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Monthly Archives: March 2018

Laura Ingraham mocked this Parkland survivor. His response was dignified and swift.

Making fun of Parkland survivors is in bad taste. Turns out, it’s also bad for business.

Conservative media commentators are getting a crash course in decency from the Parkland shooting survivors. The latest example is Fox News host Laura Ingraham, who mocked survivor David Hogg on her Twitter account for not getting into the colleges of his choice, writing:

“David Hogg Rejected By Four Colleges To Which He Applied and whines about it. (Dinged by UCLA with a 4.1 GPA…totally predictable given acceptance rates.)”

Laura Ingraham @IngrahamAngle

David Hogg Rejected By Four Colleges To Which He Applied and whines about it. (Dinged by UCLA with a 4.1 GPA…totally predictable given acceptance rates.) https://www.dailywire.com/news/28770/gun-rights-provocateur-david-hogg-rejected-four-joseph-curl 

Gun Rights Provocateur David Hogg Rejected By Four Colleges At Which He Applied

David Hogg, a self-appointed spokesman for a generation, revealed on Tuesday that four universities he has applied to have rejected his application.

People quickly took notice and many of them weren’t happy.

Hogg responded by asking people to contact the advertisers who pay for Ingraham’s show, another example of how much better the Parkland teens understand social media than their critics.

David Hogg@davidhogg111

Pick a number 1-12 contact the company next to that #

Top Laura Ingraham Advertisers
1. @sleepnumber
2. @ATT
3. Nutrish
4. @Allstate & @esurance
5. @Bayer
6. @RocketMortgage Mortgage
7. @LibertyMutual
8. @Arbys
9. @TripAdvisor
10. @Nestle
11. @hulu
12. @Wayfair

The Parkland students are showing adults there’s a new level of accountability in 2018.

No doubt Hogg and his supporters were angry. But instead of lowering themselves to Ingraham’s level, he went for direct action. Ironically, he also used a guiding principle of conservative thought against Ingraham by “letting the market speak.”

And speak it did.

This isn’t new ground for the Parkland teens. As Hogg’s own pinned tweet from March 11 explains:

Can we please not debate this as Democrats and Republicans but discuss this as Americans? In the comments if you see someone you dissagree with do not attack each other  talk to one another, this applies to me too. WE MUST WORK TOGETHER TO SAVE OUR FUTURE.

David Hogg@davidhogg111

Can we please not debate this as Democrats and Republicans but discuss this as Americans? In the comments if you see someone you dissagree with do not attack each other talk to one another, this applies to me too. WE MUST WORK TOGETHER TO SAVE OUR FUTURE.

Advertisers quickly began announcing they were pulling their dollars from her show. As the story went viral, Ingraham finally published an apology to her over 2 million Twitter followers, writing:

“Any student should be proud of a 4.2 GPA —incl.@DavidHogg111.  On reflection, in the spirit of Holy Week, I apologize for any upset or hurt my tweet caused him or any of the brave victims of Parkland. For the record, I believe my show was the first to feature David immediately after that horrific shooting and even noted how “poised” he was given the tragedy. As always, he’s welcome to return to the show anytime for a productive discussion.”

Laura Ingraham 

Any student should be proud of a 4.2 GPA —incl. @DavidHogg111. On reflection, in the spirit of Holy Week, I apologize for any upset or hurt my tweet caused him or any of the brave victims of Parkland. For the record, I believe my show was the first to feature David…(1/2)

Laura Ingraham @IngrahamAngle

… immediately after that horrific shooting and even noted how “poised” he was given the tragedy. As always, he’s welcome to return to the show anytime for a productive discussion. WATCH: https://youtu.be/K0v7yxczipo  (2/2)

Ingraham’s apology didn’t sound sincere. But she had to do it anyway.

It’s hard to take Ingraham’s apology at face value. Like so many other half-baked apologies from celebrities and politicians, she expressed remorse not on principle but “for any upset or hurt.” She then quickly pivoted to taking credit for having previously interviewed him, and offered to have him back on her show — something that would undoubtably be good for her ratings and advertisers.

Hogg himself doesn’t buy it, writing:

I 100% agree an apology in an effort just to save your advertisers is not enough. I will only accept your apology only if you denounce the way your network has treated my friends and I in this fight. It’s time to love thy neighbor, not mudsling at children.

David Hogg@davidhogg111

I 100% agree an apology in an effort just to save your advertisers is not enough. I will only accept your apology only if you denounce the way your network has treated my friends and I in this fight. It’s time to love thy neighbor, not mudsling at children. https://twitter.com/fred_guttenberg/status/979423447859318786 

David Hogg@davidhogg111

Focus less on fear and more on facts. Then we can save lives in this country together.

Holding Ingraham and others accountable is the right thing to do and shows a better way forward.

It’s totally fine to disagree with Parkland survivors and their ideas. It’s not fine to make personal attacks that have nothing to do with the issue at hand.

It should be the standard for anyone in any debate.

That Hogg and his fellow students are leading the way here is yet another way they’re showing all of us that there’s a different way to do things.

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Medicare Extra for All

A Plan to Guarantee Universal Health Coverage in the United States

Medicare Extra for All
Getty/Joe Raedle

A woman sits for a checkup at a Planned Parenthood health center on June 23, 2017, in West Palm Beach, Florida.

  • OVERVIEW

    This proposal guarantees the right of all Americans to enroll in the same high-quality plan modeled after the Medicare program.

  • PRESS CONTACT

Introduction and summary

Health care is a right: No American should be left to suffer without the health care they need. The United States is alone among developed countries in not guaranteeing universal health coverage.

Over the past half century, there have been several expansions of health coverage in the United States; today, it is past time to ensure that all Americans have coverage they can rely on at all times.

The most recent coverage expansion, the Affordable Care Act (ACA), was an historic accomplishment, expanding coverage to 20 million Americans—the largest expansion in 50 years.1 The law has also proved to be remarkably resilient: Despite repeated acts of overt sabotage by the Trump administration—and repeated attempts to repeal the law—enrollment has remained steady.2

In the near term, there is an urgent need to resist sabotage and efforts to undermine Medicaid, to push for stabilization to mitigate coverage losses and premium increases, and to expand coverage through Medicaid expansion in all states that have not already done so. At the same time, it is imperative to chart a path forward for the long-term future of the nation’s health care system.

