All Things Russia & Ukraine

[Farfromgeneva]

There’s short term wins for small people who ignore the human condition at their peril.

I prefer to be long term greedy.

[Brooklyn]

Bellicose name calling and strident indifference to how human free will actually works in a completely anti intellectual manner is the path to human prosperity!

Sounds like the Republican ways and means: hate, indifference to what goes on in the ghettos, book burning and censorship ~ the Republican way.

[Farfromgeneva]

Bellicose name calling and strident indifference to how human free will actually works in a completely anti intellectual manner is the path to human prosperity!

Sounds like the Republican ways and means: hate, indifference to what goes on in the ghettos, book burning and censorship ~ the Republican way.

And here you are angry and bitter regularly arguing pedantic points to get small wins akin to spelling errors and ignore or misunderstand the essence of concepts.

You’re entire cultural interests amount to make America regressive again in arts and society in so many ways as to run parallel to MAGA folks. Barely try to open up to anything after 1994. Spending actual time on YouTube videos of people talking. Who the hell does that? It’s not intellectual curiosity it’s weak form fight training

[Brooklyn]

And here you are angry and bitter regularly arguing pedantic points to get small wins akin to spelling errors and ignore or misunderstand the essence of concepts.

You’re entire cultural interests amount to make America regressive again in arts and society in so many ways as to run parallel to MAGA folks. Barely try to open up to anything after 1994. Spending actual time on YouTube videos of people talking. Who the hell does that? It’s not intellectual curiosity it’s weak form fight training

Typical right wing projections. If you are so hellbent on having another war, why don't you enlist and do your own fighting? The war between Russia and Ukraine has gone on for over 1,000 years. It will continue for centuries to come. So, if you are the hero you imagine yourself to be, go ahead. Enlist, fight, be a "hero". Send us a picture postcard when you get there.

[Farfromgeneva]

And here you are angry and bitter regularly arguing pedantic points to get small wins akin to spelling errors and ignore or misunderstand the essence of concepts.

You’re entire cultural interests amount to make America regressive again in arts and society in so many ways as to run parallel to MAGA folks. Barely try to open up to anything after 1994. Spending actual time on YouTube videos of people talking. Who the hell does that? It’s not intellectual curiosity it’s weak form fight training

Typical right wing projections. If you are so hellbent on having another war, why don't you enlist and do your own fighting? The war between Russia and Ukraine has gone on for over 1,000 years. It will continue for centuries to come. So, if you are the hero you imagine yourself to be, go ahead. Enlist, fight, be a "hero". Send us a picture postcard when you get there.

Hellbent?? So dumb. I’m only hellbent on avoiding simpleton reductive binary thinking that plagues so many wanna be intellectuals.

Have a good night. I’ve got one petty person who thinks having the last word has value and I debate if that’s someone of value to me so…enjoy

[Brooklyn]

Everybody loves a war so long as they don't have to fight it or pay for it. Of course, the nifty profits people make from them serve as incentive for more warmongering.

[old salt]

afan -- I'm still not confident that we will defend Taiwan, or that we should. Thus strategic ambiguity.
To deter China, we need to be ABLE to effectively defend Taiwan IF we choose to, & we need to equip them as we are equipping Ukraine

What do you think XI is thinking when he sees what happened in Ukraine?

And Taiwan isn't Ukraine. What's Xi gonna do? Lob Cruise missiles until Taiwan is a pile of rubble?

And whats the FIRST thing that neo con Biden does if Xi is dumb enough to invade? Straight out of the box, no shots fired.

Hint: it will cost China a GENERATION of innovation.

......only we need to do it in advance & (unlike Ukraine) Taiwan needs to pay for it, because they can afford it.
The forces & arms we still have tied down in E Europe fighting Russia were intended for our pivot to Asia by now.

And this forces us into an instant confrontation for NO REASON.

Why would we care if Xi is stupid enough to kill the ONE center of innovation in the region? Let him. Let your enemy (supposed enemy) make dumb mistakes. Get out of their way, and point at Taiwan.

China is gambling that we are so economically intertwined & dependent on them that we won't block them in Taiwan.

Pot. Meet kettle. All that this would do is to force the US to triple down on the CHips act. This would F*ck China in the long run. Let him do this.

We won't have "chip" independence for a decade.

Sez the guy who was on the team that fulfilled Kennedy's impossible promise. You have no faith in our country anymore, and that's sad. Put my daughter in charge. It will get done.

We are in Ukraine for ideological reasons.

Yes. I told you before he took office, OS, if you'll recall-------Biden will be global cop, like the neocon that he is.

How confident do you think Xi is in his troops. Either he's an utter moron....or he's thinking it over: are my troops, that have never seen combat, even worse than Putin's?

This, naturally, is a huge reason why Biden intervened: it sends a message to China.

The message SHOULD be: if you're dumb enough to set your country back by a generation when your economy is falling apart? By all means, give yourself a self inflicted migraine, and invade Taiwan.

Right. Xi won't crack down on Hong Kong either. It's not in his economic interests to do so. Right ?

China can impose a naval & air blockade of Taiwan. Who's going to challenge it ?
The idea is to make Taiwan a porcupine. Too well defended for China to risk an invasion with an air defense system capable of knocking down cruise & ballistic missiles. Learn the lessons from Ukraine. Air defense systems determine the course of the war.

Biden's not a NeoCon. He's not a Conservative of any stripe. You don't know what a NeoCon is.
Biden is a globalist, liberal interventionist.

It doesn't matter how fast we "triple down" on chip manufacturing, it's not going to happen soon enough.
Lost faith in my country ? Put your daughter in charge ? Have you seen our latest test scores ?
Watch your Zenith tv, listen to your GE transistor radio, & drive your Nash Rambler.

[Farfromgeneva]

Everybody loves a war so long as they don't have to fight it or pay for it. Of course, the nifty profits people make from them serve as incentive for more warmongering.

Says the guy who is bellicose here all the time anonymously. Your incentive structure is to get stroked by your echo chamber friends. Those are profits too. What’s my profit? Go looks at the array of positions I take and tell me.

THE FALL

By Albert Camus.
147 pages
Translated from the French, "La Chute," (1956) by Justin O'Brien
New York: A Vintage Book, 1956.

Comments and outlines by Bob Corbett
June 2003

Jean-Baptist Clamence has become a judge-penitent and offers his services to selected visitors to his office, the bar Mexico City, on the quays in Amsterdam. The clients don’t come to the Mexico City to seek his services, he trusts himself upon those selected.

But what is a judge-penitent? This is complex, even purposely a bit unclear, a bit contradictory. Being a judge-penitent involves both content and form. It seems some sort of amalgamation of Dostoevsky’s Grand Inquisitor, Nietzsche’s Overman, and Heidegger and Sartre’s “authentic” man.

The entire book is first person narrative and Clamence is the sole speaker. The book is one long five day monologue to his latest…. – latest what? Victim? Client? Student? Penitent? Consoled? Initiate? It will depend more on outcome than process.

As judge-penitent Clamence first tells his own story, his life story, selected to explain several things – his quest for meaning; the process of his life crisis; his ascent or decent (choose what you will) from everyday life into the role of judge-penitent.

Clamence was a criminal lawyer and a good one. He tended to choose clients whom he had good reason to believe were guilty of murder. He then used his considerable skill and the constraints of law, to get the murders off, to set them free.

He was by most human standards a great success – wealthy, well-respected (if viewed as a bit odd), cultured, a known gourmet and man phenomenally successful among women of all sorts and classes.

Then he began to hear the laughter – voices clearly laughing some sort of cynical laughter, yet no one could be seen near him. He began to create this laugher of questioning even in his own inner being.

A decisive act occurred one night in Paris when he was walking across a bridge. After passing a woman he heard her jump into the Seine, and while he hesitated and thought about it, he kept walking. He even avoided reading the newspapers for several days after to keep from knowing the outcome.

The mysterious laughter, his guilt over the woman brought him to question his whole life.

The central thing he learned seemed to be that unlike the law or football or tennis, life itself had no rules and thus pure innocence made no sense.

To stop the laughter and guilt he first had to embrace this world of freedom. This made him a judge of and for himself, but this was not enough. To give his life meaning and silence and peace, he had to become a judge-penitent for others and he set himself up at the Mexico City.

I found the book to be brilliantly crafted. A significant part of the philosophical message of the novel is that human knowledge of both the meaning of life and the nature of “the good” are beyond any exact human knowledge. Rather, the intellect is likely, on Clamence/Camus’s view, to be contradictory, uncertain, fraught with risk of error. It is seen as difficulty and likely to produce the mechanics of escape into certainty on the part of us mere humans.

Clamence is a living model of this. His early years were a serious attempt to live a life of clear meaning and absolute rules. But in mid-life he began to have the doubts of both ontological and moral skepticism. His choices mirror the anxiety predicted in the theory he later propounded, and his acts are often contradictory and puzzling – actually suggesting a coherence toward his skepticism.

In Jean-Paul Sartre’s analysis of this novel he believed it was Camus’s best, he argues that Clamence is, in fact, Camus, and the novel is what I’ve described above and Camus’s personal “confession” to the world of who he is and what his work is about.

I don’t have any evaluation of Sartre’s thesis. But it does seem at least consistent with what we know of Camus’s quest for personal authenticity and his drive to share that view with others.

Along the way in the novel are several positions, views and insights which struck me as particularly interesting or rich and I shall comments on several below.

