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Riders on the Storm

An examination of Colorado's mental health care system after the Aurora theater shooting. The state passed a $25 million initiative to restructure its crisis system for mentally ill patients, but still has a lot of work to do:

Colorado has underfunded mental health care for decades. Exactly how much is uncertain because there are at least 34 separate mental health line items in the state budget. “At the state Legislature, we cut provider rates for Medicaid and for drug and alcohol [programs] in 2002, when we had the downturn,” says Moe Keller, who spent 16 years in the state Legislature and is now the vice president of public policy and strategic initiatives at Mental Health America of Colorado , the local outpost of a national group that advocates for mental wellness reform. “We cut beds, and we closed a couple of units around the state. We never really re-funded that when the economy came back.” Then in 2008, the state again cut Medicaid providers and closed more units along with consolidating and reducing services. “Today, the prison system is by default the largest behavioral health center,” Keller says. “Police are the first responders.”

PUBLISHED: Nov. 26, 2013
LENGTH: 31 minutes (7839 words)

The Surge

Health care workers are attempting to eradicate polio by penetrating remote areas in Afghanistan and Pakistan controlled by the Taliban:

Because all the Afghan polio cases in 2013 have been reported here in the eastern half of the country, these National Immunization Days have special importance in this region. As with the global campaign writ large, polio here has receded greatly over the past two decades but with serious setbacks along the way: Although cases dropped after the fall of the Taliban regime in 2001, an outbreak in 2011 brought 80 new cases and a general sense of emergency. And so the eradication program—which is government-run but supported financially by who and unicef —ordered a “surge” in Afghanistan. They doubled the international staff and cracked down on underperforming and corrupt officials. This year, the surge has paid a huge dividend, in that the war-torn south of the country, for a long time the greatest problem area, now appears to be free of the virus. It’s the inaccessible areas in the east, where Jalalabad is, that are now the main concern.

PUBLISHED: Nov. 21, 2013
LENGTH: 17 minutes (4382 words)

Almost Without Hope: The State of Health Care on the Rosebud Indian Reservation

Native Americans were promised health care by the government, but what are they really getting? A visit to the Rosebud Indian Reservation in South Dakota, where health services are underfunded, suicide rates are high, and the life expectancy is just 46 years:

It’s well-documented that the government’s attempts to meet its obligations to the Native Americans have failed miserably; the primary cause is insufficient funding. Currently, prisoners receive significantly higher per capita health-care funding than Native Americans. The U.S. Commission on Civil Rights reports the federal government spends about $5,000 per capita each year on health care for the general U.S. population, $3,803 on federal prisoners and $1,914 on Indian health care.

PUBLISHED: Nov. 2, 2013
LENGTH: 14 minutes (3655 words)

Special Deal

An examination of the American Medical Association's special committee that meets three times a year to determine how much Medicare should pay doctors for the medical procedures they perform:

In a free market society, there’s a name for this kind of thing—for when a roomful of professionals from the same trade meet behind closed doors to agree on how much their services should be worth. It’s called price-fixing. And in any other industry, it’s illegal—grounds for a federal investigation into antitrust abuse, at the least.

But this, dear readers, is not any other industry. This is the health care industry, and here, this kind of 'price-fixing' is not only perfectly legal, it’s sanctioned by the U.S. government. At the end of each of these meetings, RUC members vote anonymously on a list of 'recommended values,' which are then sent to the Centers for Medicare and Medicaid Services (CMS), the federal agency that runs those programs. For the last twenty-two years, the CMS has accepted about 90 percent of the RUC’s recommended values—essentially transferring the committee’s decisions directly into law.
PUBLISHED: July 11, 2013
LENGTH: 24 minutes (6017 words)

Caterpillar's Doug Oberhelman: Manufacturing's Mouthpiece

Portrait of an American company with billions in profits, and questions about how much it should be sharing that wealth with its own workforce:

"Oberhelman’s activism has also made him a target of criticism from those who say Caterpillar is thriving at its workers’ expense. Last year, as the company racked up a record $66 billion in sales, generating $5.7 billion in profits, it repeatedly landed in the news for clashing with production employees. In January 2012, Caterpillar locked out union workers at a locomotive factory in Ontario after they rejected a pay cut of about 50 percent; the company shuttered the plant and moved production to Muncie, Ind., where workers accepted lower wages. Last May, Caterpillar took a hard line during negotiations with employees at its Joliet (Ill.) hydraulic-parts factory, insisting on cuts to health care and other benefits. After striking for three months, employees caved at the end of the summer. Senior workers’ wages were frozen for six years. Caterpillar is currently battling union workers at its Milwaukee plant."
AUTHOR:Mina Kimes
PUBLISHED: May 21, 2013
LENGTH: 11 minutes (2909 words)

Schizophrenic. Killer. My Cousin.