Costs and deductibles remain much too high: 28 percent of nonelderly adults, or 41 million Americans, remain underinsured, which means that out-of-pocket costs exceed 10 percent of income.3 In the wealthiest nation on earth, 28.8 million individuals remain uninsured.4

To address these challenges, the Center for American Progress proposes a new system—“Medicare Extra for All.” Medicare Extra would include important enhancements to the current Medicare program: an out-of-pocket limit, coverage of dental care and hearing aids, and integrated drug benefits. Medicare Extra would be available to all Americans, regardless of income, health status, age, or insurance status.

Employers would have the option to sponsor Medicare Extra and employees would have the option to choose Medicare Extra over their employer coverage. Medicare Extra would strengthen, streamline, and integrate Medicaid coverage with guaranteed quality into a national program.

The cost of coverage would be offset significantly by reducing health care costs. The payment rates for medical providers would reference current Medicare rates—and importantly, employer plans would be able to take advantage of these savings. Medicare Extra would negotiate prescription drug prices by giving preference to drugs whose prices reflect value and innovation. Medicare Extra would also implement long overdue reforms to the payment and delivery system and take advantage of Medicare’s administrative efficiencies. In this report, CAP also outlines a package of tax revenue options to finance the remaining cost.

Medicare Extra for All would guarantee universal coverage and eliminate underinsurance. It would guarantee that all Americans can enroll in the same high-quality plan, modeled after the highly popular Medicare program. At the same time, it would preserve employer-based coverage as an option for millions of Americans who are satisfied with their coverage.

Health systems in developed countries

In developed countries, health systems that guarantee universal coverage have many variations—no two countries take the exact same approach.5 In England, the National Health Service owns and runs hospitals and employs or contracts with physicians. In Denmark, regions own and run hospitals, but reimburse private physicians and charge substantial coinsurance for dental care and outpatient drugs. In Canada, each province and territory runs a public insurance plan, which most Canadians supplement with private insurance for benefits that are not covered, such as prescription drugs or vision and dental care. In Germany, more than 100 nonprofit insurers, known as “sickness funds,” are payers regulated by a global budget, and about 10 percent of Germans buy private insurance, including from for-profit insurers. Across all of these systems, the share of health spending paid for by individuals out of pocket ranges from 7 percent in France to 12 percent to 15 percent in Canada, Denmark, England, Germany, Norway, and Sweden.6 In short, health systems in developed countries use a mix of public and private payers and are financed by a mix of tax revenue and out-of-pocket spending.

In the United States, Medicare is a model of these systems for the elderly population and provides a choice of a government plan or strictly regulated plans through Medicare Advantage. Medical providers are private and are reimbursed by the government either directly or indirectly.

These various systems share two defining features. First, payment of premiums through the tax system—rather than through insurance companies—guarantees universal coverage. The reason is that eligibility is automatic because individuals have already paid their premiums. Second, these systems use their leverage to constrain provider payment rates for all payers and ensure that prices for prescription drugs reflect value and innovation. This is the main reason why per capita health care spending in the United States remains double that of other developed countries.7

Medicare Extra: Legislative specifications

Medicare Extra adopts the U.S. Medicare model and incorporates both of the common features of systems in developed countries. The following are detailed legislative specifications for the plan.

Eligibility

All individuals in the United States would be automatically eligible for Medicare Extra. Individuals who are currently covered by other insurance—original Medicare, Medicare Advantage, employer coverage, TRICARE (for active military), Veterans Affairs medical care, or the Federal Employees Health Benefits Program (FEHBP), all of which would remain—would have the option to enroll in Medicare Extra instead. Individuals who are eligible for the Indian Health Service could supplement those services with Medicare Extra.

Newborns and individuals turning age 65 would be automatically enrolled in Medicare Extra. This auto-enrollment ensures that Medicare Extra would continue to increase in enrollment over time.

Individuals who are not enrolled in other coverage would be automatically enrolled in Medicare Extra. Participating medical providers would facilitate this enrollment at the point of care. Premiums for individuals who are not enrolled in other coverage would be automatically collected through tax withholding and on tax returns. Individuals who are not required to file taxes would not pay any premiums.

In concert with comprehensive immigration reform, people who are lawfully residing in the United States would be eligible for Medicare Extra.

Benefits

Medicare Extra would provide comprehensive benefits, including free preventive care, free treatment for chronic disease, and free generic drugs. The plan would guarantee the following benefits:8

  • Primary and preventive services
  • Hospital services, including emergency services
  • Ambulatory services
  • Prescription drugs and medical devices
  • Laboratory services
  • Maternity, newborn, and reproductive health care
  • Mental health and substance use disorder services
  • Habilitative and rehabilitative services
  • Dental, vision, and hearing services
  • Early and periodic screening, diagnostic, and treatment services for children

Over time, these benefits would be updated, just as benefits are updated under Medicare, through its National Coverage Determination (NCD) process.

The Center for Medicare Extra (described below) would determine base premiums that reflect the cost of coverage only. These premiums would vary by income based on the following caps:

  • For families with income up to 150 percent of the federal poverty level (FPL), premiums would be zero.9
  • For families with income between 150 percent and 500 percent of FPL, caps on premiums would range from 0 percent to 10 percent of income.
  • For families with income above 500 percent of FPL, premiums would be capped at 10 percent of income.

The average share of costs covered by the plan, or “actuarial value,” would also vary by income. For individuals with income below 150 percent of FPL, the actuarial value would be 100 percent—meaning these individuals would face zero out-of-pocket costs. The actuarial value would range from 100 percent to 80 percent for families with middle incomes or higher.

Consistent with these actuarial values, the Center for Medicare Extra would set deductibles, copayments, and out-of-pocket limits that would vary by income. For individuals with income below 150 percent of FPL and lower-income families with incomes above that threshold, the deductible would be set at zero. Preventive care, recommended treatment for chronic disease, and generic drugs would be free.

Enrollees would have a free choice of medical providers, which would include any provider that participates in the current Medicare program. Copayments would be lower for patients who choose centers of excellence that deliver high-quality care, as determined by such measures as the rate of hospital readmissions.