For Clamence the human has two dominant drives:

Toward things of the mind.
Toward passion, especially sex.
Together they adequately describe humanity.

“It always seemed to me that our fellow citizens had two passions: ideas and fornication…. A single sentence will suffice for moderns man: he fornicated and read the paper.”

I was much taken with an image Clamence uses on how society quietly, steadily and relentlessly steals human individual freedom. He likens this process to the tiny “nibbles” of one pariah fish takes of a victim.

“You have heard, of course, of those tiny fish in the rivers of Brazil that attack the unwary swimmer by thousands and with swift little nibbles clean him up in a few minutes, leaving only an immaculate skeleton? Well, that's what their organization is. "Do you want a good clean life? Like everybody else?" You say yes, of course. How can one say no? "O.K. You'll be cleaned up. Here's a job, a family, and organized leisure activities." And the little teeth attack the flesh, right down to the bone. But I am unjust. I shouldn't say their organization. It is ours, after all: it's a question of which will clean up the other.”

Part of the role of the judge-penitent is to challenge his target people to change their lives toward what Existentialists would call authenticity. Part of that would be to be more honest concerning interpersonal relations with others. Clamence argues that while human have formally barred slavery (at least in the west), what we have in effect done is to alter its form, coating it with some icing which hides the substance of the cake beneath.

He even acknowledges that having slavery but not calling it that – even denying it and congratulating ourselves for this advance is “useful.” It has two consequences:

It soothes the consciousness of the slave “owner.”
The illusion of non-slavery often, even usually, internalized by the slaves themselves, gives them at least some sense of (false) hope.
“Just between us, slavery, preferably with a smile, is inevitable then. But we must not admit it. Isn't it better that whoever cannot do without having slaves should call them free men? For the principle to begin with, and, secondly, not to drive them to despair. We owe them that compensation, don't we? In that way, they will continue to smile and we shall maintain our good conscience.”

Sartre has claimed that this novel is a brilliant phenomenology of human being and especially a real “confessional” of Camus. The passage below if worth considering in this regard:

“However that may be, after prolonged research on myself, I brought out the fundamental duplicity of the human being. Then I realized, as a result of delving in my memory, that modesty helped me to shine, humility to conquer, and virtue to oppress. I used to wage war by peaceful means and eventually used to achieve, through disinterested means, everything I desired. For instance, I never complained that my birthday was overlooked; people were even surprised, with a touch of admiration, by my discretion on this subject. But the reason for my disinterestedness was even more discreet: I longed to be forgotten in order to be able to complain to myself. Several days before the famous date (which I knew very well) I was on the alert, eager to let nothing slip that might arouse the attention and memory of those on whose lapse I was counting (didn't I once go so far as to contemplate falsifying a friend's calendar?). Once my solitude was thoroughly proved, I could surrender to the charms of a virile self-pity.”

I close these note with three pages from near the end of the book in which a critical thesis – and a tension – is resolved.

The experience of guilt, arrived at via the judge-penitent role and guidance, is the path to freedom and authenticity.

At the same time there is for me the puzzle. Since someone else, the judge-penitent leads others to this clarity of being, does the person arrive at his or her own freedom, or does the person become the slave of Clamence/Camus/The Existentialists?

I’ve wrestled with this issue for all 36 years of my own teaching philosophy. I would never describe myself as much of either a judge or penitent (in any public world, even in teaching) but I was certainly both of those in my own heart. Like Clamence, I wanted to challenge others and rather than “setting up shop” in the Mexico City or as a parish priest, I chose the venue of the university classroom, and perhaps even now in retirement, this cyber-space of my web page. But what does the judge-penitent inspire or produce? Freedom and authenticity in the other or the subtle slavery of which Clamence speaks?

Camus’s challenging passage is below:

No excuses ever, for anyone; that's my principle at the outset. I deny the good intention, the respectable mistake, the indiscretion, the extenuating circumstance. With me there is no giving of absolution or blessing. Everything is simply totted up, and then: "It comes to so much. You are an evildoer, a satyr, a congenital liar, a homosexual, an artist, etc." Just like that. Just as flatly. In philosophy as in politics, I am for any theory that refuses to grant man innocence and for any practice that treats him as guilty. You see in me, tres cher, an enlightened advocate of slavery.

Without slavery, as a matter of fact, there is no definitive solution. I very soon realized that. Once upon a time, I was always talking of freedom: At breakfast I use to spread it on my toast, I used to chew it all day long, and in company my breath was delightfully redolent of freedom. With that key word I would bludgeon whoever contradicted me; I made it serve my desires and my power. I used to whisper it in bed in the ear of my sleeping mates and it helped me to drop them. I would slip it… Tchk! Tchk! I am getting excited and losing all sense of proportion. After all, I did on occasion make a more disinterested use of freedom and even – just imagine my naiveté -- defended it two or three times without of course going so far as to die for it, but nevertheless taking a few risks. I must be forgiven such rash acts; I didn't know what I was doing. I didn't know that freedom is not a reward or a decoration that is celebrated with champagne. Nor yet a gift, a box of dainties designed to make you lick your chops. Oh, no! It’s a choice, on the contrary and a long-distance race, quite solitary and very exhausting. No champagne No friends raising their glasses as they look at your affectionately. Alone in a forbidding room, alone in the prisoner's box before the judges, and alone to decide in face of oneself or in the face others' judgment. At the end of all freedom is a court sentence; that's why freedom is too heavy to bear, especially when you're down with a fever, or are distressed, or love nobody.

Ah, mon cher, for anyone who is alone without God and without a master, the weight of days is dreadful. Hence, one must choose a master, God, before being out of style. Besides, the word has lost its meaning; it’s not worth the risk of shocking anyone

[Brooklyn]

the profit motive is always the best motive for those who want a war ---


Over 100,000 Americans died from last year from the drug menace. That's one million over the past decades and about two million over the past score of years. Eradicating that plague should be everyone's priority. Naturally, there's no profit in that and this is why they concern themselves with fomenting another foreign war because of its profitability.

[old salt]

Oct 28 update from Defense One :

"Rough years are coming" for Europe, Germany's president predicted Friday, saying Russia's Ukraine invasion has "plunged" the continent "into an insecurity we thought we had overcome: a time marked by war, violence and flight, by concerns about the expansion of war into a wildfire in Europe."

More than a million Ukrainian refugees have fled to Germany, where citizens are facing "possible energy shortages this winter after cuts in Russian gas supplies," Reuters reported Friday. President Frank-Walter Steinmeier made the above remarks in his annual "state of the union" address, which came just days after he visited Kyiv for the first time since Russia invaded eight months ago.

"One thing is clear: we will have to accept some financial constraints over the next few years," Steinmeier said Friday, and admonished his countrymen, "This crisis demands that we learn to be modest again."

New: Ukraine's military is bracing for a flood of new Russian troops sometime in the next 10 to 14 days, the Wall Street Journal reported Friday after comments from Kyiv's General Staff Deputy Chief Oleksii Hromov. And that's welcome news for Moscow, whose top army officer in Ukraine reportedly had to put a gun to recruits heads to get them to stop retreating near the occupied Luhansk city of Svatovo, according to The Insider, reporting Thursday.

The conflict is tilting toward stalemate again as autumn rains muck up the battlefield. That's according to the New York Times, reporting Friday as well, and citing conflicts across two centuries. "Both armies are now dealing with the challenges posed by the thick clay sludge that hindered Napoleon's army in 1812, slowed Hitler's advance on the eastern front in 1941 and wreaked havoc on Russia's plans for a lightning advance into Ukraine in the spring of this year," Marc Santora of the Times writes.

"This is the rainy season, and it's very difficult to use fighting carrier vehicles with wheels," Ukraine's military chief, Oleksii Reznikov told reporters earlier this week. Meantime, Ukrainian troops are trying to hold off Russian forces approaching the eastern city of Bakhmut. "Taking Bakhmut would rupture Ukraine's supply lines and open a route for Russian forces to press on toward Kramatorsk and Sloviansk, key Ukrainian strongholds in Donetsk province," the Associated Press reported Friday from the city.

The tactical big picture: "In the last six weeks there has been a clear move from Russian ground forces to transition to a long-term, defensive posture on most areas of the front line in Ukraine," the British military said Friday. But "Even if Russia succeeds in consolidating long-term defensive lines in Ukraine, its operational design will remain vulnerable." And that all suggests, according to British military intelligence, that for Moscow, "To regain the initiative, it will need to regenerate higher quality, mobile forces which are capable of dynamically countering Ukrainian breakthroughs and conducting their own large-scale offensive operations."

The even bigger picture: Gain a better understanding of why many nations in the developing world have avoided condemning Russia's Ukraine invasion, via a new essay from Yaroslav Trofimov of the Wall Street Journal. In short, "Tolerance for Russia's actions across the developing world stems from a historical resentment of the West that now taints the Ukrainian cause by association, as well as from a practical need to remain on Moscow's good side and an often genuine lack of understanding of the conflict's nature," he writes.

[a fan]

Right. Xi won't crack down on Hong Kong either. It's not in his economic interests to do so. Right ?

Didn't say he wouldn't. LET HIM! Kill yet another city that's important to Chinese trade. Let him kill that golden goose, and let his country's future slide further behind.

China can impose a naval & air blockade of Taiwan. Who's going to challenge it ?

