Month: August 2017

Costs And Outcomes Of Mental Health And Substance Use Disorders In The US

This Visualizing Health Policy infographic looks at costs and outcomes of mental health and substance use disorders in the United States (US).

Nearly 18% of adults reported having a mental, behavioral, or emotional disorder in 2015, including more than 1 in 5 women. Furthermore, nearly 3% of people aged 12 years or older reported addiction to or misuse of an illicit drug in 2015, including more than 7% of people aged 18 to 25 years. However, 1 in 5 people say they or a family member had to forego needed mental health services because they couldn’t afford the cost, their insurance wouldn’t cover it, they were afraid or embarrassed, or they didn’t know where to go. Mental illness treatment accounted for $89 billion, or 5%, of total medical services spending in 2013, behind checkups/prevention and circulatory disorders. Mental health and substance use disorders together were the leading cause of disease burden in 2015, surpassing cancer and cardiovascular disease, among others. Relative to countries of similar size and wealth, the US has had higher rates of death from unintentional poisonings, the majority of which were due to drug overdoses. In 2013 the age-standardized rate of death from unintentional poisonings per 100,000 population was 12.4 in the US compared with 2.5 on average in comparable countries.


State Laws And Policies: Emergency Contraception

Emergency contraception (EC) can prevent pregnancy when taken shortly after unprotected sex. Currently there are four FDA-approved products on the market. Three of these products are approved for preventing pregnancy when taken within 72 hours after unprotected sex. One of these products, Plan B One-Step, was approved for over-the-counter sale by the FDA in 2013.

Since the late 1990s, state legislatures have taken different paths to expand access to emergency contraception. First, some states have mandated emergency contraception–related services for women who have been sexually assaulted. Second, some states permitted a woman to obtain the medication without having to obtain a physician’s prescription. Third, one state has limited pharmacists’ ability to refuse to dispense emergency contraception on moral or ethical grounds. Finally, in some states, regulations discourage pharmacists from refusing to fill prescriptions for contraceptives, with one state having gone so far as to require pharmacies that stock contraceptives to dispense all contraceptive methods. At the same time, other states have attempted to restrict access by excluding emergency contraception from state Medicaid family planning eligibility expansions or  contraceptive coverage mandates, or by allowing pharmacists and potentially some pharmacies, to refuse to provide contraceptive services.


18 states and the District of Columbia require hospital emergency rooms to provide emergency contraception–related services to sexual assault victims.

  • 17 states and the District of Columbia require emergency rooms to provide information about emergency contraception to sexual assault victims.
  • 13 states and the District of Columbia require emergency rooms to dispense the drug on request to sexual assault victims.

8 states allow pharmacists to dispense emergency contraception without a physician’s prescription under certain conditions.

  • 6 states allow pharmacists to distribute it when acting under a collaborative-practice agreement with a physician.
  • 3 states, including 1 that also gives pharmacists the collaborative-practice option, allow pharmacists to distribute emergency contraception in accordance with a state-approved protocol.

3 states direct pharmacies to fill all valid prescriptions.

1 state directs pharmacists to fill all valid prescriptions.

Restricting Access

9 states have adopted restrictions on emergency contraception.

  • 1 state excludes emergency contraception from the services to be covered in the state’s family planning program.
  • 2 states exclude emergency contraception from their contraceptive coverage mandate.
  • 6 states explicitly allow pharmacists to refuse to dispense contraceptives, including emergency contraception.
  • 3 states allow pharmacies to refuse to dispense emergency contraception.



? Permanently enjoined; law not in effect.
* Pharmacists may dispense any prescription drug, including emergency contraception.
† A broadly worded refusal policy may apply to pharmacists or pharmacies, but does not specifically include them.
‡ A hospital may contract with an independent medical professional in order to provide the emergency contraception services.
? Policy does not include an enforcement mechanism.
Ψ A hospital may refuse based on religious or moral beliefs to provide emergency contraception when requested by a woman who has been sexually assaulted. However, a refusing hospital is then required to immediately transport the woman to the closest medical facility that will provide her with the medication.

Medicaid, Explained: Why It’s Worse To Be Sick In Some States Than Others

This video from Vox looks at the Medicaid system through the eyes of an individual on Medicaid, Matthew, who has Crohn’s Disease. He is one of the 1 in 5 Americans who get their healthcare paid for by Medicaid.

The video states “The thing about Matthew is, if he lived in a different state, he might not have Medicaid.” It explains the history of healthcare in the United States, the attempts of certain presidents (FDR, Truman, and LBJ) to create a national healthcare system, the reason behind the emergence of a private healthcare market, and the ultimate expansion of Medicaid under the Affordable Care Act.

Due to the Supreme Court decision that made this expansion voluntary by state, the video explains that the specific states get to decide who gets covered and what service gets covered. Some individuals are consistently covered across the board, like children and Pregnant women; However, coverage of other groups like individual who make below a certain amount per year are only covered in certain states.

The video goes on to describe the rising costs of Medicaid, due to the rising costs of health care in the United States, and ways that Republicans have proposed to change Medicaid.


America’s Dangerous Anti-Iran Posturing

In recent weeks, US President Donald Trump and his advisers have joined Saudi Arabia in accusing Iran of being the epicenter of Middle East terrorism. The US Congress, meanwhile, is readying yet another round of sanctions against Iran. But the caricature of Iran as “the tip of the spear” of global terrorism, in Saudi King Salman’s words, is not only wrongheaded, but also extremely dangerous, because it could lead to yet another Middle East war.