With the exception of employer-sponsored insurance, private insurance companies would be prohibited from duplicating Medicare Extra benefits, but they could offer complementary benefits during an open enrollment period. Complementary insurance would be subject to a limitation on profits and banned from denying applicants, varying premiums based on age or health status, excluding pre-existing conditions, or paying fees to brokers.

Long-term services and supports

Millions of Americans rely on long-term services and supports (LTSS) to support their daily living needs, making expansion and improvement of LTSS coverage an important part of health care reform, especially for Americans with disabilities.

Currently, individuals with disabilities who receive Social Security Disability Insurance are subject to a two-year waiting period before they are eligible for Medicare. Medicare Extra would eliminate this waiting period. In addition, individuals with disabilities can be disqualified from Medicaid coverage if their assets exceed a limit. Medicare Extra would eliminate this asset test and allow individuals with disabilities to earn and keep their savings.

Under the current Medicaid program, there is a wide variation in the benefits offered for LTSS. Medicare Extra would establish a benefit standard based on the benefits of high-quality states, as rated by access and affordability. The Medicare Extra benefit would include coverage of home and community-based services, which make it possible for seniors and people with disabilities to live independently instead of in institutions.

As discussed below, states would make maintenance-of-effort payments to Medicare Extra. States that currently provide more benefits than the Medicare Extra standard would be required to maintain those benefits, sharing the cost with the federal government as they do now. States would continue to administer the benefits that would be financed by Medicare Extra.

The Center for American Progress is developing additional LTSS policy options to supplement this new Medicare Extra benefit.

Medicare Choice

Within the current Medicare program, Medicare Advantage provides a choice of plans that deliver Medicare benefits to seniors. Currently, an estimated 20.4 million seniors are enrolled in Medicare Advantage, or 34 percent of total Medicare enrollment.10 There is evidence that these plans can provide care that is high quality.11 However, Medicare often overpays these plans compared with the traditional Medicare program.12

Medicare Extra would reform Medicare Advantage and reconstitute the program as Medicare Choice. Medicare Choice would be available as an option to all Medicare Extra enrollees. Medicare Choice would offer the same benefits as Medicare Extra and could also integrate complementary benefits for an extra premium.

To eliminate overpayments to plans, Medicare Extra would use its bargaining power to solicit bids from plans. Medicare Extra would make payments to plans that are equal to the average bid, but subject to a ceiling: Payments could be no more than 95 percent of the Medicare Extra premium. This competitive bidding structure would guarantee that plans are offering value that is comparable with Medicare Extra. If consumers choose a plan that costs less than the average bid, they would receive a rebate. If consumers choose a plan that costs more than the average bid, they would pay the difference.

Employer choice

U.S. employers currently provide coverage to 152 million Americans and contribute $485 billion toward premiums each year.13 Surveys indicate that the majority of employees are satisfied with their employer coverage.14 Medicare Extra would account for this satisfaction and preserve employer financing so that the federal government does not unnecessarily absorb this enormous cost.

At the same time, employer coverage is becoming increasingly unaffordable for many employees. Among employees with a deductible for single coverage, the average deductible has increased by 158 percent—faster than wages—from 2006 to 2017.15 The Health Care Cost Institute recently found that price growth accounts for nearly all of the growth in health care costs for employer-sponsored insurance.16

Medicare Extra balances the desire of most employees to keep their coverage with the need of many employees for a more affordable option. Employers would have four options designed to ensure that they pay no more than they currently do for coverage.

First, employers may choose to continue to sponsor their own coverage. Their coverage would need to provide an actuarial value of at least 80 percent and they would need to contribute at least 70 percent of the premium; the vast majority of employers already exceed these minimums.17 The current tax benefit for premiums for employer-sponsored insurance—which excludes premiums from income that is subject to income and payroll taxes—would continue to apply (as modified below).

Second, employers may choose to sponsor Medicare Extra for all employees as a form of employer-sponsored insurance. Employers would need to contribute at least 70 percent of the Medicare Extra premium. Under this option, employers would automatically enroll all employees into Medicare Extra. The Medicare Extra cost-sharing structure would apply and employees would pay the Medicare Extra income-based premium for their share of the premium. The tax benefit for employer-sponsored insurance would not apply to premium contributions under this option.

Third, employers may choose to make maintenance-of-effort payments, with their employees enrolling in Medicare Extra. These payments would be equal to their health spending in the year before enactment inflated by consumer medical inflation. To adjust for changes in the number of employees, health spending per full-time equivalent worker (FTE) would be multiplied by the number of current FTEs in any given year. The tax benefit for employer-sponsored insurance would not apply to employer payments under this option.

Fourth, employers may choose to make simpler aggregated payments in lieu of premium contributions. These payments would range from 0 percent to 8 percent of payroll depending on employer size—about what large employers currently spend on health insurance on average.18 The tax benefit for employer-sponsored insurance would not apply to employer payments under this option.

Small employers—71 percent of which do not currently offer coverage—would not need to make any payments at all.19They may choose to offer no coverage, their own coverage subject to ACA rules in effect before enactment, or Medicare Extra. Small employers are defined as employers that employ fewer than 100 FTEs for purposes of the options described above.20

Employee choice

When employers choose to offer their own coverage, employees may choose to enroll in Medicare Extra instead.21 At the beginning of open enrollment, employers would notify employees of the availability of Medicare Extra and provide informational resources. If employees do not make a plan selection, employers would automatically enroll them into their own coverage.

When employees enroll in Medicare Extra, their employers would contribute the same amount to Medicare Extra that they contribute to their own coverage. The Medicare Extra income-based premium caps would apply to the employee share of the premium. Because employees would be subsidized by Medicare Extra, the tax benefit for employer-sponsored insurance would not apply to employer premium contributions under this option.

State maintenance of effort

Medicaid and the Children’s Health Insurance Program (CHIP) would be integrated into Medicare Extra with the federal government paying the costs. Given the continued refusal of many states to expand Medicaid and attempts to use federal waivers to undermine access to health care, this integration would strengthen the guarantee of health coverage for low-income individuals across the country. It would also ensure continuity of care for lower-income individuals, even when their income changes.