Hopefully not us. This would be like Biden imposing a blockade on California. Please, pretty please---cut off a key tech sector that China itself needs for trade. And hope the minds at work there don't bail for a better life.

The idea is to make Taiwan a porcupine. Too well defended for China to risk an invasion with an air defense system capable of knocking down cruise & ballistic missiles. Learn the lessons from Ukraine. Air defense systems determine the course of the war.

So....pick a fight where none exists? All because.....why? Because you don't understand how trade works.

You didn't answer my question: what's the first thing Biden would do if China goes after Taiwan? You REALLY can't figure it out?

Biden's not a NeoCon. He's not a Conservative of any stripe. You don't know what a NeoCon is.

Says the guy who's a Bernie Bro. but he's too worried about Drag Queens to figure it out. You wouldn't know what a conservative was if one fell on you.'

Trump made government 66% larger in just four years-----you didn't utter a sound in all that time. But sure, you're a conservative, and know what one is. Right.

Biden is a globalist, liberal interventionist.

Biden last week....."We are united in the belief that Russia's aggression must not be tolerated. No peaceful international order is possible if larger states can devour their smaller neighbors"

Straight out of the neo-con playbook, my man. But sure, Biden is a wide-eyed hippie lefty.

It doesn't matter how fast we "triple down" on chip manufacturing, it's not going to happen soon enough.

Says who? The guy who's been wrong about Putin for the last decade?

Lost faith in my country ?

Yep. A couple drag queens make headlines, and you lose your mind.

Put your daughter in charge ? Have you seen our latest test scores ?

a. you think my daughter's test scores are at the US average?

b. you, your party, and the Dem NeoCons chose to be global cops instead of investing in our children since wwii. So unlike every other 1st world country, our children don't enjoy .gov health care and training/education. Want to get upset over test scores? Next time, choose to invest in the children in America instead of Afghanistan, Iraq, and Syria.

Seems you FINALLY figured this out with Ukraine (hat tip)...and then IMMEDIATELY forgot your lesson, and want us to bankroll Taiwan, and pick a fight with China for no reason whatsoever.

[Farfromgeneva]

the profit motive is always the best motive for those who want a war ---


Over 100,000 Americans died from last year from the drug menace. That's one million over the past decades and about two million over the past score of years. Eradicating that plague should be everyone's priority. Naturally, there's no profit in that and this is why they concern themselves with fomenting another foreign war because of its profitability.

Is it enjoyable being monotone and obtuse or just make your life easier so you don't have to try as hard? Reductive isn't elegant, its just simple.

I'm increasingly of the opinion you are a mouthpiece for others and are at your home field of friends and associates like a dog looking for a belly rub by not shitting on their carpet.

Maybbe try stepping out of yoru comfort zone occasionally before you talk with authority and end up being wholly out of your element worse than Donny in the Big Lebowski. The inverse of Walter...

Lots of money in keeping folks high. Your analysis is off. It's not that there isn't profit in fixing problems, the money is too good on the other side.

Or there's money in mental health???? But you have all the answers right? You even have me all figured out of course. Sadly I'm an open book and as transparent as I can be and I know you don't get me at all. Not that I care, but the day I let you toss a label on me that's not right is the day you'll be jerking Netanyahu off.

https://www.npr.org/2021/02/15/96370073 ... hical-cris

As Addiction Deaths Surge, Profit-Driven Rehab Industry Faces 'Severe Ethical Crisis'
February 15, 20217:08 AM ET
Heard on Morning Edition
BRIAN MANN

4-Minute Listen
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Transcript

This 2017 photo shows a slogan is on the storefront of Journey, a former substance abuse treatment center, in Lake Worth, Fla. Now closed, it was one of two centers owned by Kenneth Chatman, who is now serving a 27-year federal prison sentence for health care fraud and money laundering convictions.
Lynne Sladky/AP
As the nation's addiction crisis deepened, Tamara Beetham, who studies health policy at Yale University, set out to answer a simple question: What happens when people try to get help?

Her first step was to create a kind of undercover identity — a 26-year-old, using heroin daily. Using this fictional persona, her research team called more than 600 residential treatment centers all over the country.

"We'd kind of call and say, I'm looking to, you know, start treatment and kind of go from there," Beetham said.

For people suffering addiction, this can be a life-or-death moment. Studies show that getting high-quality medical care can make a huge difference, leading to long-term recovery and a healthier life. So what Beetham's team found was troubling.

'American Rehab' And The Dark History of Rehabilitative Treatment
"A lot of people believe instilling a work ethic in people with substance abuse disorders will cure them, but what we found is that these programs don't work for most people," says reporter Shoshana Walter.

Want to support 1A? Give to your local public radio station and subscribe to this podcast. Have questions? Find us on Twitter @1A.

Start with 'American Rehab' And The Dark History of Rehabilitative Treatment
According to their peer-reviewed study, published in the February issue of the journal Health Affairs, many for-profit rehab programs charged inflated fees and used misleading sales practices to attract patients without evaluating their actual medical needs.

It turns out the people answering the phones at for-profit rehab programs when Beetham's team called typically weren't nurses or therapists. They often weren't asking medical questions at all.

They were sales people using aggressive marketing tactics to get credit card numbers while demanding a lot of cash up front, averaging more than $17,000. Researchers found the sales pitch at for-profit clinics often focused on things that have nothing to do with medical care.

Sponsor Message

"It used to be a spa for the rich and famous," a rehab program sales person told one of Beetham's researchers, according to notes of the conversation provided to NPR. "It's got all this extra stuff, outdoor and indoor pools, five-star chef, massage, acupuncture."

Despite the high price tag, however, Beetham's team found most programs don't provide evidence-based care using medications such as buprenorphine and methadone.

"We actually found less than a third of the programs offered medication maintenance treatment, which is the gold standard of treatment," she said.

These findings, based on data collected in 2019, come as far more Americans are dying from drug overdoses during the pandemic — more than 81,000 last year, according to the Centers for Disease Control and Prevention.

An addiction gold rush

Experts interviewed by NPR say this problem — residential rehab programs operating more like luxury spas or used car dealerships — is an unintended result of the Affordable Care Act.

A decade ago, the ACA mandated that private insurance programs cover people suffering addiction. It's a widely praised reform that helped many patients find healthcare as the opioid epidemic exploded.

But it created a kind of addiction gold rush, says Dave Aronberg, state attorney for Palm Beach County, Fla.

"You had all these bad actors descend on the legitimate recovery community to take advantage of people in recovery and exploit them for their insurance," Aronberg said.

So many for-profit rehab clinics and "sober homes" opened in his area of South Florida that Aronberg created a task force to investigate allegations of corruption, insurance fraud and other abuses.

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"It's the Wild West," said Assistant State Attorney Alan Johnson, who leads the task force. "The good providers were being driven out of business by these rogue bad actors."

Johnson described a case he investigated in 2017 in which parents sent their daughter to South Florida for treatment.

"She was in Florida for seven months, and she overdosed and died," Johnson said. "They got their statement at the end of the year. Their insurance company was billed for $660,000."

Fear, greed and little government oversight

Experts say there are many good recovery programs, but families and desperate patients trying to find help say it's often impossible to tell legitimate rehab programs from unethical ones.

"It's a very hard system to navigate," said Ryan Hampton, who spent years trying to get help for his addiction to prescription opioids and heroin.

He said his family "was preyed upon by unscrupulous treatment centers." He said they borrowed money and maxed out credit cards to pay his rehab bills.

Hampton has been in recovery for six years and works now as an advocate for people with substance use disorders. He said much of the industry is still shaped by two forces: greed and fear.

"You've got a highly unregulated addiction treatment industry on the greed side," he told NPR. "And then you've got fear on the other hand which are families, people who need help right away."

Former Walmart Pharmacists Say Company Ignored Red Flags As Opioid Sales Boomed
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Former Walmart Pharmacists Say Company Ignored Red Flags As Opioid Sales Boomed
In recent years, some states including Florida have tightened regulations on rehab programs, but rules and requirements vary wildly from state to state.

Academics, recovery advocates and government officials told NPR that roughly half the states provide little or no meaningful oversight over the industry.

The federal government, meanwhile, plays little role setting or enforcing professional or medical guidelines for residential addiction care.

Many rehab programs are "accredited" by private companies that review their operations in exchange for a fee.

But the Health Affairs study found many of those rehab programs still use hard-sell marketing practices.

"We actually found ones with accreditation were more likely to recruit patients with inducements and without full clinical evaluations," Beetham said.

Efforts at reform within the industry

"The addiction treatment industry is really suffering from a lack of standards," said Dr. Paul Earley, president of the American Society of Addiction Medicine.

He said many care providers, along with advocacy groups, are working to improve and standardize addiction programs to be more science-based.

"We believe once ethical well-meaning treatment programs begin adopting these standards, it will eventually marginalize bad actors in the treatment field," Earley told NPR.

But there's frustration over the pace of change.

In 2019, a trade group called the National Association of Addiction Treatment Providers published a report acknowledging "a severe ethical crisis" in the recovery field.

Ethical standards at many rehab programs were so poor that the organization purged "numerous members of the association at considerable financial loss," according to the report.

Peter Thomas, NAATP's director of quality assurance, said the new study in Health Affairs shows there's still a lot of work to be done.

"I do think that it's still a problem," Thomas told NPR. "The hard sells, the deceptive marketing practices, fraudulent billing."

