Homer Simpson on Health Insurance
Andrew Malekoff© June 2010
We are all familiar with stories about the ineptitude of government officials and regulators in protecting the public. At the SEC, they fell asleep at the wheel as Bernie Madoff made off with billions. In its eagerness to put more low-income families into its own homes, HUD failed to rein in Freddie Mac and Fanny Mae from saddling borrowers with mortgages they could not afford. So, it comes as no surprise to me that I cannot get a straight answer about who regulates the commercial insurance industry in New York State.
New York State is on the verge of implementing a plan for restructuring the financing of community-based mental health clinics. The plan discriminates against the underinsured middle class and working poor and is scheduled to commence on October 1. It represents a dramatic shift away from universal mental health care and towards care for families with Medicaid insurance only.
Those who have Medicaid are able to easily access community-based mental health services. Otherwise, you will soon be out of luck. When a family cannot get essential community-based mental health services that is what is known, in insurance industry parlance, as an inadequate network of care. Network adequacy has to be monitored and enforced.
In an attempt to get some straight answers, I contacted nuclear power plant safety inspector Homer Simpson, who was recently quoted as saying, “America's health care system is second only to Japan, Canada, Sweden, Great Britain; well, all of Europe. But you can thank your lucky stars we don't live in Paraguay!”
Andrew Malekoff: It is great to see you Mr. Simpson. You are looking dapper as ever.
Homer Simpson: D’OH!
AM: I know, I know, enough small talk. So, let’s get down to business. As someone with quality assurance experience, do you have any insights into who is overseeing the commercial insurance industry in New York State?
HS: D’OH!
AM: Are you expressing astonishment at my question, or are your referring to the D.O.H. - the New York State Department of Health?
HS: D’OH!
AM: A state official told me that this was the State Insurance Department’s (SID) jurisdiction.
HS: D’OH!
AM: Okay, okay, take it easy. I contacted a senior examiner at SID and she told me that they (SID) had regulatory authority over all licensed insurance companies and that they did enforce the insurance laws and all policy provisions but, she was quick to add, “We do not get involved in the network adequacy issue.” She said that that was the Department of Health’s job. I take it that you concur?
HS: D’OH!
AM: As I am sure you know, the commercial insurance industry uses managed-care companies to hold down costs. They decide, usually from hundreds of miles away, who gets what kind of mental health care, for how long and at what rate of reimbursement. In other words, they don’t really manage care, they manage cost and sometimes they even mangle care - at a nice profit.
HS: D’OH!
AM: According to Patrick Gauthier from Advocates for Human Potential Healthcare Solutions, “Despite the deepest and most enduring recession in 70 years…the five largest health-insurance companies in the nation disclosed combined profits of $12.2 billion last year — a 56 percent increase over the previous recessionary year. They managed this feat even though they experienced a combined loss of nearly two-million members to unemployment.”
HS: D’OH!
AM: My sentiments exactly! I am not sure that families know what to do if they cannot find a provider in the advertised network of care available to them via their health plan. May I ask you one final question, Mr. Simpson?
HS: D’OH!
AM: It will be quick. I promise. I raised the issue of network adequacy with the network manager for a well-known insurance company. She said to me, “We have a large volume of therapists within a five-mile radius of your agency that see young children which supports that our network needs are being met. What brings clients to your agency rather than an individual clinician's office?” How do you think I should answer her?
HS: First of all, Marge and I want to thank the Guidance Center for helping our family. Here is what I recommend you say in response to the network manager’s question: “The kind of comprehensive service that a community-based provider offers cannot be duplicated by any private practitioner in your network. For example, at North Shore Child and Family Guidance Center, the wrap-around services, for which they are not reimbursed by you or any commercial insurer, are by no means unnecessary frills or perks. They are essential services for working with a growing population of families in emergent crisis and in need of a community-based agency approach that is designed for this population, versus an individual private practitioner with limited availability, time and resources.” That should set her straight. Now I have to leave before happy-hour is over at Moe’s.
AM: D’OH!
To learn more about your rights as a health care consumer go to the following website: http://www.ins.state.ny.us/hrights.htm.
Published in the Anton chain of 18 newspapers, Long Island, New York in June 2010
Saturday, May 29, 2010
Sunday, May 9, 2010
MAKING ROUNDS
MAKING ROUNDS
by Andrew Malekoff © 2010
I have been writing this column since February 2007. Although I try to make points to be helpful to parents and other community members that care about kids, sometimes I think what I make are “rounds” that are less hard-edged and softer than points.
My reflections in this month’s column don’t unfold in a straight line, rather in a circular and pattern. I do not think that my memories are remarkable. They are made up of a combination of milestones, transitions and random, mundane associations. I am not sure if they will have universal appeal. I will leave that for you to decide.
I was born in Newark, New Jersey on May 14, 1951. In my early years I grew up in a second floor flat in the same neighborhood where author Philip Roth once lived. The best thing about where I lived was that there were stores around the corner. Among my favorites were a bakery, candy store, luncheonette and a burger joint with a pinball machine.
My grandfather Joe was a carpenter who emigrated from Russia. He lived with us for a few months. He lost an eye in an on-the-job accident. It was replaced with a glass eye that he removed from time to time to show to me. He once mistook a box of Spic ‘n Span, a cleaning product, for a box of Wheatena oatmeal. The boxes were similar in size, rectangular shape and orange color. As a result of the mix-up, a pot of boiling water and cleaning powder overflowed and flooded the kitchen with soap suds.
My other grandfather Harry was a tavern owner who came to the U.S. from Poland. He had diabetes and two prosthetic legs that I once saw him take off and put on. I often wondered what fake parts I would have when I got older.
My aunt Rose, my dad’s younger sister, told me a story about when my mom and dad first met. The two families planned a get together at my mom’s house. I found out that my dad’s family was worried because Grandpa Joe slurped his soup. Aunt Rose told me that, although they were poor, they did not want to appear to be low class. When the soup was served they held their breath waiting for Grandpa Harry to start. He slurped too. Everyone was relieved and, well, the rest is history.
