Corporal Punishment for Kids

We've had conclusive proof for the last half-century that striking kids is counterproductive. Corporal punishment makes kids more violent, angry, and likely to break rules when you're not around instead of incorporating rules into their personal values. It's one of the more stupid things an adult can do. Corporal punishment is especially counterproductive as a response to children's behaviors related to mental illnesses or developmental disabilities, as those behaviors are generally a result of anxiety, disregulation, and an inability to understand situations. Punishment increases the anxiety and disregulation, and makes further behavior problems more likely. Punishment of any kind is a terrible way to reduce unwanted behavior, especially for kids with disabilities. Teachers and school administrators should know this.

The American Civil Liberties Union just reported on a study of corporal punishment in schools. The report is unfortunately diluted with emotional anecdotes by people who clearly do not understand clinical diagnoses (not that they should, just keep the junk out of a report). It does have some interesting data in it, though.

Who is doing all this counterproductive nonsense?
It's our good friends in the South. The states that do the most are (in decreasing order): Texas, Mississippi, Alabama, Arkansas, Georgia, Tennessee, Oklahoma, Louisiana, Florida, and Missouri. We recall that these are also the states with the lowest education, most crime, lowest life expectancy, highest teen pregnancy, highest infant mortality, lowest incomes, etc... New England, the west coast, and the north central states have outright banned corporal punishment in schools.

What does this have to do with health care?
For starters, kids with disabilities are more frequently targeted for corporal punishment, which exacerbates their problems rather than treating them. I think this is also yet another symptom of the Southern culture. This is a culture that does not value human dignity, civil rights, or evidence-based interventions. This is a culture that relies more on invalid beliefs and tradition in making policy decisions. This is evident in their overall health care practices, as well as the educational system and so forth. Everyone needs to make decisions based on empiricism. Physically punishing (nearly any punishing, really) kids today is going to create greater ongoing mental health care needs, and the problems are more likely to get passed down generationally. Stop the cycle now.

More Truth about Proposed Plans

Since there are so many lies being propagated by those who oppose improving our health insurance system, the White House has had to create this site to help citizens understand what is really going on. Unfortunately, I expect that the people least likely to automatically recognize that death panels and so forth are lies are also the people least likely to go to the website.

Truth-o-meter

St. Petersburg Times' Truth-o-Meter is a good resource. There is so much misinformation getting propagated, especially by Republicans and other free market ideologists who want insurance companies to stay rich at the expense of America's health and productivity, and Obama shows up on the site very often. Both sides are represented, and it is interesting to see so many comments and sources evaluated side by side. Some statements are true, and some are qualified. The site does a good job going into detailed explanations of its ratings for each statement.

Conservatives for Patients' Rights - Fearmongering Liars

I'm really busy this month with a big project, but I will take a minute to remark on the commercials being run by CPR. They've been on CNN during pieces about health care reform. These commercials use scare tactics to raise a fervor against a public health insurance plan. These commercials are misleading.

The one that comes to mind warns people that a public plan would put government bureaucrats between them and their doctors.
A) So what? That's better than having insurance company bureaucrats between people and their doctors. Insurance company bureaucrats do what they can to deny treatments. The government is proposing a public plan to increase the availability of care.
B) Good! As I've discussed before, doctors don't always follow best practices, and too often make uninformed, biased, ignorant decisions that could be prevented by informed oversight.
C) 47,000,000 Americans don't even get to see doctors right now, and the public plan would fix that. What stands between these people and their doctor is the absence of government involvement.
D) NO ONE IS FORCING ANYONE TO SIGN UP FOR THE PROPOSED PUBLIC PLAN. IT IS VOLUNTARY. IF YOU DON'T WANT IT, DON'T JOIN IT. There is no reason to oppose its creation.

The commercials also claim that the government would be financially wasteful, and cites other examples of government waste. This completely ignores the fact that the government-run health payers we already have (Medicare and Medicaid) are the least wasteful health payers, and are extremely efficient. In fact, many other corporate stoog... I mean Republicans are opposing a public insurance plan on the grounds that it would be so financially efficient that people would flock to it and private insurance companies would lose too much business. You can't have it both ways, conservatives. Stop with the obvious lies and misleading claims. Stop trying to convince the public to oppose what's good for the whole country just so you can keep collecting contributions from the insurance companies. Stop blindly believing that capitalism will make everything good, and start looking at the real world.