States would be required to make maintenance-of-effort payments to Medicare Extra equal to the amounts that they currently spend on Medicaid and CHIP.22 For states that did not expand Medicaid, these amounts would be inflated by the growth in gross domestic product (GDP) per person plus 0.7 percentage points.23 For states that did expand Medicaid, these amounts would be inflated by the growth in GDP per person plus 0.2 percentage points. After 10 years of payments, they would then increase by the growth in GDP per person plus 0.7 percentage points for all states. This structure would ensure that no state spends more than they currently spend, while giving a temporary discount to states that expanded their Medicaid programs.

States that currently provide benefits that are not offered by Medicare Extra would be required to maintain those benefits, sharing the cost with the federal government as they do now. They would provide “wraparound” coverage that would supplement Medicare Extra coverage.

Administration

Medicare Extra would be administered by a new, independent Center for Medicare Extra within the current Centers for Medicare and Medicaid Services, which would be renamed the Center for Medicare. To ensure that the Center for Medicare Extra is immune from partisan political influence within the administration, the legislative statute would leave little to no discretion to the administration on policy matters. In this respect, the administration of Medicare Extra would resemble the administration of the current Medicare program and not of the Medicaid program.

Transitioning to Medicare Extra

The transition to Medicare Extra would be staggered to ensure a smooth implementation. The steps would be sequenced based on need, fairness, and ease of implementation. Before Medicare Extra is launched, a public option would fill immediate gaps and provide immediate relief.

In the first year after enactment (Year 1), the Center for Medicare Extra would be established and would offer a public option in any counties that are not served by any insurer in the individual market. The provider payment rates of the plan would be 150 percent of Medicare rates. In Year 2, this plan could be extended to other counties in the individual market.

In Year 4, the Center would launch Medicare Extra. Auto-enrollment would begin for current enrollees in the individual market, the uninsured, newborns, and individuals turning age 65. Enrollees in the current Medicare program and employees with employer coverage would have the option to enroll in Medicare Extra instead. Small employers would have the option to sponsor Medicare Extra for all employees.

In Year 6, enrollees in Medicaid and CHIP would be auto-enrolled into Medicare Extra. In Year 8, large employers would have the option to sponsor Medicare Extra for all employees, and the tax benefit for employer-sponsored insurance would be limited for high-income employees.

Financing Medicare Extra

Medicare Extra would be financed by a combination of health care savings and tax revenue options. CAP intends to engage an independent third party to conduct modeling simulation to determine how best to set the numerical values of the parameters. Developed countries are able to guarantee universal coverage while spending much less than the United States because their systems use leverage to constrain prices. In the United States, adopting Medicare’s pricing structure—even at levels that restrain prices by less than European systems—is an essential part of financing universal coverage.

Health care savings

Provider payment rates

Extensive research recently has shown that variation in prices charged by medical providers is the main driver of health care costs for commercial insurance.24 Hospital systems in particular can act as a monopoly, dictating prices in areas where there is little competition. Excessive prices are not a major issue for Medicare because it has leverage to set prices administratively.

To lower both the level and growth of health care costs, provider payment rates under Medicare Extra would reference current Medicare rates. Currently, Medicaid rates are lower than Medicare rates, and both are significantly lower than commercial insurance rates.25 Medicare Extra rates would be lower than current commercial rates in noncompetitive areas where hospitals reap windfalls, but higher than current Medicaid and Medicare rates.

Medicare Extra rates would reflect an average of rates under Medicare, Medicaid, and commercial insurance—minus a percentage. For illustrative purposes, CAP estimates that if Medicare Extra rates are 100 percent of Medicare rates for physicians and 120 percent of Medicare rates for hospitals, the rates would be roughly 10 percentage points lower than the current average rate across payers.26 For rural hospitals, these rates would be increased as necessary to ensure that they do not result in negative margins.

For physicians, average rates for primary care would be increased by 20 percent relative to certain rates for specialty care on a budget neutral basis. This adjustment would correct Medicare’s substantial bias in favor of specialty care at the expense of primary care. Extensive research suggests that greater shares of spending on primary care result in lower costs and higher quality of care.27

Importantly, the benefits of Medicare Extra rates would extend to employer-sponsored insurance and significantly lower premiums. For employer-sponsored insurance, providers that are out of network would be prohibited from charging more than Medicare Extra rates. Research shows that this type of rule—which currently applies to Medicare Advantage plans—indirectly lowers rates charged by providers that are in network.28

Prescription drug costs

Until Medicare Extra is launched, drug manufacturers would pay the Medicaid rebate on drugs covered under Medicare drug plans for low-income beneficiaries. The Congressional Budget Office estimates that this policy would reduce federal spending by $134 billion over 10 years.29

Medicare Extra would negotiate prices for prescription drugs, medical devices, and durable medical equipment. To aid the negotiations, multiple nonprofit, independent evaluators would vet data submitted by manufacturers, conduct studies, and make periodic value assessments. If negotiated prices are within the range of prices recommended by all evaluators, Medicare Extra would include the product on a preferred tier with limited cost sharing. If prices for existing products rise faster than inflation, manufacturers would pay rebates on products covered under Medicare Extra—just as they do under the current Medicaid program.

Payment and delivery system reform

Medicare Extra would reform the payment and delivery system to reward high-quality care. Medicare Extra would pay hospitals for a bundle of services, including associated care for 90 days after discharge. The objective of this reform is to reduce variation in post-acute care, which is the main driver of health care costs under Medicare.30 Medicare Extra would phase in this reform over three years until it applies to half of spending on hospital admissions.

Medicare Extra would make “site-neutral” payments—the same payment for the same service, regardless of whether it occurs at a hospital or physician office.31 The current Medicare program pays hospitals far more than it pays freestanding physician offices for physician office visits. Not only is this excess payment wasteful, it provides a strong incentive for hospitals to acquire physician offices—aggregating market power that drives up prices for commercial insurance.

Administrative efficiencies

Excessive administrative costs are a key reason why health care costs are so much higher in the United States compared to other developed countries.32 Medicare Extra would take advantage of the current Medicare program’s low administrative costs, which are far lower than the administrative costs of private insurance.33 In particular, the cost and burden to physicians of administering multiple payment rates for multiple programs and payers would be greatly reduced.

