space, Wilson, Kaptur, Ryan, and Driehaus voted for the Stupak amendment and for the final Obamacare bill.
• Democrats Sutton, Kilroy, and Fudge voted against the Stupak amendment and for the final Obamacare bill.

Question:  Whose re-election bids were helped and whose were hurt by their votes on Saturday?

Republicans are helping themselves with these Saturday votes, and some need all the help they can get.  For Austria, he’s a freshman, so he needs votes like these to establish himself.  Boehner, Tiberi, and Schmidt all voted for the initial Wall Street bailout last fall, so they’ve got some catching up to do, as their votes started our nation down the socialist path.  LaTourette, who, in past years, has always faced very liberal campaign opponents, and who’d also been labeled as a RINO by many inside the GOP, has really benefited by Pelosi’s uber-left agenda.  With no middle ground being sought in the Pelosi house, LaTourette has had no middle ground to steer towards, and, having to steer either left or right, LaTourette has steered right, thus bolstering his conservative credentials and winning greater favor from the base.  Though his district lies in Northeast Ohio, and though local Democrats may postulate that LaTourette has moved too far to the right to be relevant in his district, I think LaTourette has strengthened his hold on the district, as Pelosi has steered Congress much further to the left than voters in LaTourette’s district can stomach.  LaTourette’s liberal campaign opponents didn’t gain enough traction against him in the past, and now that the true colors of liberals are openly displayed, I don’t think they’ll gain enough traction against him in 2010.

Leave it to Dennis Kucinich to march to the beat of a different drum.  Some speculate that if the vote had been 217 to 217 on the Obamacare bill, with Kucinich being the last person to cast a vote, that he would’ve capitulated, and voted for the measure.  He was given wiggle-room this time.  I’m not sure whether his constituents will be amused or annoyed by his capriciousness, but he’s dodged every bullet so far.

Though there are some liberal Democrats around Ohio that are incensed by Boccieri’s vote, I think the vote helps him.  The lefty voices claim that Boccieri can’t win over conservatives because they’ll still fault him for cap-and-trade and various sundry bailout votes, which is true, yet I think this vote, because it’s so highly publicized, will help Boccieri among independent, middle-of-the-road voters.

For Kaptur and Ryan, they haven’t sufficiently alienated their constituencies by these votes.  Their support of the Stupak amendment spares them from Catholic backlash while their support of the Obamacare bill leaves them in good standing with the unions.  Though Driehaus voted the same way, I don’t think it helps.  The high tide of Democrat turnout that carried Driehaus into office on Obama’s coattails won’t recur in the 2010 election, and I think his seat reverts back to Republican control.  Space and Wilson like to talk as if they are middle-of-the-road, but with no middle ground in the Pelosi House, they’ve chosen to steer to the left on every vote.  Somehow, eastern Ohio doesn’t keep close tabs on their Congressional representatives until scandal erupts, like it did with Bob Ney, Jim Traficant, and Wayne Hays.  If they were keeping close tabs, Space and Wilson would be dead meat in 2010.

Lastly, there are the Emily’s List delegation members.  In Fudge’s district, she’s a shoo-in.  I can’t imagine her re-election being screwed up by any Congressional vote. Whether she votes uber-liberal or ultra-conservative for the rest of her term, just the fact that she’ll have a “D” by her name in November 2010 will ensure her election.  Sutton has shown that she cares more about the views of liberal lobbyists around the Beltway than she does about the views of voters in her district.  Though her district leans slightly left, it’s not an uber-liberal district, so I think Sutton is hurting herself and increasing the risk that she could be successfully outflanked on the right.  Finally, there’s Kilroy.  Come November 2010, she’s toast.

One final note about the gamesmanship of Beltway lobbyists, I highly recommend this BizzyBlog post that explains how Obamacare might have been defeated if not for National Right-to-Life blocking the route.  Pathetic.