We moved to a suburb of Newark called Maplewood when I was 10-years-old. It happened fast and without any warning. There was a moving truck one day and the next day my younger brother and I were sleeping in a new bedroom where we heard crickets outside the window. No one consulted me about moving. I left all of my friends behind and had to make new friends.
In the suburbs I rode my bike everywhere since there were no stores around the corner. My father, Izzy, took over the tavern after Grandpa Harry died. The tavern was called the P.O.N. which stands for the Pride of Newark. One day someone set the P.O.N. on fire. Some years later there were race riots in Newark. I did not see my dad that much in those days.
My mother, Evelyn, started her own business when I was in junior high school. I didn’t understand. I later learned that it was to help pay the bills. She was an antiques dealer. In time she opened her own store. The sign on the store read: Antique Evelyn. That is what she was known by for the rest of her years.
My parents died in the 1990’s after at least a decade of serious health problems.
My father had multiple myeloma and my mother had heart disease. During my earlier childhood years my parents each smoked three packs of Camels every day. Sometimes they sent me to the store to buy them for twenty-five-cents a pack.
One day in the early 1990’s, when her health was failing and she was living alone, my mother fell. She called me from a hospital in Newark. The call came at two-in-the-morning. She sounded groggy when she asked me to bring her a box of tooth powder. By this time I was living on Long Island. I drove to the hospital. Her face was bruised and swollen from the fall. She wanted the tooth powder to hold her dentures in place so that she would look good. I stayed with her for a little while and then drove home and went to work.
My father died in the same hospital where I was born. I slept in my dad’s hospital room for several days before I watched him take his last breath on a late Sunday afternoon in May. And, then I drove back to Long Island, to a neighborhood where there are stores that I can walk to, just around the corner from where I live.
Published in the Long Island based Anton Newspapers in April / May 2010.
by Andrew Malekoff © 2010
I have been writing this column since February 2007. Although I try to make points to be helpful to parents and other community members that care about kids, sometimes I think what I make are “rounds” that are less hard-edged and softer than points.
My reflections in this month’s column don’t unfold in a straight line, rather in a circular and pattern. I do not think that my memories are remarkable. They are made up of a combination of milestones, transitions and random, mundane associations. I am not sure if they will have universal appeal. I will leave that for you to decide.
I was born in Newark, New Jersey on May 14, 1951. In my early years I grew up in a second floor flat in the same neighborhood where author Philip Roth once lived. The best thing about where I lived was that there were stores around the corner. Among my favorites were a bakery, candy store, luncheonette and a burger joint with a pinball machine.
My grandfather Joe was a carpenter who emigrated from Russia. He lived with us for a few months. He lost an eye in an on-the-job accident. It was replaced with a glass eye that he removed from time to time to show to me. He once mistook a box of Spic ‘n Span, a cleaning product, for a box of Wheatena oatmeal. The boxes were similar in size, rectangular shape and orange color. As a result of the mix-up, a pot of boiling water and cleaning powder overflowed and flooded the kitchen with soap suds.
My other grandfather Harry was a tavern owner who came to the U.S. from Poland. He had diabetes and two prosthetic legs that I once saw him take off and put on. I often wondered what fake parts I would have when I got older.
My aunt Rose, my dad’s younger sister, told me a story about when my mom and dad first met. The two families planned a get together at my mom’s house. I found out that my dad’s family was worried because Grandpa Joe slurped his soup. Aunt Rose told me that, although they were poor, they did not want to appear to be low class. When the soup was served they held their breath waiting for Grandpa Harry to start. He slurped too. Everyone was relieved and, well, the rest is history.
We moved to a suburb of Newark called Maplewood when I was 10-years-old. It happened fast and without any warning. There was a moving truck one day and the next day my younger brother and I were sleeping in a new bedroom where we heard crickets outside the window. No one consulted me about moving. I left all of my friends behind and had to make new friends.
In the suburbs I rode my bike everywhere since there were no stores around the corner. My father, Izzy, took over the tavern after Grandpa Harry died. The tavern was called the P.O.N. which stands for the Pride of Newark. One day someone set the P.O.N. on fire. Some years later there were race riots in Newark. I did not see my dad that much in those days.
My mother, Evelyn, started her own business when I was in junior high school. I didn’t understand. I later learned that it was to help pay the bills. She was an antiques dealer. In time she opened her own store. The sign on the store read: Antique Evelyn. That is what she was known by for the rest of her years.
My parents died in the 1990’s after at least a decade of serious health problems.
My father had multiple myeloma and my mother had heart disease. During my earlier childhood years my parents each smoked three packs of Camels every day. Sometimes they sent me to the store to buy them for twenty-five-cents a pack.
One day in the early 1990’s, when her health was failing and she was living alone, my mother fell. She called me from a hospital in Newark. The call came at two-in-the-morning. She sounded groggy when she asked me to bring her a box of tooth powder. By this time I was living on Long Island. I drove to the hospital. Her face was bruised and swollen from the fall. She wanted the tooth powder to hold her dentures in place so that she would look good. I stayed with her for a little while and then drove home and went to work.
My father died in the same hospital where I was born. I slept in my dad’s hospital room for several days before I watched him take his last breath on a late Sunday afternoon in May. And, then I drove back to Long Island, to a neighborhood where there are stores that I can walk to, just around the corner from where I live.
Published in the Long Island based Anton Newspapers in April / May 2010.
“Will all parenting experts please leave the room!”
“Will all parenting experts please leave the room!”
By Andrew Malekoff © 2010
“We have a new word in our lexicon – parenting. The word refers to what I call the technology of being a parent. The increased usage of the term is most unfortunate, and I avoid it wherever possible.” So says La Jolla, California psychologist Richard Farson in his new book, “Will all Parenting Experts Please Leave the Room!” (Western Behavioral Sciences Institute: http://www.wbsi.org/farson/books.htm).