Some who have worked in the for-profit rehab industry agree the culture is still often driven by profit rather than proper medical care.

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Investors See Big Opportunities In Opioid Addiction Treatment
"It's horrific, there isn't really any reform," said Dr. Howard Samuels, who ran high-end rehab clinics in California until last year. He still maintains a private therapy practice for people in recovery.

According to Samuels, it's often impossible for patients to know which programs offer appropriate care for their type of addiction.

"You don't know what you're going to get because when you call the admission for treatment centers they'll tell you whatever you want to hear," he said.

Samuels said his programs did provide high-quality recovery care. But he acknowledged charging high rates for spa-like amenities — horseback riding, fine cuisine and swimming pools — with no proven therapeutic value.

"I'm one of the first people who created that," Samuels told NPR, noting that rates at his in-patient programs ran as high as $60,000 a month. "You have to seduce the client in by having nice accommodations."

In fact, studies show for many patients, far less expensive nonprofit residential programs or even outpatient addiction care can be equally as effective.

Where are the doctors?

Many of the experts interviewed for this story point to one needed reform: expanding the role of doctors, physician assistants and other trained medical professionals in addiction care.

"The addiction treatment industry is a cottage industry," said activist Ryan Hampton. "We need full integration into the health care system."

The idea is that doctors should guide patients suffering substance use disorder, just as they would individuals facing other life-threatening illnesses.

This view has grown rapidly in recent years, as research-based treatments have gained ground in a field long dominated by programs based on spiritual and ethical concepts.

"Addiction treatment is health care, and it should be obtained in the same way that other specialty services are — you should get a referral from your primary care doctor," said the NAATP's Thomas.

But despite scientific advances and far better insurance coverage for addiction care, this rarely happens.

After decades of being treated separately from mainstream health care, studies show many physicians are still unwilling, or lack the training, to treat patients suffering substance use disorders.

"That's part of the stigma of addiction," said Earley with ASAM. "Addiction is a treatable brain disease. When you look at physicians, the amount of training and education they have with this illness is marginal."

For now, experts say that means many people who fall into addiction wind up going it alone, navigating a rehab system that too often pushes them into debt without helping them heal.

https://drugfree.org/parent-blog/my-son ... nt-system/

My Son Is Caught in the Cycle of Patient Brokering
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By Alice
December 2017
Related Reading
Seeking help: What to look for, what to avoid
Unethical addiction treatment is unfortunately abundant. Learn to discern quality, clinical treatment from providers without your child's best interest at heart.

My 22-year-old son with addiction has been caught up in the vicious cycle of detox, treatment and relapsing — all perpetuated by a terrible scheme called “patient brokering.”

With the growing number of drug treatment facilities, many unscrupulous players in the treatment industry are participating in kickback schemes known as patient brokering or “body brokering.” In return for referring a patient to a drug treatment facility, the broker receives a generous compensation of $500 to $5,000. Brokers will offer to share these kickbacks with patients or entice them with substances to leave an existing facility and qualify for another because they have relapsed. These brokers troll AA meetings, coffee shops in popular rehab towns and, in my son’s case, detox and rehab facilities.

My son’s recruitment into this darker side of drug treatment occurred when he met a broker about his age at a Florida detox facility. He persuaded my son and a few others to fly to another detox in California, all expenses paid. After a week in California, they decided to go back to Florida where this broker was able to fly them back to another detox, all expenses paid. The night before leaving, he put everyone up at a hotel on the Sunset Strip providing cash so they could party all night on whatever drugs they could find.

The sad truth is that once these kids were entwined in this scheme, they quickly become a highly sought-after commodity. It becomes very difficult for them to break away from this cycle, as it offers them a means of surviving without financial help or oversight from parents. These brokers are preying on people with brain diseases, building false hope and trust, only to set them up for failure. Patient brokering is illegal in many states; however, it is prevalent in Southern California and Florida. It enables the person with addiction, as they believe there will always be another place to land. And it mocks the efforts of true recovery.

This corrupt practice by players with no credentials in drug treatment, other than experience using substances themselves, has been perpetuated by a combination of events. This includes legislature that needs tighter boundaries, more oversight of treatment centers and stronger regulation of sober houses. The Affordable Care Act (ACA) requires insurers to pay for all substance use treatment including drug testing. This benefit has been highly leveraged by unethical treatment facilities opening a floodgate for opportunistic billing practices. My insurance once copied me on a $20,000 claim for a one-time drug test submitted by a lab I had never seen before. My insurance information was likely passed on or sold, just like bank account numbers are for purposes of identity theft.

Well-meaning laws have financed a billion-dollar industry over the past ten years and have created a trail of millionaires who have sold profitable treatment centers to larger health care companies. Being able to keep children on policies up to age 26 has also fed the industry the largest at-risk population to the doorsteps of these treatment facilities and sober houses with the guarantee they can be perpetually cycled through the system. The business model is not recovery. “The business model is relapse,” explains Alan Johnson, chief assistant state attorney for Palm Beach County, in the South Bend Tribune.

My son has been in dozens of residential and detox programs since he graduated from high school over three years ago. Like most young people, his substance use was propelled by mental illness. His depression and anxiety started around middle school and grew worse toward the end of his father’s battle with cancer. After the death of my husband, my son’s substance use escalated from marijuana and alcohol to prescription drugs. He struggled socially even though he had a wonderful sense of humor, intelligence and a warm heart. He showed great promise and enthusiasm for history, music and writing. Adolescence can be a harsh place for those who feel and observe more in life. His increasing anxiety and chronic depression became so debilitating he had to eventually leave school his sophomore year, suffering another bout his senior year. It was a struggle for his teachers and me to get him through to graduation.

In high school, his psychiatrist decided to try ADHD stimulant medications. My son began to assertively campaign to administer these meds himself or asking the psychiatrist for an increased dosage. It was a constant battle to keep him from intentionally misusing them; I knew then that stimulants were his drug of choice. This was one of my earliest mistakes — that I didn’t take him to an addiction specialist. An otherwise competent psychiatrist, who attended a top medical school and trained in New York City, couldn’t recognize a budding substance use disorder. More emphasis on addiction and treatment needs to be taught in medical schools and other health care fields.

When my son wasn’t depressed, his behavior became more egregious when he was home from boarding school. He had multiple incidents of rage and anger that was always substance-fueled. One such episode resulted in a 911 call that began the trail of legal issues that are still unresolved. He received psychiatric care at a well-known facility for 30 days and was discharged with a diagnosis of an addiction disorder. It was “highly recommended” that he go to a pricey long-term treatment facility for young adult men. They never explained to me or my son that this was at least a one-year commitment until he was enrolled.

He called me almost everyday begging to come home. After eight months my son walked out and took a train to New York City. The next day he awoke at New York-Presbyterian Columbia University Medical Center with no recollection of how he got there after stealing and drinking five tall boys of beer at Penn Station.

I desperately wanted him back home but he struggled to stay sober. He did all right the first month going to meetings, enlisting in a local Intensive Outpatient Program (IOP) and holding a part-time job. After noticing he was withdrawing more from his brother and me and not attending meetings, I became suspicious. Shortly thereafter, he tested positive for over-the-counter stimulants and was discharged from the IOP.

At that point, I couldn’t continue the financial bleed of paying for treatment and sent him to a 30-day rehab in Florida that would take my insurance. Although he did attend a few decent programs in Florida, he had difficulty making the transition into sober living. The longest he lasted at one facility was four months. After leaving the highly structured environment of a residential program, his anxiety and depression quickly kicked in and he relapsed.

He bounced back and forth between a sober house that tolerated substance use (which was eventually shut down) in exchange for attending treatment at an affiliated IOP. Eventually I contacted the regional the National Alliance on Mental Illness (NAMI) office, which was very helpful in suggesting a few reputable facilities. He agreed to enter one and I thought he was making real progress but he left before treatment ended for the allure of more substance use and another shady sober house. The pain of doing “the work” and confronting his feelings proved too painful. Tiring of these living conditions, he eventually asked to return home and agreed to try more local options.

After trying detox and a new treatment program, my son was unable to stay sober and eventually fled to California again with the help of his previous broker. He is still in the Los Angeles area, cycling through facilities.

Both my son and I have been victimized by this broken system. I have entrusted professionals with my son’s health and have rarely felt that he received effective care. It seems to be a business fraught with greed, false hope and ridiculous fees that play on parents’ worst fears and anxiety. I’ve also struggled with the guilt and shame I feel about my son. There’s no shortage of people wanting to give me advice or pass judgment. When uninformed family members or friends feel that my son’s addiction could have been quelled by sending him to college, I am discouraged beyond measure for all I have done in hopes of helping him.

There are still many well-intentioned and excellent treatment programs out there. There are plenty that take insurance and the quality of care is no different than those that charge above and beyond insurance. This I’ve learned the hard way. My experience is partly due to my son’s inability to commit and stay the course. I lost a lot of influence over his decisions once he became a legal adult, which is why communication skills are so important. I was lucky to have a local support group led by a parent coach who educated us on the CRAFT approach. It hasn’t stopped my son’s substance use, but it has helped me keep the lines of communication open even in the most contested moments. Parents need to try their best in due diligence in helping their children select a program that gives them their best shot at change. There is always a sense of urgency in making this decision, but doing research can help. The best resource out there is parent support groups. This is where you will get recommendations and honest feedback from others’ experiences.

