Perhaps the most frustrating aspect of healthcare reform is the fact it has little to do with the delivery of healthcare. read any article or proposed legislation and you will find plenty of information about Insurance, money, and the uninsured: almost nothing about delivering healthcare to the underserved.
In an October 13, 2017, Press Release, The AmericanPsychological Association APA President Antonio E. Puente said, “This move, coming hours after the president issued an executive order to allow trade associations and other groups to offer their own health plans, will wreak havoc on the health insurance markets". There it is; it is about the health insurance markets.
I agree the availability of mental health services is atrocious, at best, for a highly developed nation like the United States. My theory is no one wants to talk about it because: 1) it can be an uncomfortable subject, 2) It would add a great deal of expense to the healthcare basket, 3) It is misunderstood. I also understand the position of the Mental heal providers. The service is vital and almost no one is paying for it.
I am an advocate of improving the delivery and quality of healthcare. As a nation, we just cannot seem to get past the money part. Population Health is in its infancy, although some providers have made great strides. However, Population Health is often misunderstood: and who wants to deal with the "uninsured' population?
Let me share a little-known secret about the Affordable Care Act (ACA). a family of 2 who does not make between 100 and 400 percent of the Federal poverty wage ($16,700) annually IS NOT ELIGIBLE FOR A SUBSIDY! That is correct, if you make $12,500.00 per year, the only thing you are eligible for is a tax waiver (thanks a lot) or an open market policy (which you could get anyway) which you cannot afford. I looked and the least expensive policy available and It was around $1080 per month with a $12,000.00 deductible. You do the math: it does not work.
President Trump stopped subsidies to INsurance companies. Lamar Alexander (R) and Patty Murry (D) worked together to thwart that effort. When it comes to Healthcare, bottom-line is politicians have no idea what to do! Talk to you elected representatives.
Las Vegas Massacre: What Indicators Were Missed?
As the facts continue to come out about the shooter in the Las Vegas massacre, the things we know now are that it took an extensive amount of planning to carry out such a nefarious attack. Currently, at least 59 people have been killed, over 500 hospitalized and 23 firearms were found stashed in gunman Stephen Paddock’s hotel room. The rifles and caliber of ammunition were .308 and .223, the kind of ammo that would be used in small and big game hunting. It’s hard to imagine, based on what we know now, that somebody did not notice key indicators leading up to the tragedy
The 32nd floor of the Mandalay Bay Hotel provided the perfect overlook for the madman to carry his act out on concertgoers. In reviewing video coverage of the incident, the hotel sits prominently in the foreground of the venue. Apparently, the gunman checked into the room from where the shooting took place last Thursday, September 28. Although initial reports indicate that Paddock acted alone, it is a way to early to confirm this or speculate on what, if any connections he had to other groups. ISIS came out early taking credit, stating that he is a Muslim convert. So far, this has been discounted by the FBI, but it is still too early to draw conclusions. They may not be calling it an act of terrorism in the traditional sense, but it certainly was an act of terror.
Hotels and concert venues represent very soft targets for those who wish to carry out these kinds of acts. They are like churches, theaters, stadiums, shopping centers and mass transit stations in terms of the ease of planning and the challenge of detection. Any place where there are multiple points of entry and egress and where there are large crowds increase the risk of these kinds of incidents. It is hard to imagine that somebody didn’t notice something suspicious about Stephen Paddock in the days and weeks leading up to the massacre. His actions were well planned. He was able to stockpile an arsenal of weapons and ammo in the few days leading up to the attack. Someone had to notice something unusual about him, the way he might have been acting or things that he might have said, etc. Aegis Protective Services lists 7 possible signs of a workplace shooter. This was not a workplace shooting but the traits would fit many active shooters and terrorist characteristics and perhaps Paddock exhibited some of these. The 7 possible Signs are:
1. Bullying/Intimidating Behavior
2. Paranoia or Conflicts with Others
3. Obsession with Weapons
4. Deteriorating Work Habits
5. Significant Personal Problems
6. Poor Social Skills or Antisocial Attitudes
7. Argumentative Behavior
One has to go backward from the event and “reverse engineer” the incident to determine what the indicators were that could have prevented this. Also, it would help to take some pointers from the Israelis who have the best counter-terrorism program in the world in reducing the risk of mass casualty situations like we witnessed last night.
After the November 2015 Paris massacre by ISIS terrorists, there was an article published in Real Clear World about the threat of violence and terrorism that the Israelis live with every day, and their effective strategies and tactics for countering the threat. The article states the importance of a vigilant and aware public and outstanding intelligence cooperation. While not everything the Israelis implement would work in our society, there are some venues, especially the ones where large crowds gather, where it might make sense to take lessons from the Israelis on perimeter security, defense, and rapid response.
Photo credit: David Becker/Getty Images