In my unvarnished view of parenthood, it is less a well-posed, still-life portrait and more a roller-coaster ride; harrowing yet fun, with unexpected twists and turns, ascents and descents. You experience anxious anticipation and vertigo-inducing surround-sound. Sometimes, however, it is not so exciting - more like a crawling commute in rush- hour traffic, enervating, meandering, puzzling and endless.
As many of us know, parenthood can bring confusion, misunderstanding and doubt. This is an inescapable reality for most parents. Parenthood is rarely neat. It is more abstract than still life, more jazz than classical. Yet, according to Richard Farson, there is a myth that one can learn parenting techniques and all will be good.
Many times parents feel helpless because their kids make noise and move about, laugh and have fun at what feel like the most inopportune times. Raw parenthood looks like it just crawled out of bed; it is a half-eaten slice of pizza, a shirt hanging out, a chair leaning back, a runny nose, mismatched socks and a dripping ice cream cone. And there are moments when it can also be compared to a sunset. Parenthood is an adventure.
At times, parents feel ashamed and apologetic; and yet, the unspoken message from the “experts,” according to Farson, is that “somewhere there exists a person, an expert, who has it all figured out and knows how [be a perfect parent]. No wonder parents feel vaguely incompetent at the very time they think they are acquiring helpful information.” Farson offers readers a fresh, if controversial, view on the absurdities and paradoxes of parenthood, in the face of a consistent downpour of advice on what has come to be known as “parenting.” For example, he says, “Most parents love their children. Most would die for them. Paradoxically, however, as a society we do not honor or respect or even like our children. We indoctrinate, patronize, ignore, mistreat, segregate, dominate, prohibit, compel and incarcerate them.”
Among his riffs is one on the myth of quality time and the belief that how much time we spend with our children is less important than how the time is spent.
Farson reasons that genuine quality time should not be measured in discrete bursts of undivided attention. Quite the contrary he says, “It is the time when you don’t have to do anything with your child, when the child simply knows that you are around and available. It is taking comfort in the simple awareness of each other’s presence. It is allowing yourself to be angry with your child, in the knowledge that there will be time to get over it and make up.”
His advice about the myriad of books on how to have quality time with your children is to ignore them. My advice: don’t ignore Farson’s book. It will make you scratch your head. It may even make your head hurt and make you feel angry. At just 107 pages, and, with such chapter headings as “Parenting is Impossible” and “Don’t Pity the Latchkey Children,” this anti-parenting parenthood book is a must read.
And, if you are really looking for a headache, you can then read Farson's “Will All Marriage Experts Please Leave the Room!”
To be published in the Long Island based Anton Newspapers in May 2010.
By Andrew Malekoff © 2010
“We have a new word in our lexicon – parenting. The word refers to what I call the technology of being a parent. The increased usage of the term is most unfortunate, and I avoid it wherever possible.” So says La Jolla, California psychologist Richard Farson in his new book, “Will all Parenting Experts Please Leave the Room!” (Western Behavioral Sciences Institute: http://www.wbsi.org/farson/books.htm).
In my unvarnished view of parenthood, it is less a well-posed, still-life portrait and more a roller-coaster ride; harrowing yet fun, with unexpected twists and turns, ascents and descents. You experience anxious anticipation and vertigo-inducing surround-sound. Sometimes, however, it is not so exciting - more like a crawling commute in rush- hour traffic, enervating, meandering, puzzling and endless.
As many of us know, parenthood can bring confusion, misunderstanding and doubt. This is an inescapable reality for most parents. Parenthood is rarely neat. It is more abstract than still life, more jazz than classical. Yet, according to Richard Farson, there is a myth that one can learn parenting techniques and all will be good.
Many times parents feel helpless because their kids make noise and move about, laugh and have fun at what feel like the most inopportune times. Raw parenthood looks like it just crawled out of bed; it is a half-eaten slice of pizza, a shirt hanging out, a chair leaning back, a runny nose, mismatched socks and a dripping ice cream cone. And there are moments when it can also be compared to a sunset. Parenthood is an adventure.
At times, parents feel ashamed and apologetic; and yet, the unspoken message from the “experts,” according to Farson, is that “somewhere there exists a person, an expert, who has it all figured out and knows how [be a perfect parent]. No wonder parents feel vaguely incompetent at the very time they think they are acquiring helpful information.” Farson offers readers a fresh, if controversial, view on the absurdities and paradoxes of parenthood, in the face of a consistent downpour of advice on what has come to be known as “parenting.” For example, he says, “Most parents love their children. Most would die for them. Paradoxically, however, as a society we do not honor or respect or even like our children. We indoctrinate, patronize, ignore, mistreat, segregate, dominate, prohibit, compel and incarcerate them.”
Among his riffs is one on the myth of quality time and the belief that how much time we spend with our children is less important than how the time is spent.
Farson reasons that genuine quality time should not be measured in discrete bursts of undivided attention. Quite the contrary he says, “It is the time when you don’t have to do anything with your child, when the child simply knows that you are around and available. It is taking comfort in the simple awareness of each other’s presence. It is allowing yourself to be angry with your child, in the knowledge that there will be time to get over it and make up.”
His advice about the myriad of books on how to have quality time with your children is to ignore them. My advice: don’t ignore Farson’s book. It will make you scratch your head. It may even make your head hurt and make you feel angry. At just 107 pages, and, with such chapter headings as “Parenting is Impossible” and “Don’t Pity the Latchkey Children,” this anti-parenting parenthood book is a must read.
And, if you are really looking for a headache, you can then read Farson's “Will All Marriage Experts Please Leave the Room!”
To be published in the Long Island based Anton Newspapers in May 2010.