It has taken me years before I could understand and accept this awful disease on its own terms. I’ve had internal turmoil over how much support to give my son without inadvertently supporting substance use. “Detaching with love” sometimes seems like a convenient excuse to check out and not deal with the chaos anymore, but at times, it seems like the only thing left to do for my own self-care. But to remove myself from helping him is counter-intuitive to being a parent. So, I feel the constant struggle of walking the thin line between helping and enabling.

But I won’t give up on my son.


MONEY & FINANCE
Investors See Far Out Profits in Psychedelic Medicine
A former hedge-fund portfolio manager raises millions from scientists, financiers and crypto bros eager to buy into treatments that aren’t even legal yet

ILLUSTRATION: VIRGINIA GABRIELLI
AUTHOR

MATT WIRZ Follow
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JULY 13, 2022 11:00 AM ET
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7 MINUTE READ

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It’s been a long strange trip for Brom Rector to become one of the few venture capitalists investing exclusively in psychedelic medicine. The 31-year-old has been experimenting with drugs like LSD for a decade but he never imagined he could turn that interest into a career.

Now Mr. Rector, a former hedge-fund portfolio manager, is raising millions of dollars from scientists, financiers and crypto bros eager to buy into treatments that aren’t even legal yet. They are betting that hallucinogens will eventually be approved for medical treatment and recreational use, spurring a boom from biotech to the entertainment industry that will far outstrip the fitful growth of legal cannabis.

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Mr. Rector burned out from his job as a quantitative researcher for Los Angeles-based Crabel Capital Management in December 2020 and launched a podcast a few months later to delve into the budding psychedelics market. Listeners began asking him for investment ideas, prompting him to open his VC firm—Empath Ventures—in the fall.

Empath has since raised $2.1 million of a $10 million target for its first fund and made 10 investments. Portfolio companies include Mindstate Design Labs, which develops new psychedelics, and Wavepaths, a company that designs smart music software to help therapists steer clients’ trips. The firm is one of a small but growing cadre of investors, including JLS Fund and billionaire Peter Thiel, taking interest in psychedelics.

Psychedelics are making the jump from party drugs to prescription drugs because some clinical research shows they are effective at treating conditions like depression, post traumatic stress disorder and addictions. Investors are also backing research and development in new drugs with other applications, like treating traumatic brain injuries. Much of how psychedelics affect the brain is unknown and critics worry about potential long-term damage or psychosis from excessive use.

The Food and Drug Administration approved the use of a drug similar to ketamine for treatment-resistant depression several years ago, and is expected to rule on an application for MDMA-assisted therapy in 2023. MDMA is more commonly known as the main ingredient in Ecstasy. Psilocybin, the hallucinogenic compound in mushrooms, could also see action from the FDA in the next few years.

The Wall Street Journal spoke to Mr. Rector about his return targets, legalization and convincing his mom to trip.



Brom Rector runs Empath Ventures venture-capital firm, focused on investments in the budding psychedelics market.
PHOTO: ELISABETH CAREN FOR THE WALL STREET JOURNAL
What are the returns you are looking for in your investments?
It’s just like a traditional biotech play. There’s a high probability of failure and potential upside of 10, 20, maybe 50 times.

I also invest in the infrastructure and accessories around psychedelics. The clinics where the stuff is delivered, the companies that make software to support the clinics. A lot of those businesses are not going to have that 50 times potential but they have a lot higher probability of becoming cash flow positive.

When most people think of psychedelic therapy they think magic mushrooms, maybe ayahuasca, both of which grow in nature. What about man-made drugs?
The final frontier is the exciting world of novel psychedelic molecules. It blows my mind that LSD was invented in 1938—before computers. We have all these amazing tools at our disposal now, and we’re entering a time where it’s culturally acceptable to apply those tools to the discovery of new psychedelic drugs.

LSD is amazing, as are classic cars from the 1930s. The Tesla Model S of psychedelics is yet to be created.

What is socially acceptable psychedelic use in the industry? Do you trip with your investors?
I’ve had a lot of people tell me that if I want to raise capital I should just start passing out psychedelics to my investors. I think there’s a moral issue with that. No, I have not tripped with my investors and I don’t plan on tripping with any of my investors. I haven’t tripped with any of my portfolio companies either.

There are some other investment groups out there that do not have the same answer that I just gave you. I know that it happens.

Are there medical applications of psychedelics other than mental health coming down the road?
Mental-health indications and addiction treatment will likely be the dominant applications of psychedelic medicine in the short term.

That said, psychedelics are really good at inducing neuroplasticity and reducing inflammation, so it makes sense to research them as treatments for any indication that could theoretically benefit from either of those things.

There are in-progress Phase 1 trials of psychedelics as treatment for ischemic stroke, alzheimers and TBI [traumatic brain injury]. I also know someone who personally used psychedelics as part of a treatment program to regain cognitive and motor function after suffering a severe TBI. It’s too early to say for sure, but it seems like there might be something there.

Why are cryptocurrency traders now investing in psychedelics companies?
To really get into crypto you have to be a big believer in crazy bold new ideas. Psychedelics is similar to crypto in the sense that it is a crazy big sort of bold new investment thing.

But, I think that the underlying technology and application of psychedelics is much more proven than that of crypto. In crypto the upside is enormous because it doesn’t seem like anyone is actually policing it in these exchanges. I think in the long run the upside of psychedelics is more similar to the upside of any other sort of revolutionary biotech play.

What about recreational use of psychedelics? Is that also coming?
One of the things I emphasize in my pitch deck for investors is that I want to invest in companies that are not threatened by de-regulated recreational-use regimes because I think they are inevitable. In the long run, I think we’ll see a few states that will have fully recreationally legal psychedelics

When you look at what Oregon is doing [decriminalized psilocybin and legalized therapeutic use] they’re being very open minded about the use of psychedelics. It wouldn’t surprise me to see concerts or other events there in the future where everyone gets a low dose of psilocybin to make the colors brighter and the music sound better.

Are there any potential risks in wider recreational use, among young people?
The more that users are educated on the importance of “set and setting” [mindset and environment] and know about potential interactions of psychedelics with other drugs and other contraindications, the better outcomes will be. When things become legal, the stigma around them lifts, and it becomes easier to share this information openly—so I think that recreational legalization would actually be a harm-reduction method.

I hope the industry ends up being proactive and responsible with its messaging. There is still stigma around the use of psychedelics and a single, high-profile case of a bad trip could rob the industry of a lot of social credibility, even though many people die from socially acceptable drugs like alcohol and cigarettes each day.

SHARE YOUR THOUGHTS
Would you invest in psychedelics? Why or why not? Join the conversation below.

Could there be a political backlash against liberalizing use of psychedelics?
Conservatives are much more open minded about psychedelics than you might think because of the narrative of psychedelics treating PTSD. Who gets PTSD a lot? It’s veterans. [Former Texas Gov.] Rick Perry has gone on the record saying Texas should fund studies on it.

Psychedelics are gaining ground all over the place even amongst the midwestern housewife subsegment of the population.

And you mentioned your mom has tried them?
My mom, who never really did any sort of substance or alcohol consumption, ended up deciding that she wanted to try it. As I started the fund she started paying more attention to it and read all the articles she could find about it, including the one in Good Housekeeping.

You hear enough experiences from people that are in your own demographic and soon enough you’re like “Maybe I should try it. It’s not just for those weird hippies after all. It’s for me too.”

Abstract
Background:
Mental health insurance laws are intended to improve access to needed treatments and prevent discrimination in coverage for mental health conditions and other medical conditions.

Objectives:
The aim was to estimate the impact of these policies on mental health treatment utilization in a nationally representative longitudinal sample of youth followed through adulthood.

Methods:
We used data from the 1997 National Longitudinal Survey of Youth and the Mental Health Insurance Laws data set. We specified a zero-inflated negative binomial regression model to estimate the relationship between mental health treatment utilization and law exposure while controlling for other explanatory variables.

Results:
We found that the number of mental health treatment visits declined as cumulative exposure to mental health insurance legislation increased; a 10 unit (or 10.3%) increase in the law exposure strength resulted in a 4% decline in the number of mental health visits. We also found that state mental health insurance laws are associated with reducing mental health treatments and disparities within at-risk subgroups.

Conclusions:
Prolonged exposure to comprehensive mental health laws across a person’s childhood and adolescence may reduce the demand for mental health visitations in adulthood, hence, reducing the burden on the payors and consumers. Further, as the exposure to the mental health law strengthened, the gap between at-risk subgroups was narrowed or eliminated at the highest policy exposure levels.

It is estimated that about half of the US population is diagnosed with a mental illness at some point in their life; in 2015, ∼20% of all adults had a mental illness and 4% had serious mental illness and over one-fifth of children had a serious mental illness.1 Mental illnesses are identified as the third most common cause of hospitalizations among 18–44 years old adults2 and lead to a shorter life expectancy.3 In the United States, mental illness accounts for the second largest disease burden, and severe mental health disorders account for about a quarter of hospital admissions and disability payments.4 About half of these chronic illnesses begin by age 14 and 75% begin by age 24.1 If detected early in childhood or adolescence, many mental health conditions can be managed effectively or occasionally prevented entirely in adulthood, which will substantially reduce the economic and psychological burden.4 Despite evidence that early detection and treatment can ease the impact on outcomes and reduce the prevalence of mental illnesses, ∼70% of children and adolescents do not receive needed mental health treatment services.4,5 Inadequate insurance coverage for mental illness is reported as one of the primary reasons for such insufficient access.4,6,7

Public health laws and policies aim to disrupt the status quo by shifting resources and mandating certain actions to improve the underlying health outcomes. Mental health insurance laws are intended to improve access to needed treatment and to prevent discrimination in insurance coverage by requiring equal coverage for mental health treatment and treatment for other medical conditions.4,8,9 Lack of such parity imposed substantial financial burden on families, especially for those with private health insurance that lacked adequate mental health provisions.8 This problem has been addressed in the past decades by adopting parity laws at both federal and state levels.

