Friday, 27 January 2012 15:24

California Attempting to Institute Single Payer

David Gorn

California Healthline

 

 

The idea of a single-payer health care system in California stalled on the Senate floor yesterday, falling two votes short of passage.

 

Reconsideration of the bill was granted, though, so proponents of SB 810 by Mark Leno (D-San Francisco) have until Tuesday to reintroduce the bill. First they will have to come up with two big votes. The bill failed on a 19-15 vote.

 

"We don't want to follow the path of Europe, where the economy is in trouble, where the Euro is failing," Sen. Ted Gaines (R-Roseville) said. "It's not the example we should follow. We don't have the money. I don’t know where the money's going to come from."

 

Gaines also pointed out that California, when compared with nations, has slipped to ninth in economic ranking. Bill author Leno had an answer for that one: "Those other eight economies larger than ours, they all have health care that costs them a lot less than ours does. Maybe we're missing something here."

 

All Republicans present voted against the bill. The abstention of four moderate Democrats and one Democrat's "No" vote turned the political tide on single payer, proponents said.

 

The idea of universal coverage has been passed by the Legislature before. In 2007 and 2009, both houses approved the idea, only to have it vetoed by Gov. Schwarzenegger. Last year, it passed the Senate and stalled when it was not brought to the floor in the Assembly.

 

In yesterday's Senate discussion, Joseph Simitian (D-Santa Clara) said he had some reservations about the bill but felt it was too important an issue to dismiss.

 

"I sometimes think we have the wrong debate on the Senate floor," Simitian said. "The fundamental question is: Does every Californian have the right to access quality, affordable health care? I will be casting an aye vote today, because I believe every Californian should have that, everyone should get quality, affordable health care in California."

 

If the bill is reintroduced by Tuesday and it gets 21 votes on the Senate floor, it would move to the Assembly.

3 comments

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    "Molly" wrote "Why is suicide usually looked upon as a desperate and forbidden act? Can't we accept that in addition to poverty, loneliness, alienation, ill health, life in world that is sometimes personally pointless means that death is a relief? I believe the right to die, in a time and place (and wishfully peacefully without violence) is a basic human right."
    Visit ScientificAmerican.com for the latest in science, health and technology news.
    On the NYTimes readers' page, I saw exactly this transpiring. I began to see other readers both acknowledge the existence of suicidal thoughts within themselves, but also point to protective factors present in their lives - a family, a home, a job. They began to protect each other. There was hardly any of the "oh banish such thoughts from your heads" but rather, comments like these: "please go hug your friend, tell him that you are there for him, and take him to the emergency room."
    My first thought was to worry that by acknowledging the appeal of suicide, the NYTimes readers would somehow descend into suicide advocacy and subsequently, actual suicides. As a student of psychiatry, I watched patients create 'chain analyses' where they mapped out for themselves how an emotion led to a thought, which led to a behavior, and subsequently an action. After all, the whole field of cognitive behavioral therapy rests on the principle that governing thought patterns is critical to staying safe and maintaining control.
    Why aren't the NYTimes editors moderating and removing these comments? I thought.
    Often, it is up to peers, friends and strangers on the Internet alike, to listen to and try to understand each other. As many of the NYTimes readers acknowledged, the slow burn of aspirations meeting harsh reality, the progressive compromise of our deepest wishes, and surrender of hope for change in the future is the disappointing but normal trajectory of a human life.
    Mathias CW et al. What's the harm in asking about suicidal ideation? Suicide Life Threat Behav. 2012; 42(3):341-51.

    漏 2013 ScientificAmerican.com. All rights reserved.
    One reader expanded on this sound advice by recommending walks through one's city. "These walks, if no more than around the block, are always interesting," he wrote. "Incredible and changing sights, a constant and changing background of sounds, smells - and a gratifying reminder of the human race, of which we are members, even yet. We are not alone. It ain't over 'til it's over. Meanwhile, it's all - all, every aspect of it, pain and pleasure - interesting."