Wednesday, March 24, 2010
IF YOUR CHILD IS NOT HEALTHY, MY CHILD IS NOT SAFE
IF YOUR CHILD IS NOT HEALTHY, MY CHILD IS NOT SAFE
Andrew Malekoff © 2010
Gladys Carrión, Commissioner of the New York State Office of Children & Family Services, oversees 26 juvenile detention facilities that hold close to 2,000 kids under 16 who have committed criminal acts. In a 2008 interview with New York Daily News, she stated that over 80% of the adolescents in this system have serious mental health problems that go untreated. Carrión described the network of juvenile facilities as a “pipeline to prison.” The system damages children and families and fails to make our neighborhoods safer.
Sara Montalbano, a social worker at North Shore Child and Family Guidance Center, who specializes in mental health counseling for delinquents and juvenile offenders and their families, has worked with a wide range of adolescents. “On one end of the spectrum,” she explains, “there are kids who were arrested for punching a hole in the wall at home. On the other end, there are kids who set fires and committed assaults and murders.” Montalbano asserted that, “There are not adequate resources to help these children and families on either end of the continuum.”
In an exposé by New York magazine (Feb. 10, 2010), it was reported that a US Department of Justice investigation found that employees in several New York State juvenile detention facilities were “restraining kids so often and with so much force that kids had endured concussions, broken teeth and broken bones.”
Since her appointment in 2007, Commissioner Carrión has closed 9 juvenile residential facilities. This has been replaced, in part, with alternatives-to-prison prevention programs that include psychiatric support and family therapy. However, historically elected officials have hesitated to support “pay now or pay later” prevention programs.
“The fundamental problem with elected officials,” according to Lee Staples, clinical professor at the University of Boston School of Social Work, “is that they almost always choose to ‘pay later’ because when the bill comes due, they frequently are no longer in the same office. They are resistant to ‘paying now’ for fear of losing the immediate votes of angry taxpayers.” This is a structural problem that works against almost all preventive programs. Add in “the paradox of prevention,” whereby the general public no longer sees a pressing problem when social programs are successful, and those same programs suddenly are at risk.
According to Dr. Staples, “We saw the phenomenon clearly in the city of Boston when gang violence spiked more than a decade ago. Some very effective preventive programs were put in place, violent crime statistics dropped dramatically, the programs were cut and the statistics almost immediately shot back up. It is not so much that politicians cannot learn that prevention really saves money but, rather, they see an imperative to act based on short-term electoral self-interest and immediate budgetary constraints – which, of course, is always present in an underdeveloped social welfare system.”
Closer to home, in 2009, then Nassau County Executive Tom Suozzi threatened to shut down 43 community-based youth services that served over 60,000 children and families across Nassau County, to help close a reported $130-million dollar county budget deficit. The impact of eliminating critical prevention services would have resulted in a greater cost to taxpayers - $200,000 per year to lock-up a juvenile in a state residential facility. And, the return on the investment is poor, as almost 90% of those locked up in these settings engage in ongoing criminal activity.
The citizens that fought back to preserve youth services in Nassau County were operating at a higher moral standard than those who were counting votes. Morality aside, though, advocates for youth services have a visceral understanding about the real consequences of not supporting prevention. They are not, as the old insult goes, “bleeding hearts.” If a person supports prevention it does not mean that they excuse criminal behavior.
It does not take a bleeding heart, only a rationale mind, to know that if your child is not healthy, my child is not safe.
This Parenting Plus column by Andrew Malekoff was first published in the Anton Newspapers chain of Long Island on March 25, 2010.
Andrew Malekoff © 2010
Gladys Carrión, Commissioner of the New York State Office of Children & Family Services, oversees 26 juvenile detention facilities that hold close to 2,000 kids under 16 who have committed criminal acts. In a 2008 interview with New York Daily News, she stated that over 80% of the adolescents in this system have serious mental health problems that go untreated. Carrión described the network of juvenile facilities as a “pipeline to prison.” The system damages children and families and fails to make our neighborhoods safer.
Sara Montalbano, a social worker at North Shore Child and Family Guidance Center, who specializes in mental health counseling for delinquents and juvenile offenders and their families, has worked with a wide range of adolescents. “On one end of the spectrum,” she explains, “there are kids who were arrested for punching a hole in the wall at home. On the other end, there are kids who set fires and committed assaults and murders.” Montalbano asserted that, “There are not adequate resources to help these children and families on either end of the continuum.”
In an exposé by New York magazine (Feb. 10, 2010), it was reported that a US Department of Justice investigation found that employees in several New York State juvenile detention facilities were “restraining kids so often and with so much force that kids had endured concussions, broken teeth and broken bones.”
Since her appointment in 2007, Commissioner Carrión has closed 9 juvenile residential facilities. This has been replaced, in part, with alternatives-to-prison prevention programs that include psychiatric support and family therapy. However, historically elected officials have hesitated to support “pay now or pay later” prevention programs.
“The fundamental problem with elected officials,” according to Lee Staples, clinical professor at the University of Boston School of Social Work, “is that they almost always choose to ‘pay later’ because when the bill comes due, they frequently are no longer in the same office. They are resistant to ‘paying now’ for fear of losing the immediate votes of angry taxpayers.” This is a structural problem that works against almost all preventive programs. Add in “the paradox of prevention,” whereby the general public no longer sees a pressing problem when social programs are successful, and those same programs suddenly are at risk.
According to Dr. Staples, “We saw the phenomenon clearly in the city of Boston when gang violence spiked more than a decade ago. Some very effective preventive programs were put in place, violent crime statistics dropped dramatically, the programs were cut and the statistics almost immediately shot back up. It is not so much that politicians cannot learn that prevention really saves money but, rather, they see an imperative to act based on short-term electoral self-interest and immediate budgetary constraints – which, of course, is always present in an underdeveloped social welfare system.”