In addition to having economies of scale and no need to make a profit, Medicare Extra would implement several administrative efficiencies. Providers would only need to report one set of quality measures and physicians would only need to submit one set of clinical credentials. Medicare Extra and providers would transmit claims information and payment electronically.34 Electronic health records would automatically convert clinical entries into claims information. Importantly, so-called churning between Medicaid and the individual market—in which individuals must frequently enroll and unenroll due to changes in eligibility—would be eliminated.35

Tax revenue options

The American people have many major unmet needs. Medicare Extra is carefully designed to leverage existing financing by states and employers and extract maximum savings so that the program would not consume all potential sources of tax revenue. Some combination of the following tax revenue options would be sufficient to finance the remaining cost of Medicare Extra.

The recently enacted Tax Cut and Jobs Act (TCJA) lowered the corporate tax rate from 35 percent to 21 percent and enacted several other tax cuts skewed toward the wealthy. As part of a broader effort to replace the tax bill, some of the revenue could help finance Medicare Extra.

Medicare Extra would be financed in part by taxes on high-income individuals. One option would be a surtax on adjusted gross income—including capital gains—on very high-income individuals. CAP’s modeling will determine the exact parameters of the surtax, including the rate. In addition, under current law, large accumulations of wealth are never subject to capital gains taxes if held until death and transferred to heirs. One option would be to eliminate this stepped-up basis so that large accumulations of wealth cannot avoid capital gains tax.

Medicare Extra would also be financed in part by increasing health care taxes and curtailing health care tax breaks. For high-earners—singles with income above $200,000 and couples with income above $250,000—the additional Medicare payroll tax and the Medicare net investment income tax (NIIT) could be increased. In addition, all business income of high-income taxpayers—including S corporation shareholders, limited partners, and members of limited liability companies—could be subject to the Medicare tax either through self-employment taxes or the NIIT. The tax benefit from the exclusion for employer-sponsored insurance would be capped at 28 percent. In addition, lower premiums for employer-sponsored insurance would significantly reduce this tax expenditure. Medicare Extra would also obviate the need for tax benefits for flexible spending accounts and health savings accounts.

Lastly, Medicare Extra would be financed in part through public health excise taxes. The federal excise tax on cigarettes would be increased by 50 cents per pack and adjusted for inflation. A tax could also be imposed on sugared drinks equal to 1 cent per ounce. These taxes would reduce health care spending, helping to offset the cost of Medicare Extra. 

Conclusion

Medicare Extra for All would guarantee the right of all Americans to enroll in the same high-quality plan, modeled after the highly popular Medicare program. It would eliminate underinsurance, with zero or low deductibles, free preventive care, free treatment for chronic disease, and free generic drugs. It would provide additional security to individuals with disabilities, strengthen Medicaid’s guarantee, improve benefits for seniors, and give small businesses an affordable option. At the same time, enrollees would have a choice of plans, and employer coverage would be preserved for millions of Americans who are satisfied with it.

Our society will be judged by how it treats the sickest and the most vulnerable among us. Health care is a right, not a privilege, because our positions in life are influenced a great deal by circumstances at birth; and beyond birth, the lottery of life is unpredictable and outside of one’s control.

America, the most powerful and wealthiest nation in the history of civilization, has endured a long journey spanning decades to fulfill these principles. The country has slowly added step upon step toward universal health coverage. The ACA was a giant step, and the sustained political fight over the law showed that the American people want to expand coverage, not repeal it. It is now time to guarantee universal coverage and health security for all Americans.