Although research has shown that these laws improve insurance coverage for mental health care,10,11 there is mixed evidence on the effectiveness of these policies at changing utilization or health outcomes. Studies from the early 2000s reported that parity laws increased mental health treatment utilization by adults with mild symptoms and low-income individuals. However, only a small effect was reported among children.9,12–14 Results from more recent studies were not conclusive. McGinty et al15 found increased utilization of substance use disorder treatment, while others reported no changes in these rates.16–20 Li and Ma4 identified that state mental health insurance laws resulted in modest increases in mental health care utilization among children from middle-income families. Sipe et al21 found that although mental health legislation broadly appeared to improve mental health outcomes for US populations, generally, few studies examine high-risk populations who experience access problems (p. 763).21

Prior studies simplified the legal intervention through use of presence or absence variables8,9,22 and characterized the strength or comprehensiveness of the state laws by their parity provisions23–26 and/or mandated coverage provisions.24,27 To date, no studies have explored the role that laws using specific mental health definitions or enforcement/compliance have had on outcomes. In addition, no known studies have explored longer term or cumulative effects of such legislation on mental health access and utilization, even though it is hypothesized that length of exposure to better legislation could improve access, resulting in better mental health outcomes.

This study estimates the association of mental health insurance laws with mental health treatment utilization in a nationally representative longitudinal sample of youth followed through adulthood. We hypothesize that cumulative exposure over time to stronger mental health insurance laws will be associated with utilization of mental health treatment in adulthood. This analysis uniquely considers life course risk and protective factors that alter adolescent trajectories of mental health and allows for evaluation of the law in future measurement periods after their adoption to determine whether such laws affect mental health treatment. Our study includes detailed nuances of the laws and their changes over a 14-year period using granular variables of state mental health insurance laws. This approach will further clarify the effect of mental health insurance legislation on improving mental health treatment access.

METHODS
We performed retrospective analysis of mental health treatment utilization in a longitudinal sample of adolescents through their adulthood. Data were obtained from the National Longitudinal Survey of Youth 1997 Cohort (NLSY97)28 and the State Mental Health Insurance Laws (SMHIL) data set.29

National Longitudinal Survey of Youth 1997
Data on mental health treatment, as well as individual and environmental characteristics, were obtained from NLSY97 Rounds 1–15, which consists of a nationally representative sample of 8984 youths born during 1980 and 1984. At Round 1, respondents were 12–18 years of age and they continued to be interviewed on an annual basis. By Round 15, 83% of the original sample was retained (for details see Technical Appendix, Supplemental Digital Content 1, https://links.lww.com/MLR/C309). We selected individual and environmental variables that were measured at baseline (1997), adolescence (2001–2005), and adulthood (2009–2011, rounds 13–15) associated with our research question and hypothesis, and available in the survey data. Not all variables were measured at every NLSY97 round.

State Mental Health Insurance Laws Data Set
SMHIL coded state mental health insurance laws across 6 legal provisions using a scientifically rigorous policy surveillance methodology.29 For each year between 1997 and 2020, state mental health insurance laws were evaluated on 6 characteristics: parity (does a state statute require that coverage for mental health services is equal to coverage for other medical conditions); coverage (does a state statute mandate insurance coverage of mental health conditions); definition (does a state statute define mental illness); all conditions defined (does a state statute define mental health conditions as all conditions listed in the Diagnosis and Statistical Manual of Mental Disorders); enforcement (is a state agency required to enforce existing state and/or federal mental health parity laws); and compliance (are insurers required to submit reports demonstrating compliance with state and/or federal parity legislation). All 6 characteristics except parity were scored yes (1 point) or no (0 points), and parity was scored as full parity (2 points), partial parity (1 point), or no parity (0 points). The total score for each state for each year ranged from 0 to 7.

The outcome variable, asked at Rounds 13–15 (2009–2011), was the number of self-reported mental health treatments that the respondent had when they were 24–30 years old. Respondents were asked “How many times have you been treated by a mental health professional?” Responses were coded as “0,” “1,” “2,” “3,” or “4 or more” visits in a year. We created a new variable that measured the number of times the respondent has visited a mental health provider over the 3-year period. The count variable was right censored and the total number of mental health visits in this 3-year period ranged from 0 to 12 visits.

The mental health insurance law variable (Law) is the strength of the respondents’ cumulative exposure to the state mental health insurance laws over time during their adolescence and young adulthood. The Law was constructed using the SMHIL data set.29 For this study, we used data between 1997 and 2011 (beginning and ending period for our outcome variable). The effective dates of insurance laws adopted by states ranged throughout the calendar year, but for our analysis, we chose to adjust the actual effective date to January 1 of the following year, which typically aligns with the insurance plan’s effective date. We assigned each survey respondent a Law strength score based on the state they resided in for each year of the survey (1997–2011). State of residence was obtained from the Bureau of Labor Statistics (BLS) to link NLSY97 and SMHIL data. We aggregated individual mental health insurance law strength scores across all years to create a single value for each respondent that described the amount of exposure they had to mental health insurance laws over the 1997–2011 period. The Law could range between 0 and 97, where a higher value indicated exposure to stronger mental health insurance laws.

Other Variables
In our model, we also accounted for individual [age, sex, race, ethnicity, education, marital status, number of children in the household, adult general health, employment status, exposure to adverse childhood experiences (ACEs)], receiving government assistance measured during respondents’ adolescent period in 2005–2009, household federal poverty level (FPL) and health insurance status at adulthood, whether they live in a rural area, and having had emotional problems in childhood) and environmental factors (state unemployment rate, percent uninsured in the state) that are likely to affect individual’s access to mental health care or outcomes over the life course (The Technical Appendix, Supplemental Digital Content 1, https://links.lww.com/MLR/C309 discusses the construction of ACEs variable).

Analysis
We used NLSY97 Custom Weighting program30 to create custom sampling weights based on the design features and years used in this study. Respondents missing any predictor variable for any reason were retained as a separate category (labeled as “unknown”) and were included in our analyses. Only those missing the outcome variable [n=1031 (11.5%)], were dropped. Per NLSY97, weights were applied when generating descriptive statistics, but not when running complex regressions.30 All analyses were done using Stata 16.31

We specified a regression model to estimate the relationship between mental health treatment utilization and law exposure while controlling for other explanatory variables. Our dependent variable is a count ranging between 0 and 12 with a heavy concentration of zero values (ie, no mental health visits). Given the nature of our dependent variable, we used a zero-inflated negative binomial regression model to account for concentration of large number of zeros and possible overdispersion. For ease of interpretation, Table 2 reports the incidence rate ratio (IRR), which is the ratio of the rate of mental health visit counts (incidents) for those experiencing any mental health visit and shows the percent change in the mean outcome, mental health visits, when Law is increased by 1 unit. In auxiliary regressions (not reported), we also examined law exposure interactions with race, employment, and health insurance status as well as an alternative specification for the inflation model (Technical Appendix, Supplemental Digital Content 1, https://links.lww.com/MLR/C309). None of the interactions were statistically significant. The final model was chosen based on the best fit by the Akaike (AIC) and Bayesian (BIC) information criteria.