Closer to home, in 2009, then Nassau County Executive Tom Suozzi threatened to shut down 43 community-based youth services that served over 60,000 children and families across Nassau County, to help close a reported $130-million dollar county budget deficit. The impact of eliminating critical prevention services would have resulted in a greater cost to taxpayers - $200,000 per year to lock-up a juvenile in a state residential facility. And, the return on the investment is poor, as almost 90% of those locked up in these settings engage in ongoing criminal activity.
The citizens that fought back to preserve youth services in Nassau County were operating at a higher moral standard than those who were counting votes. Morality aside, though, advocates for youth services have a visceral understanding about the real consequences of not supporting prevention. They are not, as the old insult goes, “bleeding hearts.” If a person supports prevention it does not mean that they excuse criminal behavior.
It does not take a bleeding heart, only a rationale mind, to know that if your child is not healthy, my child is not safe.
This Parenting Plus column by Andrew Malekoff was first published in the Anton Newspapers chain of Long Island on March 25, 2010.
Saturday, February 6, 2010
RED DOT IN HAITI, TEAR DROPS ON LONG ISLAND
RED DOT IN HAITI, TEAR DROPS ON LONG ISLAND
By Andrew Malekoff© 2010
Ludmyard Charles, 16, said that when she got home the phone rang. It was her father. He told her to get a glass of water. Then he asked her if she was sitting down. Next, he shared the heartbreaking news that her aunt, Ludmyard, was killed in the earthquake. The aunt she was named after who was pregnant, had lost her life when the earth opened up. The girl’s eyes filled up and she said of her aunt - “We were like sisters.”
A few days ago, I had the privilege of meeting Ludmyard and six of her fellow Westbury High School students, all of whom have roots in Haiti. I asked them about the emotional aftershocks of the January 12th earthquake that toppled national landmarks and shantytown homes and killed and injured untold hundreds of thousands of people in and around the capital city Port-au-Prince.
Each one of the four girls and three boys learned about the earthquake when they arrived home after being together in an after-school program led by North Shore Child and Family Guidance Center. Eighteen-year-old Vayola Justinian recalled, “When I got home my mom was crying. The TV was on. When I looked at the screen I saw a map of Haiti. There was a red dot.”
I asked the students about the media coverage and they said that it was both good and bad. “It was good to have updates,” said 18-year-old Joes Paraison, “but bad to see pictures of the dead and injured.” The others nodded and Joes said, “By the second day it felt like my family was going crazy” watching television. He said that the faces on the screen were hard to see clearly, leading them to wonder if anyone of them was a family member. Joes then recalled a most troubling of images - “a truckload of dead children.” Seeing such devastation from afar, including pictures of people buried underneath rubble, added to their feelings of helplessness and their wish to be there to help.
Their counselor Pascale Beaubrun, a native of Haiti, who is based at the Guidance Center’s Leeds Place in Westbury, later said that they turned their sorrow into action by collecting money and contributing to the Yéle Haiti Earthquake Fund, a charity initiated by Grammy-award-winning musician and producer, Wyclef Jean.
Myriam Jerome, 18, reasoned that it was better that the earthquake happened in the afternoon when everyone was out and about. Had it happened in the late evening when they were asleep in their homes, she explained, there would have been an even greater human toll.
Unwinding from a day at school Michael Belizaire, 17, played a video game, while the youngest in this group, 15-year-old Policia Jean, turned on MTV. Both were later alerted by family members to tune in to CNN. In a short time they too saw the red dot in Haiti. Michael told us that his family’s house in Haiti was near the National Palace in Champs de Mars. He worried about his father and uncle who, he later learned, had survived.
Joes said that he tried to “move on” and had discovered that it was not as easy as it sounded. “Each day when I go to school, I try to forget, but every day when I get there someone else is crying.”
“How do you cope?” I asked. They turned to one another and gestured in a manner that emphasized their deep connection to one another. They talked about the support offered by groups of Haitian youths in school and in the community.
Camy Pierre, 16, said that it was important “to comfort one another and don’t do anything reckless or lose control.” I asked Camy what he meant by that. He said that some of their peers were insensitive and said hurtful things about Haiti. Michael chimed in and stated how important it was to always “think positive.”
I asked about what they did when friends alone were not enough. One of the girls said that she was worried about a girlfriend who was so distraught that she thought she could hurt herself. When she realized that more than friendship was needed, she advised a trusted school counselor. All of them said that they were aware of where and who to go to for more specialized support in school and in the community and found support in that as well.
Expressions of helplessness and grief quickly turned to frustration and anger as they talked about disturbing phone calls from Haiti and learning about mass graves and rampant lawlessness and rape. I said that it must be unbearable to sit with such news. Joes emphasized the importance of talking and not allowing one’s feelings to get "all bunched up."
Long after we said goodbye, I was left with a feeling of abiding respect and pride for this group of thoughtful and deeply empathic young people. They are, without a doubt, among the finest of Haiti’s - and Long Island’s - sons and daughters. Let us never forget them.
To be published in the Anton Newspapers on Long Island New York, February 24, 2010.
By Andrew Malekoff© 2010
Ludmyard Charles, 16, said that when she got home the phone rang. It was her father. He told her to get a glass of water. Then he asked her if she was sitting down. Next, he shared the heartbreaking news that her aunt, Ludmyard, was killed in the earthquake. The aunt she was named after who was pregnant, had lost her life when the earth opened up. The girl’s eyes filled up and she said of her aunt - “We were like sisters.”
A few days ago, I had the privilege of meeting Ludmyard and six of her fellow Westbury High School students, all of whom have roots in Haiti. I asked them about the emotional aftershocks of the January 12th earthquake that toppled national landmarks and shantytown homes and killed and injured untold hundreds of thousands of people in and around the capital city Port-au-Prince.
Each one of the four girls and three boys learned about the earthquake when they arrived home after being together in an after-school program led by North Shore Child and Family Guidance Center. Eighteen-year-old Vayola Justinian recalled, “When I got home my mom was crying. The TV was on. When I looked at the screen I saw a map of Haiti. There was a red dot.”