Deinstitutionalization moved thousands of mentally ill people out of hospitals and into the prison system. States are cutting mental-health funding. A look at America's mental health care crisis:

"'Homelessmentallyilldeinstitutionalized was one noun in the media at the time,' says SAMHSA's Roth, who is the source of the oft-cited data point that a third of America's homeless people are seriously mentally ill (helping to rebut the misconception then that they all were). In 1984, Dr. John A. Talbott, then president of the American Psychiatric Association, apologized for the association's role in the disaster. 'The psychiatrists involved in the policymaking at that time certainly oversold community treatment,' he said, 'and our credibility today is probably damaged because of it.'

"'Think of it as haircuts,' says Roth, who watched deinstitutionalization unfold in her 37 years as chief of evaluation and research at the Ohio Department of Mental Health. 'In the age of the great gothic castle on the hill, mentally ill patients had everything taken care of. Health care, sleeping, eating, etc. When they got out, they were supposed to have everything. They got Medicare and Medicaid, but [policymakers] didn't think about food. And haircuts. Clothes. How to find a place to live.' How to do laundry; how to grocery shop. How to ensure people who need meds take them. What to do with people who had too many behavioral problems to avoid being evicted six times in a row."
PUBLISHED: April 29, 2013
LENGTH: 33 minutes (8317 words)

If This Was a Pill, You'd Do Anything To Get It

A Medicare experiment is facing possible shutdown, despite its proven effectiveness. The secret? It's nurses making frequent house calls to those with chronic diseases:

"But Health Quality Partners, with its emphasis on continuous nurse-to-patient contact, did work. Of the 15 programs, four improved patient outcomes without increasing costs. Only HQP improved patient outcomes while cutting costs. So Medicare extended it again and again — now it’s the only program still running under the demo. But Medicare has notified Coburn that it intends to end HQP’s funding in June.

"Medicare’s official explanation is carefully bureaucratic. 'The authority that CMS had to conduct this specific demonstration, which predated the health care law, did not allow us to make the program permanent and limited our ability to expand it further,' says Emma Sandoe, a spokeswoman for the Centers on Medicare and Medicaid Services. 'As we design new models and demonstrations, we are integrating lessons from this experience into those designs.'"
AUTHOR:Ezra Klein
PUBLISHED: April 28, 2013
LENGTH: 17 minutes (4336 words)

Bitter Pill: Why Medical Bills Are Killing Us

An investigation into the complicated and costly world of medical billing in the U.S.:

"Out of work for a year, Janice S. had no insurance. Among the hospital’s charges were three 'TROPONIN I' tests for $199.50 each. According to a National Institutes of Health website, a troponin test “measures the levels of certain proteins in the blood” whose release from the heart is a strong indicator of a heart attack. Some labs like to have the test done at intervals, so the fact that Janice S. got three of them is not necessarily an issue. The price is the problem. Stamford Hospital spokesman Scott Orstad told me that the $199.50 figure for the troponin test was taken from what he called the hospital’s chargemaster. The chargemaster, I learned, is every hospital’s internal price list. Decades ago it was a document the size of a phone book; now it’s a massive computer file, thousands of items long, maintained by every hospital.

"Stamford Hospital’s chargemaster assigns prices to everything, including Janice S.’s blood tests. It would seem to be an important document. However, I quickly found that although every hospital has a chargemaster, officials treat it as if it were an eccentric uncle living in the attic. Whenever I asked, they deflected all conversation away from it. They even argued that it is irrelevant. I soon found that they have good reason to hope that outsiders pay no attention to the chargemaster or the process that produces it. For there seems to be no process, no rationale, behind the core document that is the basis for hundreds of billions of dollars in health care bills."
PUBLISHED: Feb. 20, 2013
LENGTH: 102 minutes (25502 words)

The Shooter

The man who killed Osama bin Laden is now out of the Navy, without health care, pension or protection for himself and his family:

"Since Abbottabad, he has trained his children to hide in their bathtub at the first sign of a problem as the safest, most fortified place in their house. His wife is familiar enough with the shotgun on their armoire to use it. She knows to sit on the bed, the weapon's butt braced against the wall, and precisely what angle to shoot out through the bedroom door, if necessary. A knife is also on the dresser should she need a backup.

"Then there is the 'bolt' bag of clothes, food, and other provisions for the family meant to last them two weeks in hiding.

"'Personally,' his wife told me recently, 'I feel more threatened by a potential retaliatory terror attack on our community than I did eight years ago,' when her husband joined ST6."
PUBLISHED: Feb. 11, 2013
LENGTH: 61 minutes (15479 words)