Endnotes

  1. Office of the Assistant Secretary for Planning and Evaluation, Health Insurance Coverage and the Affordable Care Act, 2010 – 2016 (U.S Department of Health and Human Services, 2016), available at https://aspe.hhs.gov/sites/default/files/pdf/187551/ACA2010-2016.pdf
  2. Emily Gee, “Marketplaces Prove Stable Despite Trump’s Attempts to Sabotage Enrollment,” Center for American Progress, February 15, 2018, available at https://www.americanprogress.org/issues/healthcare/news/2018/02/15/446737/marketplaces-prove-stable-despite-trumps-attempts-sabotage-enrollment/
  3. Sara R. Collins, Munira Z. Gunja, Michelle M. Doty, “How Well Does Insurance Coverage Protect Consumers from Health Care Costs?: Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2016” (New York: The Commonwealth Fund, 2017), available at http://www.commonwealthfund.org/publications/issue-briefs/2017/oct/insurance-coverage-consumers-health-care-costs
  4. Emily P. Zammitti and others, “Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–June 2017” (National Center for Health Statistics, 2017), available at https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201711.pdf. People of color are the growing majority in America and are disproportionately uninsured. This plan will increase access to health coverage for this growing population.  
  5. Elias Mossialos and others, ed., International Profiles of Health Care Systems (New York: The Commonwealth Fund, 2017). 
  6. Organization for Economic Co-operation and Development, “OECD Data: Health Spending,” available at https://data.oecd.org/healthres/health-spending.htm (last accessed February 2018). 
  7. Bradley Sawyer and Cynthia Cox, “How does health spending in the U.S. compare to other countries?”, Peterson-Kaiser Health System Tracker, February 13, 2018, available at https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#item-average-wealthy-countries-spend-half-much-per-person-health-u-s-spends
  8. The nondiscrimination provisions of 42 U.S.C. 18116 would apply. 
  9. The tax filing threshold is $10,400 or 86 percent of poverty for singles and $20,800 or 127 percent of poverty for married couples. See Internal Revenue Service, “Publication 501: Exemptions, Standard Deduction, and Filing Information” (2018), available at https://www.irs.gov/pub/irs-pdf/p501.pdf
  10. Centers for Medicare and Medicaid Services, “Medicare offers more health coverage choices and decreased premiums in 2018,” Press release, September 29, 2017, available at https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2017-Press-releases-items/2017-09-29.html
  11. Austin Frakt, “Medicare Advantage Is More Expensive, but It May Be Worth It,” The New York Times, August 14, 2014, available at https://www.nytimes.com/2014/08/19/upshot/medicare-advantage-is-more-expensive-but-it-may-be-worth-it.html
  12. Austin Frakt, “Medicare Advantage Spends Less on Care, So Why Is It Costing So Much?,” The New York Times, August 7, 2017, available at https://www.nytimes.com/2017/08/07/upshot/medicare-advantage-spends-less-on-care-so-why-is-it-costing-so-much.html
  13. Kaiser Family Foundation, “State Health Facts: Health Insurance Coverage of Nonelderly 0-64,” available at https://www.kff.org/other/state-indicator/nonelderly-0-64/?dataView=1&currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D (last accessed February 2018); Centers for Medicare and Medicaid Services, “National Health Expenditure Accounts, Table 5-1,” available at https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html (last accessed February 2018). 
  14. Paul Fronstin and Lisa Greenwald, “Workers Rank Health Care as the Most Critical Issue in the United States,” Employee Benefit Research Institute, January 25, 2018, available at https://www.ebri.org/pdf/notespdf/EBRINotes%20v39no13.pdf; Zac Auter, “Americans’ Satisfaction With Healthcare System Edges Down,” Gallup, September 15, 2016, available at http://news.gallup.com/poll/195605/americans-satisfaction-healthcare-system-edges-down.aspx
  15. Kaiser Family Foundation, “2017 Employer Health Benefits Survey,” September 19, 2017, available at https://www.kff.org/health-costs/report/2017-employer-health-benefits-survey/
  16. Health Care Cost Institute, “2016 Health Care Cost and Utilization Report” (2018), available at http://www.healthcostinstitute.org/report/2016-health-care-cost-utilization-report/
  17. The actuarial value of the typical large employer preferred provider organization (PPO) is 85 percent and the actuarial value of the FEHBP Standard Option is 80 percent (Table B2). See Frank McArdle and others, “How Does the Benefit Value of Medicare Compare to the Benefit Value of Typical Large Employer Plans? A 2012 Update” (Menlo Park, CA: Kaiser Family Foundation, 2012), available at https://kaiserfamilyfoundation.files.wordpress.com/2013/01/7768-02.pdf; Large employers contribute an average of 81 percent of the premium for single coverage and 72 percent of the premium for family coverage (Figure 6.24). Premium contributions for part-time employees would be in proportion to hours worked per week divided by 40 hours. See Kaiser Family Foundation, “2017 Employer Health Benefits Survey” (2017), available at https://www.kff.org/health-costs/report/2017-employer-health-benefits-survey/
  18. The U.S. Bureau of Labor Statistics estimates that health insurance costs for large employers are 8.5 percent of compensation subject to payroll taxes. See Bureau of Labor Statistics, “Table 8. Private industry, by establishment employment size” (2017), available at https://www.bls.gov/news.release/ecec.t08.htm
  19. This statistic is for employers with fewer than 50 employees; Kaiser Family Foundation, “State Health Facts: Percent of Private Sector Establishments That Offer Health Insurance to Employees, by Firm Size,” available at https://www.kff.org/other/state-indicator/firms-offering-coverage-by-size/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D (last accessed February 2018). 
  20. Large employers include state governments. 
  21. Although the employees who select this choice may have disproportionately higher health costs, the premium structure of Medicare Extra protects enrollees from higher premium costs. 
  22. If a state does not make maintenance-of-effort payments, residents of the state would not be eligible for Medicare Extra, and no federal health care payments, including to medical providers, would flow to the state. 
  23. The CBO projects that Medicaid growth per enrollee will be 0.7 percent higher than GDP growth per person by 2027. See Congressional Budget Office, “Longer-Term Effects of the Better Care Reconciliation Act of 2017 on Medicaid Spending,” June 2017, available at https://www.cbo.gov/system/files/115th-congress-2017-2018/reports/52859-medicaid.pdf
  24. Zack Cooper and others, “The Price Ain’t Right? Hospital Prices and Health Spending on the Privately Insured,” Working Paper No. 21815 (National Bureau of Economic Research, 2015), available at http://www.healthcarepricingproject.org/sites/default/files/pricing_variation_manuscript_0.pdf; Jared Maeda and Lyle Nelson, “An Analysis of Private-Sector Prices for Hospital Admissions,” Working Paper 2017-02 (Congressional Budget Office, 2017), available at https://www.cbo.gov/system/files/115th-congress-2017-2018/workingpaper/52567-hospitalprices.pdf
  25. Medicaid rates are 72 percent of Medicare rates for physicians and 106 percent of Medicare rates for hospitals. Commercial rates are 128 percent of Medicare rates for physicians and 189 percent of Medicare rates for hospitals. See Stephen Zuckerman, Laura Skopec, and Marni Epstein, “Medicaid Physician Fees after the ACA Primary Care Fee Bump” (Washington: Urban Institute, 2017), available at https://www.urban.org/sites/default/files/publication/88836/2001180-medicaid-physician-fees-after-the-aca-primary-care-fee-bump_0.pdf; Medicaid and CHIP Payment and Access Commission, “Medicaid Hospital Payment: A Comparison across States and to Medicare” (2017), available at https://www.macpac.gov/wp-content/uploads/2017/04/Medicaid-Hospital-Payment-A-Comparison-across-States-and-to-Medicare.pdf; Medicare Payment Advisory Commission, “March 2017 Report to the Congress: Medicare Payment Policy: Chapter 4, Physician and other health professional services” (2017), available at http://www.medpac.gov/docs/default-source/reports/mar17_medpac_ch4.pdf; Maeda and Nelson, “An Analysis of Private-Sector Prices for Hospital Admissions.” 
  26. CAP estimates that the average rate weighted by payer mix is 108 percent of Medicare rates for physicians and 132 percent of Medicare rates for hospitals. 
  27. Mark Friedberg and others, “Primary Care: A Critical Review Of The Evidence On Quality And Costs Of Health Care,” Health Affairs 29 (5) (2010): 766­–772, available at https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2010.0025
  28. Maeda and Nelson, “An Analysis of Private-Sector Prices for Hospital Admissions.” 
  29. Congressional Budget Office, “Proposals for Health Care Programs-CBO’s Estimate of the President’s Fiscal Year 2017 Budget” (2016), available at https://www.cbo.gov/sites/default/files/114th-congress-2015-2016/dataandtechnicalinformation/51431-HealthPolicy.pdf
  30. The National Academy of Medicine, “Variation in Health Care Spending: Target Decision Making, Not Geography,” July 23, 2013, available at http://www.nationalacademies.org/hmd/Reports/2013/Variation-in-Health-Care-Spending-Target-Decision-Making-Not-Geography.aspx
  31. This policy is a long-standing recommendation of the Medicare Payment Advisory Commission, which estimates that site-neutral payments could save the Medicare program more than $40 billion over 10 years. See Medicare Payment Advisory Commission, “March 2012 Report to the Congress: Chapter 3, Hospital inpatient and outpatient services” (2012), available at http://www.medpac.gov/docs/default-source/reports/march-2012-report-chapter-3-hospital-inpatient-and-outpatient-services.pdf?sfvrsn=0; Medicare Payment Advisory Commission, “June 2013 Report to the Congress: Chapter 2, Medicare payment differences across ambulatory settings” (2013), available at http://www.medpac.gov/docs/default-source/reports/jun13_ch02.pdf?sfvrsn=0; Medicare Payment Advisory Commission, “June 2017 Report to the Congress: Medicare and the Health Care Delivery System” (2017), available at http://www.medpac.gov/docs/default-source/reports/jun17_reporttocongress_sec.pdf?sfvrsn=0
  32. McKinsey estimates that administrative costs exceed the amount that would be expected based on spending levels in other developed countries by 151 percent (Exhibit 6). See McKinsey Center for U.S. Health System Reform, “Accounting for the cost of U.S. health care: Pre-reform trends and the impact of the recession” (2011), available at https://healthcare.mckinsey.com/sites/default/files/793268__Accounting_for_the_Cost_of_US_Health_Care__Prereform_Trends_and_the_Impact_of_the_Recession.pdf
  33. The CBO estimates that administrative costs are 13 percent of premium revenues overall; 11 percent for the large group market; 16 percent for the small group market; and 20 percent for the individual market (Figure 6). Based on National Health Expenditure Account data, administrative costs are $660 per enrollee for private insurance, compared with $272 per enrollee for traditional Medicare. See Congressional Budget Office, “Private Health Insurance Premiums and Federal Policy” (2016), available at https://www.cbo.gov/sites/default/files/114th-congress-2015-2016/reports/51130-Health_Insurance_Premiums.pdf; Centers for Medicare and Medicaid Services, “National Health Expenditure Accounts,” available at https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html (last accessed February 2018). 
  34. The Council for Affordable Quality Healthcare estimates that converting manual transactions to electronic transactions would save $9.4 billion each year. See Council for Affordable Quality Healthcare, “2016 CAQH Index” (2017), available at https://www.caqh.org/sites/default/files/explorations/index/report/2016-caqh-index-report.pdf
  35. Medicaid’s administrative cost for each churn was an estimated $400 to $600 in 2015. Based on the Survey of Income and Program Participation, 28 million enrollees were projected to churn between Medicaid and exchanges each year. See Katherine Swartz and others, “Evaluating State Options for Reducing Medicaid Churning,” Health Affairs 34 (7) (2015): 1180­–1187, available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4664196/; Benjamin D. Sommers and Sara Rosenbaum, “Issues In Health Reform: How Changes In Eligibility May Move Millions Back And Forth Between Medicaid And Insurance Exchanges,” Health Affairs 30 (2) (2011): 22–236, available at https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2010.1000
 