I asked the students about the media coverage and they said that it was both good and bad. “It was good to have updates,” said 18-year-old Joes Paraison, “but bad to see pictures of the dead and injured.” The others nodded and Joes said, “By the second day it felt like my family was going crazy” watching television. He said that the faces on the screen were hard to see clearly, leading them to wonder if anyone of them was a family member. Joes then recalled a most troubling of images - “a truckload of dead children.” Seeing such devastation from afar, including pictures of people buried underneath rubble, added to their feelings of helplessness and their wish to be there to help.
Their counselor Pascale Beaubrun, a native of Haiti, who is based at the Guidance Center’s Leeds Place in Westbury, later said that they turned their sorrow into action by collecting money and contributing to the Yéle Haiti Earthquake Fund, a charity initiated by Grammy-award-winning musician and producer, Wyclef Jean.
Myriam Jerome, 18, reasoned that it was better that the earthquake happened in the afternoon when everyone was out and about. Had it happened in the late evening when they were asleep in their homes, she explained, there would have been an even greater human toll.
Unwinding from a day at school Michael Belizaire, 17, played a video game, while the youngest in this group, 15-year-old Policia Jean, turned on MTV. Both were later alerted by family members to tune in to CNN. In a short time they too saw the red dot in Haiti. Michael told us that his family’s house in Haiti was near the National Palace in Champs de Mars. He worried about his father and uncle who, he later learned, had survived.
Joes said that he tried to “move on” and had discovered that it was not as easy as it sounded. “Each day when I go to school, I try to forget, but every day when I get there someone else is crying.”
“How do you cope?” I asked. They turned to one another and gestured in a manner that emphasized their deep connection to one another. They talked about the support offered by groups of Haitian youths in school and in the community.
Camy Pierre, 16, said that it was important “to comfort one another and don’t do anything reckless or lose control.” I asked Camy what he meant by that. He said that some of their peers were insensitive and said hurtful things about Haiti. Michael chimed in and stated how important it was to always “think positive.”
I asked about what they did when friends alone were not enough. One of the girls said that she was worried about a girlfriend who was so distraught that she thought she could hurt herself. When she realized that more than friendship was needed, she advised a trusted school counselor. All of them said that they were aware of where and who to go to for more specialized support in school and in the community and found support in that as well.
Expressions of helplessness and grief quickly turned to frustration and anger as they talked about disturbing phone calls from Haiti and learning about mass graves and rampant lawlessness and rape. I said that it must be unbearable to sit with such news. Joes emphasized the importance of talking and not allowing one’s feelings to get "all bunched up."
Long after we said goodbye, I was left with a feeling of abiding respect and pride for this group of thoughtful and deeply empathic young people. They are, without a doubt, among the finest of Haiti’s - and Long Island’s - sons and daughters. Let us never forget them.
To be published in the Anton Newspapers on Long Island New York, February 24, 2010.
Friday, January 8, 2010
Medicaiding-the-System Redux
Medicaiding-the-System Redux
by Andrew Malekoff©
January, 2010
Executive Director, North Shore Child and Family Guidance Center
Roslyn Heights, New York 11577
BONUS-DOLLAR BLITZ CIRCA 1991
In 1991, New York State implemented a plan to use Medicaid dollars to fund outpatient community-based mental health services. That two-decade-old approach, also known as Medicaiding-the-system, is on its way out.
Medicaiding-the-system was a combination of (1) a base Medicaid rate applied for each outpatient mental health visit for Medicaid recipients only and (2) supplemental or bonus dollars paid on top of each base payment to subsidize non-Medicaid recipients. This approach to support community-based agencies was developed to replace local assistance or deficit-financing.
Local assistance was a simple and sensible public-private financing partnership. The partners were the State and County governments (through government contracts), mental health consumers (through fee-for-service payments) and the local community (through fund-raising).
Local assistance funding insured that all stakeholders chipped in a fair share to support an essential community-based service. However, New York State decided that if Medicaid could cover these costs, that they could systematically reduce and ultimately eliminate the amount that they chipped in through local assistance contracts.
If New York State will not support essential community-based mental health services for the most vulnerable members of our communities, who will?
BONUS-DOLLAR BLITZKREIG CIRCA 2010
In recent years, New York State recognized that the Medicaid bankrolled bonus-dollar approach of financing community-based clinics had the inadvertent affect of propping up commercial insurers that were paying substandard rates and limiting access to essential services. Having uncovered that festering wound, they got to work on creating a new financing plan that they refer to as clinic reform.
The clinic reform plan will raise the Medicaid-base rate and phase out bonus-dollars over a four-year-period. The Medicaid base-rate will apply only to those individuals that have what is known as straight Medicaid insurance; that is, Medicaid that is not managed by a commercial insurance company. There will be no reliable funding stream to replace the lost bonus dollars except for a finite pool of funds, presumably to cover services for indigent consumers.
In discussions with State officials about the devastating consequences of the clinic reform plan for the middle class and working poor, I was told that clinics must re-negotiate rates with commercial insurers. That is nothing new. It is common practice. The State officials advised me that if the commercial insurers do not raise their rates to sufficient levels that will help to cover the cost of services provided, then we should terminate our contracts with them.
Community-based providers routinely re-negotiate rates with the managed-care companies that represent the commercial insurers. However, they rarely agree to rates that will cover the cost of service. As one such managed-care company representative recently told us, “C’mon, we are hurting too.” For more information on public and private insurance markets in New York I refer you to the following website: http://www.uhfnyc.org/publications/880618.
If we drop the commercial insurers, as I was advised to do, it means that middle class and working-poor families are out of luck. They will not be able to afford to pay out of pocket to access community-based outpatient mental health services that are structured to meet their families’ needs. For example, at North Shore Child and Family Guidance Center, almost 30% of all evaluations in 2009 were emergencies that were seen within 24 to 48 hours. Who will take care of these emergencies? Private practitioners?
