Congress has a chance to overhaul the provision of care, making treatment more available to those who desperately need it.
.. Every day, when I am walking to work, or just walking through the streets of downtown Washington, I encounter homeless people on the street. The homeless cover many categories, but prominent among them are those with serious mental illnesses. They know no boundaries of race or education; there was a prominent story last year in the Washington Post of a homeless man with schizophrenia who told a judge that he didn’t need a lawyer, that he was a lawyer. When the judge reacted with bemused skepticism, the man informed the judge—accurately—that they had been in the same class at Harvard Law School (which also included Chief Justice Roberts!)
.. our focus has been far more on less serious illnesses like anxiety and depression than on the most serious mental illnesses, and our deep and understandable concern about civil liberties has gone too far when it comes to those who either don’t recognize they are ill or have deep psychoses. For them, freedom of choice can mean homelessness, jail, or worse.
.. 90 percent of beds in state hospitals have been eliminated, leaving only the streets, jails, or prisons for those with serious mental illness.
.. But they face another problem—getting adequate reimbursement from insurance companies—including from Medicaid and Medicare. Thanks to the yeoman efforts of the late Senator Paul Wellstone, along with Pete Domenici, the law provides for parity in insurance coverage for mental-health and physical-health services, a provision that was underscored in the Affordable Care Act. But as lots of people who have tried to get reimbursement from their providers for psychiatric care could attest, parity in theory and in practice are two different things. And even where providers cover the services, the reimbursement rates are often well below what is provided for physical health issues.
.. The best hope for the Stabenow-Blunt bill is to incorporate it into the opioid-crisis bill now in a conference committee
Vote all you want. The secret government won’t change.
Though it’s a bedrock American principle that citizens can steer their own government by electing new officials, Glennon suggests that in practice, much of our government no longer works that way. In a new book, “National Security and Double Government,” he catalogs the ways that the defense and national security apparatus is effectively self-governing, with virtually no accountability, transparency, or checks and balances of any kind. He uses the term “double government”: There’s the one we elect, and then there’s the one behind it, steering huge swaths of policy almost unchecked. Elected officials end up serving as mere cover for the real decisions made by the bureaucracy.
.. I think the American people are deluded, as Bagehot explained about the British population, that the institutions that provide the public face actually set American national security policy. They believe that when they vote for a president or member of Congress or succeed in bringing a case before the courts, that policy is going to change. Now, there are many counter-examples in which these branches do affect policy, as Bagehot predicted there would be. But the larger picture is still true—policy by and large in the national security realm is made by the concealed institutions.
.. The ultimate problem is the pervasive political ignorance on the part of the American people. And indifference to the threat that is emerging from these concealed institutions.
.. The people have to take the bull by the horns. And that’s a very difficult thing to do, because the ignorance is in many ways rational. There is very little profit to be had in learning about, and being active about, problems that you can’t affect, policies that you can’t change.
Government IT: The difference between 18F and USDS
18F’s secret sauce is that it is insistently dogmatic about collaborating in the open, and after expending a great deal of organizational energy painting a picture of a citizen-centric future and doing their best to inspire agency stakeholders that the way 18F approaches technology is vastly superior to the status quo, they will simply refuse to work with an agency unless the agency agrees to adopt 18F’s culture and workflow, at least for the project at hand.
For 18F, the goal isn’t simply to deliver the piece of software that they were asked to create, but to leave the partner agency with a better sense of and appreciation for what modern software development looks like outside the Beltway.
.. Whereas a win for 18F might be for a partner agency to grace the front cover of the Washington Post, for USDS, the goal is the exact opposite: to prevent a short list of technology-backed policy initiatives from making the news, at least not from a technology standpoint.
The Firing of Chuck Hagel
But even if the president wanted to disengage from Syria, says a senior adviser, “His hands are largely tied because of the brutal executions by ISIS.” It’s considered quite likely that ISIS will continue the beheadings; no one is sure whether the point is to provoke the US into a difficult war, but that’s the effect. A participant in the discussions of US policy in the Middle East says, “As long as ISIS is beheading Americans there’s no way the president can stand up and say that Syria isn’t our problem.” This is an assumption, not a fact.
.. Though Hagel and Obama thought quite alike and respected each other, Hagel was probably not cut out for the Obama administration, or for what it’s evolved into. Though Hagel had, and used, a direct line to Obama—calling in frustration after a larger meeting where he felt he hadn’t been listened to, and over time largely wasn’t, Obama wasn’t as welcoming of diverse voices as he’d first indicated he would be.
.. Hagel particularly chafed at the White House’s governing style on national security policy. He believed—and in this he was far from alone within and outside the administration—that national security adviser Susan Rice is in over her head. And Rice’s admittedly abrasive style put off a large number of people. But she’s been close to the president from the days of the 2008 campaign, and that appears to be what matters most to him.