http://www.cfha.net/forum_thread.php?t=89Recent posts in Ben Miller: "I got mental health parity for Christmas! Why do I feel so disappointed?"http://www.cfha.net/forum_thread.php?t=89#post216pYesterday I came home to an angry father and worried mother...They whoever they is increased the cost of insurance dad noticed they deducted 1500 from his check.nbsp What does this mean for my parents and 15 year old sisternbsp No more health insurance because its too expensive.nbsp They cant afford to have health insurancenbsp hmmm do they keep their health insurance and move to an apartment or get rid of health insurance and keep their homenbsp Better cross my fingers that my parents live long healthy lives so I dont get stuck with their medical bills after they die right sorry for my sarcasm cant help itnbspnbspppnbspppNo wonder many purposely settle for low incomenbsplives...so they can qualify for some type ofnbspassistance withnbsphealthnbspcare.nbsp nbspphttp://www.cfha.net/forum_thread.php?t=89#post208pBEN Americans simply arent ready for the healthcare reform you envision.nbsp Yes the public option has traditionally polled well but that is in the abstract.nbsp When it comes down to the taxes governmental oversight and regulation of actual legislation people who already have high-dollar insurance lose their stomach for it.nbsp This especially true in the face of an effective media campaign from conservatives and healthcare lobbyists against it.ppnbspppStill the late Senator Kennedy would have led the charge to support this bill.nbsp It is very much in-line with his incremental approach.nbsp Even with large Democratic majorities in the House and Senate this is the best that was going to happen this year.nbsp And with 2010 already being an election year it is very unclear if waiting would have brought along anything better.nbsp Beyond 2010 if the Democrats maintain a majority in both houses it will be slim.nbsp It is now or never.ppnbspppAs for the collaborative care implications of all thisnbsp I didnt read the actual bills but I believe that most of the primary-care incentives didnt make the final cut.nbsp For me that was the biggest loss.nbsp Something needs to be done to create better parity between the reimbursement that is paid to specialists vs. generalists for providing the same service.nbspppnbspppI did follow your link to Secretary Sebelius Maryland speech. It is excellent news that someone at her level has tuned in to the collaborative care signal.nbsp It would be a huge coup to get her andor Surgeon General Regina Benjamin for the Louisville CFHA Conferences summit or plenary.phttp://www.cfha.net/forum_thread.php?t=89#post207pYes it is that time of year to look back on what we have accomplished in 2009 and begin to consider what we are going to do differently in 2010 that we didnt do in 2009 for a real treat a hrefhttpblog.foreignpolicy.composts20091229foodforthoughtread how much foreign policy has changed in the past 10 yearsa. And we did accomplish a lot. Healthcare made it out of the House alive and out of the Senate on life support. Partisan politics showed us again why political ideologies trump the American publics views on what should be done in healthcare. Lets be honest a hrefhttpnews.yahoo.comsap20091225aponbigeushealthcaredeficitit is ultimately about reelectiona right But something had to be done as a hrefhttpwww.cnn.com2009HEALTH0918deaths.health.insuranceindex.htmlpeople are dyinga from lack of insurance and costs are skyrocketingnbspppnbspppConsider two studies that show the burden of healthcare costs on our pocket books. Most recently there is a a hrefhttphealthcarereform.nejm.orgp1241wonderful article in NEJMa but I still prefer the a hrefhttpwww.graham-center.orgonlinegrahamhomepublicationsonepagers2005op40-insurance-2025.html2005 Graham Center one-pagera that asks the question Who will have health insurance in 2025 The answer not surprisingly is almost no one as the average healthcare premiums will be more than the average household income. Let me say that again by 2025 the average healthcare premiums will be more than the average household income. OK so maybe this is why I am still excited that Congress got healthcare to a point where we can move forward. a hrefhttpprospect.orgcsarticlesarticletenthingstowatchinthehealthcarereformconferenceThere are still a few things to watch fora but the next steps are excitingppnbspppWe should all prepare to enact our New Years Resolutions - lets just hope dropping the a hrefhttppoliticalticker.blogs.cnn.com20091229public-option-may-be-dropped-from-final-health-care-billpublic option is not a Congressional resolutionappnbspppstrongDeep Breathstrong Lets drill down into where collaborative care fits into all this. As described in anbspa hrefforumthread.phpt83previousanbsppost I have been trying to figure out the connection between current policy initiatives and collaborative care. With the dawn of a new year I still dont know where we stand in terms of collaborative care policy and current health reform efforts. I have a few idea though which when I really think about them begin to give me a better sense of where we are heading.ppnbspppstrong1nbspnbspnbspnbspnbsp strongstrongMental Health Parity Begins January 1 2010strong Its here now what What does parity really mean How about parity in reimbursement by private health insurance plans that cover mental health and substance abuse services. This is significant as it will modify the rate of out-of-pocket spending traditionally higher for mental health than for other medical conditions and decrease the limits of treatment scope and duration. But is this enough a hrefhttpcontent.healthaffairs.orgcgicontentabstract283w490Parity will reduce some barriers but not alla.ppnbspppstrong2nbspnbspnbspnbspnbsp strongstrongSecretary of HHS Kathleen Sebelius is not afraid of using the word integratedstrong If you have not seen the speech Secretary Sebelius gave on December 16th to a crowd in Maryland a hrefhttpwww.hhs.govsecretaryspeechessp20091215a.htmlclick herea. I see this as more significant than mental health parity that the Secretary is talking about integrated care. What Who How I know I was equally as surprised that the person uttering these words was not one of the collaborative care faithful. She even names our good friends at a hrefhttpwww.cherokeehealth.comCherokeea a hrefhttpintermountainhealthcare.orgPageshome.aspxIntermountaina and the a hrefhttpwww.va.govVAa as examples. Something here Only time will tell.ppnbspnbspppstrongstrongppstrong3nbspnbspnbspnbspnbsp strongstrongBoth the House and Senate Bills still dichotomize mental health and physical healthstrong There are examples out there of how the House and Senate bills treat mental health. a hrefhttpwww.nacbhdd.orgcontentWhole20Health2020side-by-side20MH-SUD20provisions20in20House20and20Senate20bills.pdfSee here for more detaila PDF. Who knows where the final bill will land with what it wants to do with mental health but a few things we can tell Congress thinks about mental healthpula. Mental health services should be required in benefits packages ululb. Insurers shouldnt discriminate against mental health conditions ululc. Medicaid should be expanded ululd. Education is important increase in funds for higher ed and loan repayment programs ulule. Substance use is a problem SBIRT not bad ulpstrongUnfortunately nothing likestrongpula Services will be paid for regardless of if they are classified as mental or physical ululb Primary care will be compensated for treating mental health i.e. depression screening and treatment mental health will be compensated for treating physical health i.e. health behaviors ululc There is no such thing as mental and physical health- Its about the emhealthem stupid if this doesnt make you laugh a hrefhttpen.wikipedia.orgwikiIt27stheeconomystupidread the contexta. ul