Clinic reform is nothing more than a downgraded version of Medicaiding-the-system. With clinic reform, the term community-based mental health center becomes a thing of the past as only a small segment of the local community will be able to access needed services.
APRIL FOOL’S DAY 2010
New York State is throwing in the towel at a time when there is unprecedented need for community-based mental health services. As the complex funding history described above is demystified, more and more families are advocating for a freeze on clinic reform. I urge you to call your local New York State legislators and tell them to extend the projected clinic reform start date of April 1, 2010 and to restore local assistance financing.
Don’t accept, “But there is no money!” for an answer. Please listen; the fact is that the cost to place a child or teenager in a psychiatric or juvenile detention center or a young adult in jail is far greater than what it costs to support quality community-based mental health care that will keep them at home.
We all know that familiar refrain, pay now or pay later.
This is an advance proof of Mr. Malekoff’s monthly column PARENTING PLUS, that is scheduled for publication in January, 2010 in the Long Island, New York Anton chain of newspapers.
by Andrew Malekoff©
January, 2010
Executive Director, North Shore Child and Family Guidance Center
Roslyn Heights, New York 11577
BONUS-DOLLAR BLITZ CIRCA 1991
In 1991, New York State implemented a plan to use Medicaid dollars to fund outpatient community-based mental health services. That two-decade-old approach, also known as Medicaiding-the-system, is on its way out.
Medicaiding-the-system was a combination of (1) a base Medicaid rate applied for each outpatient mental health visit for Medicaid recipients only and (2) supplemental or bonus dollars paid on top of each base payment to subsidize non-Medicaid recipients. This approach to support community-based agencies was developed to replace local assistance or deficit-financing.
Local assistance was a simple and sensible public-private financing partnership. The partners were the State and County governments (through government contracts), mental health consumers (through fee-for-service payments) and the local community (through fund-raising).
Local assistance funding insured that all stakeholders chipped in a fair share to support an essential community-based service. However, New York State decided that if Medicaid could cover these costs, that they could systematically reduce and ultimately eliminate the amount that they chipped in through local assistance contracts.
If New York State will not support essential community-based mental health services for the most vulnerable members of our communities, who will?
BONUS-DOLLAR BLITZKREIG CIRCA 2010
In recent years, New York State recognized that the Medicaid bankrolled bonus-dollar approach of financing community-based clinics had the inadvertent affect of propping up commercial insurers that were paying substandard rates and limiting access to essential services. Having uncovered that festering wound, they got to work on creating a new financing plan that they refer to as clinic reform.
The clinic reform plan will raise the Medicaid-base rate and phase out bonus-dollars over a four-year-period. The Medicaid base-rate will apply only to those individuals that have what is known as straight Medicaid insurance; that is, Medicaid that is not managed by a commercial insurance company. There will be no reliable funding stream to replace the lost bonus dollars except for a finite pool of funds, presumably to cover services for indigent consumers.
In discussions with State officials about the devastating consequences of the clinic reform plan for the middle class and working poor, I was told that clinics must re-negotiate rates with commercial insurers. That is nothing new. It is common practice. The State officials advised me that if the commercial insurers do not raise their rates to sufficient levels that will help to cover the cost of services provided, then we should terminate our contracts with them.
Community-based providers routinely re-negotiate rates with the managed-care companies that represent the commercial insurers. However, they rarely agree to rates that will cover the cost of service. As one such managed-care company representative recently told us, “C’mon, we are hurting too.” For more information on public and private insurance markets in New York I refer you to the following website: http://www.uhfnyc.org/publications/880618.
If we drop the commercial insurers, as I was advised to do, it means that middle class and working-poor families are out of luck. They will not be able to afford to pay out of pocket to access community-based outpatient mental health services that are structured to meet their families’ needs. For example, at North Shore Child and Family Guidance Center, almost 30% of all evaluations in 2009 were emergencies that were seen within 24 to 48 hours. Who will take care of these emergencies? Private practitioners?
Clinic reform is nothing more than a downgraded version of Medicaiding-the-system. With clinic reform, the term community-based mental health center becomes a thing of the past as only a small segment of the local community will be able to access needed services.
APRIL FOOL’S DAY 2010
New York State is throwing in the towel at a time when there is unprecedented need for community-based mental health services. As the complex funding history described above is demystified, more and more families are advocating for a freeze on clinic reform. I urge you to call your local New York State legislators and tell them to extend the projected clinic reform start date of April 1, 2010 and to restore local assistance financing.
Don’t accept, “But there is no money!” for an answer. Please listen; the fact is that the cost to place a child or teenager in a psychiatric or juvenile detention center or a young adult in jail is far greater than what it costs to support quality community-based mental health care that will keep them at home.
We all know that familiar refrain, pay now or pay later.
This is an advance proof of Mr. Malekoff’s monthly column PARENTING PLUS, that is scheduled for publication in January, 2010 in the Long Island, New York Anton chain of newspapers.
Friday, December 25, 2009
BUILDING COMMUNITIES OF CARE
BUILDING COMMUNITIES OF CARE
By Andrew Malekoff©
What do the following have in common? Asthma, Cancer, Crohn's Disease, Cystic Fibrosis, Degenerative Disc Disease, End Stage Renal Disease, Hepatitis C, Hypoglycemia, Idiopathic Dilated Cardiomyopathy, Irritable Bowel Syndrome, Leg-Calvé-Perthes, Marfan Syndrome, Multiple Sclerosis, Migraines, Polycystic Kidney Disease, Scoliosis and Supraventricular Tachycardia.
If you guessed that they were all physical illnesses you are correct. However, another common thread is they are illnesses that a group of young people in the radical-alternative DIY (do-it-yourself) community have been diagnosed with and have written about (along with a few young people that care about them) in a publication entitled Sick, a compilation zine on physical illness.