    A recent article in NYTimes ] declared that the rising rate of suicides among our baby boomer generation now made suicides, by raw numbers alone, a bigger killer than motor vehicle accidents! Researchers quoted within the article pointed to complex reasons like the economic downturn over the past decade, the widespread availability of opioid drugs like oxycodone, and changes in marriage, social isolation and family roles. Then I scrolled down, as I always do, to peruse some of the readers' comments, and that's when I paused.
    But then I remembered something else that I learned in psychiatry: asking patients about their suicidal impulses does not actually encourage the act. Asking depressed patients about a thought or a plan does not remind them to leave your office and buy a gun. If someone is thinking about taking his or her own life, your questions will not result in an iatrogenic increase in those thoughts ]. If anything, patients welcome the opportunity to confide in someone they trust about these intrusive thoughts, and the possibility of talking through their emotions in a safe environment.
    This post was 'recommended' by 351 other readers at the time of this essay being written.
    Follow Scientific American on Twitter @SciAm and @SciamBlogs.
    References:
    "All I Really Want to Do Is Sleep"
    Havens LL. The Anatomy of a Suicide. N Engl J Med 1965; 272:401-406.
    The weight of depression is often compounded by the conviction that patients carry of not being understood. While shadowing my preceptor in an in-patient psychiatric unit, I often saw patients offer bland responses or false, brave fronts in response to our probing about mood and activity. The ability to refuse to accept such superficial facades and demand to understand the truth of a person's internal life is of the utmost significance in any psychiatrist's office, and is the hallmark of this profession. After all, a patient who understands completely the undercurrents of his or her thought processes will likely not need a shrink.
    Image: Jonathan McIntosh.

    But an empathic understanding of suicide need not be the sole province and possession of psychiatrists. As one of the great psychiatrists of our times, Leston Havens, once noted in an essay titled "The Anatomy of a Suicide," such empathy can grow from an open-minded review and understanding of our own lives, for most people have had suicidal thoughts, perhaps even suicidal impulses ].
    "MB" wrote, to the approval of 394 of fellow readers, "Has anyone considered fatigue?.... Stress and overwork (and the prospect of continuing to do so until my health gives out, without any realistic hope of retirement, assuming that I want to keep on eating when I get really old) have taken a toll. All I really want to do is sleep. I'm tired of fighting, tired of running on adrenaline for years at a stretch. Adrenaline was designed for short bursts of energy, not a multi-year slog. I dream about suicide chiefly because it would enable me to take a long rest."
    Such comments proliferated.
    I suppose in hindsight that I had expected readers to exclaim at the shocking statistics (suicide rates now stand at 27.3 per 100,000 for middle aged men, 8.1 per 100,000 for women), or lament over personal stories of relatives or friends who took their own lives. While I certainly saw a few such comments, I was amazed to discover the number of readers who were sympathetic to the idea of suicide.


    Parker-Pope, Tara. "Suicide Rates Rise Sharply in US." New York Times. N.p., 2 May 2013.

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    "Molly" wrote "Why is suicide usually looked upon as a desperate and forbidden act? Can't we accept that in addition to poverty, loneliness, alienation, ill health, life in world that is sometimes personally pointless means that death is a relief? I believe the right to die, in a time and place (and wishfully peacefully without violence) is a basic human right."