In fact, that seems to be the goal of some US hotheads, despite the obvious fact that Iran is on the same side as the United States in opposing the Islamic State (ISIS). And then there’s the fact that Iran, unlike most of its regional adversaries, is a functioning democracy. Ironically, the escalation of US and Saudi rhetoric came just two days after Iran’s May 19 election, in which moderates led by incumbent President Hassan Rouhani defeated their hardline opponents at the ballot box.

Perhaps for Trump, the pro-Saudi, anti-Iran embrace is just another business proposition. He beamed at Saudi Arabia’s decision to buy $110 billion of new US weapons, describing the deal as “jobs, jobs, jobs,” as if the only gainful employment for American workers requires them to stoke war. And who knows what private deals for Trump and his family might also be lurking in his warm embrace of Saudi belligerence.

The Trump administration’s bombast toward Iran is, in a sense, par for the course. US foreign policy is littered with absurd, tragic, and hugely destructive foreign wars that served no real purpose except the pursuit of some misguided strand of official propaganda. How else, in the end, to explain America’s useless and hugely costly entanglements in Vietnam, Afghanistan, Iraq, Syria, Libya, Yemen, and many other conflicts?

America’s anti-Iran animus goes back to the country’s 1979 Islamic Revolution. For the US public, the 444-day ordeal of the US embassy staff held hostage by radical Iranian students constituted a psychological shock that has still not abated. The hostage drama dominated the US media from start to finish, resulting in a kind of public post-traumatic stress disorder similar to the social trauma of the 9/11 attacks a generation later.

For most Americans, then and now, the hostage crisis – and indeed the Iranian Revolution itself – was a bolt out of the blue. Few Americans realize that the Iranian Revolution came a quarter-century after the CIA and Britain’s intelligence agency MI6 conspired in 1953 to overthrow the country’s democratically elected government and install a police state under the Shah of Iran, to preserve Anglo-American control over Iran’s oil, which was threatened by nationalization. Nor do most Americans realize that the hostage crisis was precipitated by the ill-considered decision to admit the deposed Shah into the US for medical treatment, which many Iranians viewed as a threat to the revolution.

During the Reagan Administration, the US supported Iraq in its war of aggression against Iran, including Iraq’s use of chemical weapons. When the fighting finally ended in 1988, the US followed up with financial and trade sanctions on Iran that remain in place to this day. Since 1953, the US has opposed Iran’s self-rule and economic development through covert action, support for authoritarian rule during 1953-79, military backing for its enemies, and decades-long sanctions.

Another reason for America’s anti-Iran animus is Iran’s support for Hezbollah and Hamas, two militant antagonists of Israel. Here, too, it is important to understand the historical context.

In 1982, Israel invaded Lebanon in an attempt to crush militant Palestinians operating there. In the wake of that war, and against the backdrop of anti-Muslim massacres enabled by Israel’s occupation forces, Iran supported the formation of the Shia-led Hezbollah to resist Israel’s occupation of southern Lebanon. By the time Israel withdrew from Lebanon in 2000, nearly 20 years after its original invasion, Hezbollah had become a formidable military, political, and social force in Lebanon, and a continuing thorn in Israel’s side.

Iran also supports Hamas, a hardline Sunni group that rejects Israel’s right to exist. Following decades of Israeli occupation of Palestinian lands captured in the 1967 war, and with peace negotiations stalemated, Hamas defeated Fatah (the Palestine Liberation Organization’s political party) at the ballot box in the 2006 election for the Palestinian parliament. Rather than entering into a dialogue with Hamas, the US and Israel decided to try to crush it, including through a brutal war in Gaza in 2014, resulting in a massive Palestinian death toll, untold suffering, and billions of dollars in damage to homes and infrastructure in Gaza – but, predictably, leading to no political progress whatsoever.

Israel also views Iran’s nuclear program as an existential threat. Hardline Israelis repeatedly sought to convince the US to attack Iran’s nuclear facilities, or at least allow Israel to do so. Fortunately, President Barack Obama resisted, and instead negotiated a treaty between Iran and the five permanent members of the United Nations Security Council (plus Germany) that blocks Iran’s path to nuclear weapons for a decade or more, creating space for further confidence-building measures on both sides. Yet Trump and the Saudis seem intent on destroying the possibility of normalizing relations created by this important and promising agreement.

External powers are extremely foolish to allow themselves to be manipulated into taking sides in bitter national or sectarian conflicts that can be resolved only by compromise. The Israel-Palestine conflict, the competition between Saudi Arabia and Iran, and the Sunni-Shia relationship all require mutual accommodation. Yet each side in these conflicts harbors the tragic illusion of achieving an ultimate victory without the need to compromise, if only the US (or some other major power) will fight the war on its behalf.

During the past century, Britain, France, the US, and Russia have all misplayed the Middle East power game. All have squandered lives, money, and prestige. (Indeed, the Soviet Union was gravely, perhaps fatally, weakened by its war in Afghanistan.) More than ever, we need an era of diplomacy that emphasizes compromise, not another round of demonization and an arms race that could all too easily spiral into disaster.