health care

“Welfare” as it now exists in the United States aims to provide a short-term safety net for very needy families with children and prepare adults to get jobs. The Temporary Assistance for Needy Families law passed by Congress in 1996 said that cash assistance should be limited to no more than five years (sixty months) over a lifetime. But states were allowed some flexibility to extend this limit for up to one-fifth of their welfare recipients who face unusual problems.

Until last year, the state of Maine took advantage of this flexibility to provide extended help to less than 15% of its caseload. Some people could continue to get benefits if they complied with all welfare rules, including the rule about seeking or preparing for employment. But in 2011, the Maine legislature voted to make the sixty-month limit virtually absolute. Exceptions would be granted only if people were awarded a special hardship extension due to coping with disability, domestic violence, or the need to care for a disabled family member.

When the new law took effect in 2012, more than 2,000 Maine families were affected. About 44% requested hardship extensions, but only a quarter of all people scheduled for termination got the exception. Since January 1, 2012, more than 1,500 Maine families, including 2,700 children have lost cash benefits. Who are these families and what are their circumstances? To answer this question and consider whether welfare has adequate protections for the most vulnerable, I surveyed a sample of 54 Maine families whose benefits were stopped and did some additional in-depth personal interviews to probe people’s experiences more deeply. more...

Are there magic bullets that will insure that every person can grow old gracefully – live out the final years with soundness in mind and body? Of course not. Illnesses or accidents can strike unexpectedly, and no one has the capacity to alter completely the influence of genetic destiny or avoid the inevitable decline of bodily systems. Yet there is much that each person can do – along with family members, friends, and caregivers – to maximize the likelihood of completing the final stages of life in strong, active, and satisfying fashion.

Professionally-vetted research, including studies I have completed with my colleague Edward Thompson, Jr., reveal that lifestyles can have a powerful effect on extending both the quality and quantity of the years available to each person as he or she grows older. Optimal choices require people to be well-informed and exercise good judgment about everything from eating habits and physical activity, to keeping in touch with other people and making regular visits to the doctor. more...

As the debate over immigration reform heats up, a number of contentious issues are front and center – including competition over jobs, border security, and the very meaning of U.S. citizenship. Politicians and pundits have plenty to say about these topics, and no doubt there will also be fierce debates about which public benefits should be available to new citizens or people on a “path to citizenship.” At what point, if any, should formerly undocumented residents gain access to welfare benefits, unemployment insurance, or the new protections included in the recently enacted health reform law?

One important topic that may not get enough attention is how the basic health of immigrants themselves could be affected by reforms. Will reforms make it easier for all migrants to get timely and adequate health care, not just for sudden problems like injuries in an accident but also for chronic diseases? The answers matter not just for the wellbeing of newcomers themselves, but for the health and prosperity of all Americans, the neighbors and co-workers of immigrants. more...

In May of 2013, the American Psychiatric Association will publish the much-anticipated fifth edition of its Diagnostic and Statistical Manual of Mental Disorders – a tome often called the “Bible of psychiatry” because it defines every recognized mental disorder and is used in all facets of the U.S. system of mental health care and psychiatric research. The first edition of this manual appeared just over six decades ago, and periodic revisions since then have evolved into major events with high stakes for patients, researchers, and mental health care providers. Over the years the process of revision has become highly controversial, as more and more disorders have been identified. Is America really suffering from an “epidemic” of mental illnesses? more...