TABLE 2 - Mental Health Policy Impact on the Mental Health Treatment Visit
Count Model Inflation Model
Variables IRR† 95% CI IRR 95% CI
Mental Health Policy Exposure Strength 0.9968** 0.9937–0.9998
Age 1.059*** 1.016–1.104
Sex (ref. male)
 Female 0.904 0.785–1.042 0.447*** 0.374–0.535
Race (ref. White)
 Black 0.811** 0.680–0.966 2.484*** 1.995–3.092
 Other 0.869 0.680–1.110 0.983 0.746–1.296
 Unknown 1.197 0.489–2.929 1.327 0.459–3.841
Hispanic ethnicity 1.012 0.807–1.269 1.692*** 1.304–2.196
General health (ref. excellent)
 Good 1.084 0.931–1.262 0.609*** 0.505–0.736
 Fair/poor 1.103 0.927–1.312 0.369*** 0.290–0.469
 Unknown 0.323*** 0.166–0.630 0.313 0.028–3.490
Employment (ref. full-time)
 none 1.392*** 1.154–1.678 0.464*** 0.376–0.573
 part-time 1.224** 1.040–1.441 0.606*** 0.497–0.739
 Unknown 1.131 0.765–1.671 0.771 0.463–1.283
State unemployment (ref. <7.5%)
 Over 7.5% 0.864** 0.747–1.000
 Unknown 0.681* 0.448–1.034
Gov assistance recipient (ref. no assistance)
 Any welfare during 2005–2009 0.988 0.839–1.163 0.562*** 0.454–0.694
Adverse childhood events (ref. none)
 1 ACE 1.112 0.917–1.347 0.735** 0.574–0.939
 2 ACEs 1.121 0.909–1.381 0.695*** 0.538–0.896
 3+ ACEs 1.236* 0.995–1.537 0.615*** 0.467–0.811
Living in rural area (ref. rural)
 Urban 0.979 0.815–1.178 0.655*** 0.516–0.830
 Unknown 0.914 0.696–1.199 0.725* 0.501–1.049
Poverty level (ref. 3.00+)
 0–0.99 0.994 0.805–1.227
 1.00–1.99 0.845* 0.692–1.031
 2.00–2.99 0.773** 0.618–0.965
 Unknown 1.051 0.877–1.260
Health insurance (ref. uninsured)
 Insured 1.363*** 1.158–1.604 0.610*** 0.501–0.742
Depression status (ref. none of the time)
 Some or all the time 1.453*** 1.248–1.693
 Unknown 1.300 0.950–1.779
Highest education completed (ref. less than HS/HS/GED)
 Associate/Junior college 0.980 0.749–1.281
 College and above 1.127 0.940–1.351
 Unknown 1.189 0.654–2.161
Marital status (ref. never married)
 Married 0.923 0.778–1.096
 Separated 0.780 0.504–1.208
 Divorced 0.974 0.773–1.227
 Widowed 0.171 0.014–2.059
 Unknown 4.409* 0.976–19.914
Children in the household (ref. none)
 1–2 0.859 0.713–1.034 1.852*** 1.480–2.316
 3+ 0.978 0.749–1.276 2.769*** 1.937–3.959
 Unknown 0.840 0.463–1.526 3.883 0.341–44.221
Percent of state population uninsured (ref. below nat. average)
 Above average 1.000 0.871–1.148 1.148 0.964–1.367
 Unknown 0.500*** 0.341–0.734 2.524*** 1.517–4.197
Having emotional problems at childhood (ref. no)
 Yes 0.719*** 0.564–0.916
 Unknown 1.175 0.906–1.524
Intercept 0.598 0.180–1.985 36.917*** 25.215–54.049
Alpha 0.447*** 0.334–0.598
N 7953 7953
†IRR is the ratio of the rate of counts (incidents), which is calculated as IRR=exp(β)=eβ, where β is the coefficient estimate from the negative binomial regression; (exp(β)–1)×100 shows the percent change in the mean outcome when model input parameter (ie, independent variable) is increased by 1 unit. In our model, IRR for the policy variable is 0.996 and implies that if policy strength were to increase by 10 units (or 10.3%) then we would expect number of mental health visits to decrease by 4%.
ACE indicates adverse childhood experience; CI, confidence interval; GED, graduate equivalency degree; HS, high school; IRR, incidence rate ratio.
*P<0.10.
**P<0.01.
***P<0.001.
Source: Authors’ analysis of data from the NLSY97.

Adjusted Predictions
Regression results generate conditional mean estimate of the effect of the Law on the mental health outcome. Adjusted predictions, calculated from the regression estimates, allow us to predict rates of mental health utilization at various levels of Law exposure for specific subgroups, while holding other variables constant. Figure 1 illustrates the predicted number of mental health visits at each level of Law for the overall model as well as by select major factors that play a key role in determining mental health outcomes (race, exposure to ACEs, employment status, depression status, and sex).

F1
FIGURE 1: Association between Mental Health Insurance Law Exposure Strength and Utilization of Mental Health Services. This figure reports the predicted number of mental health visitations associated with exposure to the Law variable, quantified by a range of 0–97 in increments of 10. These predictions are reported for the overall sample and across subgroups by employment status, race, sex, exposures to adverse childhood experiences, and depression status. For example, upper left graph illustrates the overall predicted number of visits at values of Law that range from 0 to 97 in increments of 10. Similarly, the lower left graph illustrates the predicted number of visits for men and women at values of Law that range from 0 to 97 in increments of 10. This figure shows that the predicted number of mental health visits declined as exposure to the Law increased. However, the group-wise declines were not uniform. At low levels of exposure to mental health insurance laws over the time period, the differences in mental health treatment are wide for specific subgroups after holding other variables constant; however, as exposure to stronger laws increases, the differences in mental health treatment for subgroup variables (eg, employment, race, sex, adverse childhood experiences) are lessened. Dotes denote to point estimates and vertical bars denote to the 95% confidence interval. Source: Authors’ analysis of data from the National Longitudinal Survey of Youth 1997 (NLSY97) and the Mental Health Insurance Parity Statutes data sets.
Limitations
Our study is limited to using secondary data. The NLSY97 lacks more specific mental health outcome variables, such as a diagnosis of mental illness, that we would have desired. However, this is the first study to explore: (1) the cumulative effect of insurance coverage over a 14-year period using longitudinal data; and (2) the comprehensiveness of behavioral health insurance coverage, including granular policy variables. Many previous studies use a preapproach/postapproach to study policy impact and cross-sectional data, which also have significant limitations for interpretation. We believe that this study provides a foundation for further exploration. Also, our outcome variable is censored in the top category where “4 and more” visits are coded as 4. Only 3% of the respondents experienced this, and therefore we believe that this limitation did not significantly alter the results and their interpretation.

The mental health visitation variables were only measured in NLYS97 rounds 13–15 (2009–2011). By this time, all participants were at least 24 years of age. Unfortunately, mental health visits cannot be studied during youth or adolescence. Therefore, our study solely examines self-reported and parent-reported variables from these periods and their effect on later (adult) reported mental health visits. Given the secondary nature of our data set, the results can only apply to the underlying population that they represent, specifically individuals who were born between 1980 and 1984. While we may hypothesize that the mental health insurance laws may produce similar outcomes for the other population age groups, this hypothesis is best addressed in the future research that includes data on other population subgroups. Given that laws change over time, and that exposure to different laws is hypothesized to affect outcomes, these findings should be replicated in other longitudinal cohorts of different ages.

The SMHIL data set did not include data from administrative regulations or statutes contained outside of the insurance code. These laws do not directly influence Medicare, Medicaid, or military-related health plan insured individuals. Because of the heterogeneity of state mental health insurance laws, the data set does not assess all variation contained in state statutes, but adds important nuance of legal provisions that have previously gone unstudied.

RESULTS
As reported in Table 1, in our (weighted) study population, females comprised 49% of the population. White and Black participants were 58% and 26%, respectively, and 21% were Hispanic. In 2009, respondent age ranged from 24 to 30, 63% had high school or lower education, 29% had college education, 59% were never married, 34% were married, majority (61%) had no biological children, and 59% lived in states with below average uninsured rates. During 2009–2011, about 12% of respondents reported having at least 1 visit for a mental health treatment and majority (75%) reported being in good or excellent health. In 2009, 47% of respondents had full-time employment and 18% were unemployed, 19% lived in rural areas, 26% reported being depressed some or all the time, 31% received governmental assistance during this period, the majority had experienced at least one ACE (33% one ACE, 29% two ACEs, and 19% more than 3 ACEs), and 56% had either public or private insurance.

Table 2 reports regression results estimating the relationship between Law and number of mental health visits, while controlling for other covariates. As hypothesized, the mental health Law (IRR=0.996) was statistically significant (P<0.05) and implies that if Law is increased by 10 units (or 10.3%) then we would expect number of mental health visits in adulthood to decrease by 4%. Our results also showed that Black respondents, compared with White respondents, reported lower levels of mental health treatment visits (IRR=0.806, P<0.05). Those with part-time (IRR=1.404, P<0.001) or no employment (IRR=1.680, P<0.001), reported higher mental health visits than those who were employed full time. Mental health visits increased with age at about 6% for each year (IRR=1.058, P<0.05). Those who had 1–2 children at home, had 25% less mental health visits than those without children (IRR=0.749, P<0.001) and those having reported being depressed some or all the time had 58% higher mental health visits (IRR=1.583, P<0.001).

TABLE 1 - Weighted Descriptive Summary of the NLSY97 Sample Used in This Study

[Farfromgeneva]

Right. Xi won't crack down on Hong Kong either. It's not in his economic interests to do so. Right ?

Didn't say he wouldn't. LET HIM! Kill yet another city that's important to Chinese trade. Let him kill that golden goose, and let his country's future slide further behind.

China can impose a naval & air blockade of Taiwan. Who's going to challenge it ?

Hopefully not us. This would be like Biden imposing a blockade on California. Please, pretty please---cut off a key tech sector that China itself needs for trade. And hope the minds at work there don't bail for a better life.

The idea is to make Taiwan a porcupine. Too well defended for China to risk an invasion with an air defense system capable of knocking down cruise & ballistic missiles. Learn the lessons from Ukraine. Air defense systems determine the course of the war.

So....pick a fight where none exists? All because.....why? Because you don't understand how trade works.

You didn't answer my question: what's the first thing Biden would do if China goes after Taiwan? You REALLY can't figure it out?

Biden's not a NeoCon. He's not a Conservative of any stripe. You don't know what a NeoCon is.

Says the guy who's a Bernie Bro. but he's too worried about Drag Queens to figure it out. You wouldn't know what a conservative was if one fell on you.'

Trump made government 66% larger in just four years-----you didn't utter a sound in all that time. But sure, you're a conservative, and know what one is. Right.

Biden is a globalist, liberal interventionist.

Biden last week....."We are united in the belief that Russia's aggression must not be tolerated. No peaceful international order is possible if larger states can devour their smaller neighbors"

Straight out of the neo-con playbook, my man. But sure, Biden is a wide-eyed hippie lefty.