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How to find and delete the data Facebook gathers on you

 by Jeff Rossen and Lindsey Bomnin –

National investigative correspondent Jeff Rossen demonstrated on TODAY Wednesday how to download all the information Facebook has gathered on you, as the company deals with an ongoing backlash over data breaches and privacy issues.

How to find and delete the data Facebook gathers on you

Currently, the only way to access your private information was to go online to facebook.com/settings.

At the bottom of the screen, tap “download a copy of your Facebook data,” and then click “download archive.”

Get Jeff Rossen’s new book, “Rossen to the Rescue,” here.

After you enter your password, it will send all of the data to the email address connected with your Facebook account, which took about 15 minutes when Rossen completed the process. You have to be on a computer to access the information.

 

Here’s what Facebook, Netflix, Candy Crush and other apps know about you

Rossen was surprised to learn Facebook was storing data from his personal chats, deleted friends, events attended, photos and videos of his children, and his contact list with phone numbers of everyone stored in his phone.

Not just his Facebook friends, but all the contacts in his phone regardless if they are Facebook users or not.

You can delete the information by accessing the Facebook app on your phone. Hit the button with the three lines on the bottom right, scroll to “settings,” then tap “activity log.”

From there you can go to a specific year and delete data from different categories, such as deleting all your photo and video activity from 2010.

Electing to delete a category takes it off the Facebook servers, but the company says that just like deleting your account, it could take up to 90 days for that information to be completely wiped from their servers.

Facebook announced Wednesday morning that it will be revamping its privacy settings on mobile devices in the coming weeks to make it easier for users to access their personal information.

The changes include a new “Privacy Shortcuts” menu and tools that will allow users to more easily find, manage and delete

 

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CALIFORNIA REPORT: A Space for Students Who Need Something to Eat