Insurance Industry Buys Politicians - Probably

FiveThirtyEight.com has a great post with a pretty graph about the likely effects of the amounts of money the insurance industry spends on politicians. The largest receiver of bri... contributions is Baucus, the guy leading the health care reform decisions, and who is opposed to a public insurance option.

FiveThirtyEight continues to be clear and responsible, pointing out that it did not take into account counter-lobbying from unions and other pro-public-option factions, and also that it is hard to tell if "perhaps senators receive a lot of money from the insurance industry because they hold conservative positions on health care, rather than the other way around. Although I believe that accounting for ideology should correct for most of this".

HR 676 - The Good and the Bad - Part 5

Continued from Part 1, Part 2, Part 3, and Part 4.

"Non-profit health maintenance organizations that actually deliver care in their own facilities and employ clinicians on a salaried basis may participate in the program and receive global budgets or capitation payments as specified in section 202."
"Other health maintenance organizations, including those which principally contract to pay for services delivered by non-employees, shall be classified as insurance plans. Such organizations shall not be participating providers, and are subject to the regulations promulgated by reason of section 104(a) (relating to prohibition against duplicating coverage)."

Ugly
So, these sections serve to clarify how different HMOs will be treated. Non-profit HMOs that provide care will be treated as service providers that can qualify for reimbursement by the federal plan. Other HMOs will be treated as insurance plans.

This probably has to do with cost containment and standardization, making it easier to prevent outsourced and possibly for-profit doctors or clinics from indirectly charging the federal plan for services that would be harder to efficiently monitor. We're still on section 103, and have not gotten to the later sections that explain payment more thoroughly. On the face of it, this seems potentially unnecessarily restrictive, and may strong-arm doctors to become salaried or capitated employees of non-profits. I admit to an incomplete understanding of HR676's rationale for requiring salaried or capitated providers. I will explore different payment types and their consequences in the future.

"Patients shall have free choice of participating physicians and other clinicians, hospitals, and inpatient care facilities."

Good
Most hospitals will be participants from the beginning. Many more will make the transition. Most people who already have health insurance are already familiar with "in-network" versus "out-of-network" providers, so this idea will not be confusing. The difference will be that "in-network" with HR676 means most facilities throughout the whole country.

Freedom of choice will also put pressure on facilities to be more competitive with regard to quality. Since services will be free to people under HR676, service differentiation (covered services) will involve quality instead of price. Low quality providers will be less able to rope in clients by cutting deals with third-party payers.

Bad
I am at a loss.

National Center for Complementary and Alternative Medicine

USA Today had an article on the progress of the NCCAM over the last ten years. The federal agency funds research into the effectiveness of complementary and alternative medicines. The conclusion: $2.5 billion of research shows us that almost none of that stuff works better than placebo.

The tone of the article suggests that NCCAM is bad for spending so much of our money studying stuff that doesn't work. Really, it is only partly bad, and that is due to the agency's implementation. It is important to know what works and what does not work. If no one else is going to do the research (because there is no incentive, because CAM is underregulated), then it is good that NCCAM is picking up the slack.

Where NCCAM falls short is in telling us all that these things do not work. With a board loaded with CAM supporters, the conflicts of interests are apparently too strong to allow the agency to work the way it was intended. It is not spreading the message that bogus "supplements" and "remedies" are bunk, and there is no regulatory authority to ban these misleading products and treatments that take advantage of the ignorant.

It also falls short in that it continues to research absolutely ridiculous things, such as distance healing and energy fields. It wasn't good when the military looked into psychic detection of enemy submarines, and it's not good to waste money on this complete malarky now. Until someone gets James Randi's prize, the feds should stop wasting tax money in these directions. There are a lot of things we already know don't work.

Double-blind, placebo-controlled, randomized study is the standard when possible. Never trust someone who is trying to sell you something. Our country would be better off if our government protected people who just don't know better from snake-oil salesmen.