It doesn't matter how fast we "triple down" on chip manufacturing, it's not going to happen soon enough.

Says who? The guy who's been wrong about Putin for the last decade?

Lost faith in my country ?

Yep. A couple drag queens make headlines, and you lose your mind.

Put your daughter in charge ? Have you seen our latest test scores ?

a. you think my daughter's test scores are at the US average?

b. you, your party, and the Dem NeoCons chose to be global cops instead of investing in our children since wwii. So unlike every other 1st world country, our children don't enjoy .gov health care and training/education. Want to get upset over test scores? Next time, choose to invest in the children in America instead of Afghanistan, Iraq, and Syria.

Seems you FINALLY figured this out with Ukraine (hat tip)...and then IMMEDIATELY forgot your lesson, and want us to bankroll Taiwan, and pick a fight with China for no reason whatsoever.

the sarcasm and humor falls flat all the time becasue it's based in lunacy and thoughtlessness.

[Brooklyn]

Is it enjoyable being monotone and obtuse or just make your life easier so you don't have to try as hard? Reductive isn't elegant, its just simple.

I'm increasingly of the opinion you are a mouthpiece for others ...

A major hallucination for sure. Jumping off into an ad hominem argument rather than addressing the issue shows your concession on the issue. You have abandoned the subject because you cannot successfully refute what I've written. This because I have posted a truth which is too painful and too truthful for you to deal with.

Rather than jumping off, let's get back on topic. The fact remains that the USA has absolutely nothing to gain from this conflict. One that has been going on for centuries before the USA came into being. Biden has already given the Zelenskyy regime more money that Moscow spends on its own military every year. So far, this has not benefited any American that I know of by so much as one iota. Naturally, those of you with military industrial complex portfolios are only too happy to see more wastage of our tax dollars as it increases your net worth. I repeatedly challenge anyone to prove to me that the USA derives or will derive any benefit from further involvement in this conflict. When I make such a challenge all I get in replies is the same cynicism and recriminations that you are displaying here. Again I ask of what benefit is there to the USA to being further involved in this conflict?

One million Americans have died in the past ten years because of the presence of dangerous and illegal drugs. Tens of thousands remain homeless and survive on the streets. Millions are without health care insurance. The infrastructure continues to decay. Radical right wing lunatics continue to shoot school kids. The covid plague is still menacing the nation and the seasonal flu (which is said to be highly dangerous this year) is emerging. How many more thousands of people must die before this is solved? How much must our people suffer before we learn to prioritize our own nation and its many needs???

Rather than criticize and make personal attacks like you do, how about offering some meaningful solutions to the mess created by Republicans and others who are so hellbent on destroying this nation?

[Farfromgeneva]

Is it enjoyable being monotone and obtuse or just make your life easier so you don't have to try as hard? Reductive isn't elegant, its just simple.

I'm increasingly of the opinion you are a mouthpiece for others ...

A major hallucination for sure. Jumping off into an ad hominem argument rather than addressing the issue shows your concession on the issue. You have abandoned the subject because you cannot successfully refute what I've written. This because I have posted a truth which is too painful and too truthful for you to deal with.

Rather than jumping off, let's get back on topic. The fact remains that the USA has absolutely nothing to gain from this conflict. One that has been going on for centuries before the USA came into being. Biden has already given the Zelenskyy regime more money that Moscow spends on its own military every year. So far, this has not benefited any American that I know of by so much as one iota. Naturally, those of you with military industrial complex portfolios are only too happy to see more wastage of our tax dollars as it increases your net worth. I repeatedly challenge anyone to prove to me that the USA derives or will derive any benefit from further involvement in this conflict. When I make such a challenge all I get in replies is the same cynicism and recriminations that you are displaying here. Again I ask of what benefit is there to the USA to being further involved in this conflict?

One million Americans have died in the past ten years because of the presence of dangerous and illegal drugs. Tens of thousands remain homeless and survive on the streets. Millions are without health care insurance. The infrastructure continues to decay. Radical right wing lunatics continue to shoot school kids. The covid plague is still menacing the nation and the seasonal flu (which is said to be highly dangerous this year) is emerging. How many more thousands of people must die before this is solved? How much must our people suffer before we learn to prioritize our own nation and its many needs???

Rather than criticize and make personal attacks like you do, how about offering some meaningful solutions to the mess created by Republicans and others who are so hellbent on destroying this nation?

Sure keep on fighting Jimmy.

[Brooklyn]

Sure keep on fighting Jimmy.

As always, no substantive answer whatsoever. Thank you for conceding that you have lost the debate.

[old salt]

Right. Xi won't crack down on Hong Kong either. It's not in his economic interests to do so. Right ?

Didn't say he wouldn't. LET HIM! Kill yet another city that's important to Chinese trade. Let him kill that golden goose, and let his country's future slide further behind.

China can impose a naval & air blockade of Taiwan. Who's going to challenge it ?

Hopefully not us. This would be like Biden imposing a blockade on California. Please, pretty please---cut off a key tech sector that China itself needs for trade. And hope the minds at work there don't bail for a better life.

The idea is to make Taiwan a porcupine. Too well defended for China to risk an invasion with an air defense system capable of knocking down cruise & ballistic missiles. Learn the lessons from Ukraine. Air defense systems determine the course of the war.

So....pick a fight where none exists? All because.....why? Because you don't understand how trade works.

You didn't answer my question: what's the first thing Biden would do if China goes after Taiwan? You REALLY can't figure it out?

Biden's not a NeoCon. He's not a Conservative of any stripe. You don't know what a NeoCon is.

Says the guy who's a Bernie Bro. but he's too worried about Drag Queens to figure it out. You wouldn't know what a conservative was if one fell on you.'

Trump made government 66% larger in just four years-----you didn't utter a sound in all that time. But sure, you're a conservative, and know what one is. Right.

Biden is a globalist, liberal interventionist.

Biden last week....."We are united in the belief that Russia's aggression must not be tolerated. No peaceful international order is possible if larger states can devour their smaller neighbors"

Straight out of the neo-con playbook, my man. But sure, Biden is a wide-eyed hippie lefty.

It doesn't matter how fast we "triple down" on chip manufacturing, it's not going to happen soon enough.

Says who? The guy who's been wrong about Putin for the last decade?

Lost faith in my country ?

Yep. A couple drag queens make headlines, and you lose your mind.

Put your daughter in charge ? Have you seen our latest test scores ?

a. you think my daughter's test scores are at the US average?

b. you, your party, and the Dem NeoCons chose to be global cops instead of investing in our children since wwii. So unlike every other 1st world country, our children don't enjoy .gov health care and training/education. Want to get upset over test scores? Next time, choose to invest in the children in America instead of Afghanistan, Iraq, and Syria.

Seems you FINALLY figured this out with Ukraine (hat tip)...and then IMMEDIATELY forgot your lesson, and want us to bankroll Taiwan, and pick a fight with China for no reason whatsoever.

...you think everyone who's not a hippie pacifist like you is a NeoCon. You don't know how to distinguish between a Conservative hawk, a PalieoConservative, or a liberal global interventionist. I tried to explain the genesis of NeoConservatism but was accused of anti-Semitism for pointing out the history of the movement.

I'm just grateful that my generation got our public school education while we were scared sh!tless by Sputnik & the Cuban missile crisis, before the teachers unions took over & replaced teaching math & science with training social justice warriors. There was a time when pocket protectors, slide rules & a drafting kit were cool. Everybody wanted to be an engineer.

Take 45 min & listen to Prof Chris Miller explain why Taiwan's survival is in our vital national interest & Ukraine is not.
https://www.c-span.org/video/?523287-1/ ... ris-miller (video)
https://www.c-span.org/podcasts/subpage ... afterWords (podcast)
He'll also tell you why it will take us a decade to replace Taiwan's chip making, even if we triple down.
He also explains why we can no longer rely on Mutually Assured (Economic) Destruction to deter China from seizing Taiwan,

[Brooklyn]

Biden last week....."We are united in the belief that Russia's aggression must not be tolerated. No peaceful international order is possible if larger states can devour their smaller neighbors"

Good thing this wasn't the standard during the Bush years.

[a fan]

Biden last week....."We are united in the belief that Russia's aggression must not be tolerated. No peaceful international order is possible if larger states can devour their smaller neighbors"

Good thing this wasn't the standard during the Bush years.

That's the point.....those are Bush's words. I simply swapped out Iraq with Russia.

Same MO. Same "reasoning" despite the protestations of Queen Gertrude (Old Salt).

[DocBarrister]

Russian President Vladimir Putin will likely not survive in office if he loses the war in Ukraine, the embattled nation’s head of military intelligence claimed this week.

“It’s unlikely that he survives it,” said Ukrainian Major General Kyrylo Budanov, who heads up the country’s Defense Intelligence directorate, in an interview with the War Zone. If Russia loses the war, Putin would likely be overthrown, he said, without elaborating on what he meant by “survive.”

“Currently, there’s active discussions happening in Russia about who’d be there to replace him,” said Budanov, who did not provide any more specifics.

Budanov also told the online military magazine that Ukrainian forces are poised to take back Kherson City on the Black Sea and other territory annexed by Russia at the end of November.

https://nypost.com/2022/10/29/putin-not ... chief/amp/

DocBarrister