For the uninitiated, a zine (derived from magazine) is a topical publication typically intended for an alternative or underground audience. A zine tends to include written and visual work aimed at promoting and supporting a social movement. DIY represents an ideal or value for many young people who associate themselves with the punk subculture.
One contributor, Luci, speaks for her fellow contributors when she asks, "How can a disabled person find allies and support?" This book will help supporters and supportees to find some answers, insight and inspiration.
Among the moving narratives in SICK is a love story entitled “Scar Mates” by Rainbow, who has been diagnosed with chronic kidney disease. After being rejected by one young suitor who could not deal with the scars left behind after Rainbow’s open heart surgery and kidney transplant, she fell in love with a young man that she met on-line, who has been diagnosed with Cystic Fibrosis and Diabetes.
Along with providing poignant first-hand accounts of living with physical illness and chronic disease, many of the authors offer practical advice for young people struggling with these ailments, as well as suggestions for friends and family members that care about them. For example, the authors advise patients to be kind and understanding about themselves and to ask for what they need.
There are also useful tips for friends and family members. In a piece entitled, “Illness and support,” Ben Holtzman says that people with illness do want to talk about it. He says that saying something small is almost always better than saying nothing at all. The practical advice contained in the collection might be dubbed as uncommon common sense because, although it seems very basic, it is the kind of advice that requires gentle prodding and encouragement to carry it out.
Beyond practical tips, there is great wisdom sprinkled throughout. For example, Emily Klamer, a student, writer and activist from Missouri, who is living with degenerative disc disease, writes elegantly about the “lurking threat” of illness that we all face sooner or later.
SICK editor and essayist Ben Holtzman, who was diagnosed with cancer at age 26, introduces the collection by stating that, "Illness is considered taboo; it's seen by many as awkward, if not depressing, to bring up...The collective strength of these pieces...is meant to further... action toward building communities of care."
The stories are gritty, no-holds-barred, first-hand accounts of what it is like to live and cope with physical illness and chronic disease, including the struggle to get and then find one’s way through the maze that is health insurance. By openly revealing what it feels like to be young and sick, the authors - mostly young women - go a long way towards supporting Holtzman's vision.
Hospitals and physicians would do well to have this publication, and ones like it, available as resources for young people with physical illnesses and their friends and family members. Giving voice to what it is like to suffer in silence, is a way that these young DIY authors have extended the bonds of belonging to create true communities of care.
Write to illnesszine@gmail.com if you are interested in learning more about building communities of care.
Published in the Anton newspapers on Long Island, NY in December 2009.
By Andrew Malekoff©
What do the following have in common? Asthma, Cancer, Crohn's Disease, Cystic Fibrosis, Degenerative Disc Disease, End Stage Renal Disease, Hepatitis C, Hypoglycemia, Idiopathic Dilated Cardiomyopathy, Irritable Bowel Syndrome, Leg-Calvé-Perthes, Marfan Syndrome, Multiple Sclerosis, Migraines, Polycystic Kidney Disease, Scoliosis and Supraventricular Tachycardia.
If you guessed that they were all physical illnesses you are correct. However, another common thread is they are illnesses that a group of young people in the radical-alternative DIY (do-it-yourself) community have been diagnosed with and have written about (along with a few young people that care about them) in a publication entitled Sick, a compilation zine on physical illness.
For the uninitiated, a zine (derived from magazine) is a topical publication typically intended for an alternative or underground audience. A zine tends to include written and visual work aimed at promoting and supporting a social movement. DIY represents an ideal or value for many young people who associate themselves with the punk subculture.
One contributor, Luci, speaks for her fellow contributors when she asks, "How can a disabled person find allies and support?" This book will help supporters and supportees to find some answers, insight and inspiration.
Among the moving narratives in SICK is a love story entitled “Scar Mates” by Rainbow, who has been diagnosed with chronic kidney disease. After being rejected by one young suitor who could not deal with the scars left behind after Rainbow’s open heart surgery and kidney transplant, she fell in love with a young man that she met on-line, who has been diagnosed with Cystic Fibrosis and Diabetes.
Along with providing poignant first-hand accounts of living with physical illness and chronic disease, many of the authors offer practical advice for young people struggling with these ailments, as well as suggestions for friends and family members that care about them. For example, the authors advise patients to be kind and understanding about themselves and to ask for what they need.
There are also useful tips for friends and family members. In a piece entitled, “Illness and support,” Ben Holtzman says that people with illness do want to talk about it. He says that saying something small is almost always better than saying nothing at all. The practical advice contained in the collection might be dubbed as uncommon common sense because, although it seems very basic, it is the kind of advice that requires gentle prodding and encouragement to carry it out.
Beyond practical tips, there is great wisdom sprinkled throughout. For example, Emily Klamer, a student, writer and activist from Missouri, who is living with degenerative disc disease, writes elegantly about the “lurking threat” of illness that we all face sooner or later.
SICK editor and essayist Ben Holtzman, who was diagnosed with cancer at age 26, introduces the collection by stating that, "Illness is considered taboo; it's seen by many as awkward, if not depressing, to bring up...The collective strength of these pieces...is meant to further... action toward building communities of care."
The stories are gritty, no-holds-barred, first-hand accounts of what it is like to live and cope with physical illness and chronic disease, including the struggle to get and then find one’s way through the maze that is health insurance. By openly revealing what it feels like to be young and sick, the authors - mostly young women - go a long way towards supporting Holtzman's vision.
Hospitals and physicians would do well to have this publication, and ones like it, available as resources for young people with physical illnesses and their friends and family members. Giving voice to what it is like to suffer in silence, is a way that these young DIY authors have extended the bonds of belonging to create true communities of care.
Write to illnesszine@gmail.com if you are interested in learning more about building communities of care.
Published in the Anton newspapers on Long Island, NY in December 2009.
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