    References:
    My first thought was to worry that by acknowledging the appeal of suicide, the NYTimes readers would somehow descend into suicide advocacy and subsequently, actual suicides. As a student of psychiatry, I watched patients create 'chain analyses' where they mapped out for themselves how an emotion led to a thought, which led to a behavior, and subsequently an action. After all, the whole field of cognitive behavioral therapy rests on the principle that governing thought patterns is critical to staying safe and maintaining control.
    One reader expanded on this sound advice by recommending walks through one's city. "These walks, if no more than around the block, are always interesting," he wrote. "Incredible and changing sights, a constant and changing background of sounds, smells - and a gratifying reminder of the human race, of which we are members, even yet. We are not alone. It ain't over 'til it's over. Meanwhile, it's all - all, every aspect of it, pain and pleasure - interesting."
    "MB" wrote, to the approval of 394 of fellow readers, "Has anyone considered fatigue?.... Stress and overwork (and the prospect of continuing to do so until my health gives out, without any realistic hope of retirement, assuming that I want to keep on eating when I get really old) have taken a toll. All I really want to do is sleep. I'm tired of fighting, tired of running on adrenaline for years at a stretch. Adrenaline was designed for short bursts of energy, not a multi-year slog. I dream about suicide chiefly because it would enable me to take a long rest."
    I suppose in hindsight that I had expected readers to exclaim at the shocking statistics (suicide rates now stand at 27.3 per 100,000 for middle aged men, 8.1 per 100,000 for women), or lament over personal stories of relatives or friends who took their own lives. While I certainly saw a few such comments, I was amazed to discover the number of readers who were sympathetic to the idea of suicide.

    Often, it is up to peers, friends and strangers on the Internet alike, to listen to and try to understand each other. As many of the NYTimes readers acknowledged, the slow burn of aspirations meeting harsh reality, the progressive compromise of our deepest wishes, and surrender of hope for change in the future is the disappointing but normal trajectory of a human life.
    On the NYTimes readers' page, I saw exactly this transpiring. I began to see other readers both acknowledge the existence of suicidal thoughts within themselves, but also point to protective factors present in their lives - a family, a home, a job. They began to protect each other. There was hardly any of the "oh banish such thoughts from your heads" but rather, comments like these: "please go hug your friend, tell him that you are there for him, and take him to the emergency room."

    But an empathic understanding of suicide need not be the sole province and possession of psychiatrists. As one of the great psychiatrists of our times, Leston Havens, once noted in an essay titled "The Anatomy of a Suicide," such empathy can grow from an open-minded review and understanding of our own lives, for most people have had suicidal thoughts, perhaps even suicidal impulses ].
    The weight of depression is often compounded by the conviction that patients carry of not being understood. While shadowing my preceptor in an in-patient psychiatric unit, I often saw patients offer bland responses or false, brave fronts in response to our probing about mood and activity. The ability to refuse to accept such superficial facades and demand to understand the truth of a person's internal life is of the utmost significance in any psychiatrist's office, and is the hallmark of this profession. After all, a patient who understands completely the undercurrents of his or her thought processes will likely not need a shrink.

    "All I Really Want to Do Is Sleep"
    漏 2013 ScientificAmerican.com. All rights reserved.
    Visit ScientificAmerican.com for the latest in science, health and technology news.
    This post was 'recommended' by 351 other readers at the time of this essay being written.
    Parker-Pope, Tara. "Suicide Rates Rise Sharply in US." New York Times. N.p., 2 May 2013.
    Image: Jonathan McIntosh.
    A recent article in NYTimes ] declared that the rising rate of suicides among our baby boomer generation now made suicides, by raw numbers alone, a bigger killer than motor vehicle accidents! Researchers quoted within the article pointed to complex reasons like the economic downturn over the past decade, the widespread availability of opioid drugs like oxycodone, and changes in marriage, social isolation and family roles. Then I scrolled down, as I always do, to peruse some of the readers' comments, and that's when I paused.
    But then I remembered something else that I learned in psychiatry: asking patients about their suicidal impulses does not actually encourage the act. Asking depressed patients about a thought or a plan does not remind them to leave your office and buy a gun. If someone is thinking about taking his or her own life, your questions will not result in an iatrogenic increase in those thoughts ]. If anything, patients welcome the opportunity to confide in someone they trust about these intrusive thoughts, and the possibility of talking through their emotions in a safe environment.
    Havens LL. The Anatomy of a Suicide. N Engl J Med 1965; 272:401-406.
    Such comments proliferated.

    Follow Scientific American on Twitter @SciAm and @SciamBlogs.
    Mathias CW et al. What's the harm in asking about suicidal ideation? Suicide Life Threat Behav. 2012; 42(3):341-51.
    Why aren't the NYTimes editors moderating and removing these comments? I thought.

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