By JENNIFER MEDINA –
The grand opening of the University of California, Irvine food pantry in September. Steve Zylius/University of California, Irvine
Good morning.
As you walk into the room at University of California, Irvine the first thing you notice are the fruit and vegetable baskets: apples, onions, broccoli. There’s a table of students chatting and eating, while one thumbs through a cookbook.
It’s called the Basic Needs Hub — a space for anyone on campus who needs something to eat. It looks like a miniature gourmet grocery, but it is, effectively, a food pantry.
The grand opening of the University of California, Irvine food pantry in September.
Steve Zylius/University of California, Irvine
For the last six months, the doors to the hub have been wide open, and the pantry has doled out produce, meat and granola bars, among other goods. Students are not required to show any proof of income to receive the food, though they do receive a document stating that it is meant for those who cannot afford it on their own.
“We are making it O.K. for students to say that they do need help,” said Edgar Dormitorio, the assistant vice chancellor of students affairs. “We know there are students who do without meals rather ask for assistance. We want this to be as low barrier as possible.”
A 2016 study found that roughly four in 10 students in the University of California system went hungry at least some of the time. At the Basic Needs Hub, students are asked for basic demographic information, like where they live and what year they are in college.
“Our hope is we know the needs better and cater to those needs,” he said.
The pantry is paid for in part by a $3 fee students approved in a campuswide vote last year, as well as money set aside from the office of U.C. system’s president.
“For students, knowing there is somewhere to get your food and feel dignified doing that, it is an empowering thing,” said Ernest Devin Rankin, 19, a sophomore in public health policy and educational science, who works at the pantry part time. “We have frozen meat, eggs, bread, milk, cereal — all that goes quickly. Fruit, granola bars, that stuff goes out in a second, we can’t stock it fast enough.”
California Online
(Please note: We regularly highlight articles on news sites that have limited access for nonsubscribers.)
A bald eagle near Big Bear Lake, in the San Bernardino National Forest, in 2016.
Robin Eliason/United States Forest Service
• “These eagles are more than just a symbol.” How a group of volunteers participate in an expedition to count bald eagles in Southern California. [The New York Times]
• The Orange County Sheriff’s Department is now making release dates of anyone in jail publicly available online, including those living in the country illegally. The move is a rejection of the state’s so-called sanctuary state laws, which strictly limit how local law enforcement officers communicate with federal immigration agents. [The Los Angeles Times]
• One legislative leader is scoffing at the idea of advancing a single-payer public health insurance system this year and instead proposing his own, more narrow approach, to universal coverage. [The Sacramento Bee]
• The California attorney general, Xavier Becerra, is once again suing the Trump administration, this time over questions about citizenship on the 2020 census form. [San Francisco Chronicle]
Protesters gathered outside a fund-raiser attended by President Trump in Beverly Hills.
Allen J. Schaben/Los Angeles Times, via Getty Images
“We’re all in the ghetto now.” One writer sees parallels between the distorted reality of Inglewood and South Los Angeles and the way the state of California is now perceived in Trump’s America. [The New York Times]
• With rents soaring throughout the state, activists in several cities are pushing for local ballot measures to enact rent control. Advocates for renters say the state has reached a “breaking point.” [Orange County Register]
• San Francisco may look like a boomtown, but it turns out people are leaving. In the last two years, more people left the Bay Area than moved into it, raising questions about the sustainability of growth there. [The Wall Street Journal]
• A chile vendor who owes her landlord nearly $100,000 is struggling to hold on to her spot in L.A.’s Grand Central Market, where many stalls sell high-end food to an increasingly younger clientele. [The Los Angeles Times]
Some of the spots on the wall murals in King Tut’s tomb. “The paintings are not in as bad a condition as some have claimed; they are pretty stable,” said the project’s director, Neville Agnew of the Getty Conservation Institute.
The J. Paul Getty Trust
• No, those unsightly dark brown spots covering King Tut’s tomb are not getting worse, researchers at the Getty Conservation Institute said this week. But they are here to stay. [The New York Times]
• Maybe we should turn to the students to help fix the state’s finance system? They are the ones who see how bad it truly is. [Zocalo]
• A decade ago, Janet was a drug and alcohol counselor, as well as a married homeowner. Today, she is living on the streets of Fresno, addicted to methamphetamine, which she says helps her stay awake and safe. [The Fresno Bee]
• Join us: Discuss the state of dining in California with three powerhouse chefs in Los Angeles on April 10 at 7 p.m. Melissa Clark, the New York Times food writer and cookbook author, moderates a discussion with some of Los Angeles’s leading chefs — Jessica Koslow, owner of Sqirl; Niki Nakayama, chef and owner of n/naka; and Susan Feniger, TV personality, chef and co-owner of Border Grill restaurants — about the future of American restaurants, the impact of the #MeToo movement in kitchens and the evolving meaning of California cuisine. Visit timesevents.nytimes.com/LAdining for tickets and details.
And Finally …
Who needs televised freeway chases? They’ve been replaced — at least temporarily — by migrating whales. For hours on Monday, two gray whales swam through the river channel separating Long Beach and Seal Beach, with crowds growing as the morning wore on. The cameras were just behind.
There were no signs of distress, experts said, though many bystanders worried that the 25-foot-long whales would get stuck in the shallow water. Whale sightings are common near the shore this time of year, as the whales head north for their annual migration. Scientists who watched the footage said they would most likely return to the ocean later today.
California Today goes live at 6 a.m. Pacific time weekdays. Tell us what you want to see: CAtoday@nytimes.com.
California Today is edited by Julie Bloom, who grew up in Los Angeles and graduated from U.C. Berkeley.
 

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How to Travel with Your Cat (The Ultimate Guide)

Many people travel with their cat, as can be seen by the YouTube videos that depict people taking their cats on hikes, boat trips or bike rides. While it can be fun, it requires a lot of careful planning and consideration of feline and human needs. This guide will help you travel with your cat successfully.

Things you Need to Pack

Just like humans, cats also have a list of items they need to take with them on vacation. In order to keep Fluffy healthy and happy and to prevent problems, she will need the following items:

  • Veterinary records, including health certificate and proof of vaccination

  • Cat carrier with absorbent lining

  • Any medications taken regularly

  • Contact info for the regular vet

  • Information about veterinarians in the vacation area

  • List of accommodations, restaurants and attractions that accept cats

  • Litter box, cat litter and cat litter mat

  • Food and water dishes

  • Cat Brush

  • Cat food

  • Water

  • Favorite blanket

  • Favorite toys, easy to pack like the Cat Tamboo

  • Collar, cat harness and leash

  • ID tags

  • maybe some seaweed for your cat , watermelon crab meat nibble on!

why is my cat peeing on my clothes

 Jersey says 

Meeow! Don’t forget my Cat Food!

You can also check out catster.com for more things to pack while traveling with your cat.

Travel with Your Cat by Plane

According to the Humane Society, traveling by plane is not safe for cats. It should therefore be done only if it’s absolutely necessary and there are no other alternatives.

travel with your cat by plane

Air travel is particularly dangerous for Persians and other cats with brachycephalic or “pushed-in” faces, but very affectionate. Their extremely short nasal passages increase their vulnerability to heatstroke and oxygen deprivation. Hairless cats like the Sphynx are more vulnerable to temperature extremes. Such cats should never be sent to the cargo/luggage hold.

Advanced Arrangements

Check the airlines’ guidelines regarding cats on planes while you travel with your cat.  Each airline has their own policies on travel with your cat.  Call the airline directly to make the reservation. Ask if there is space in the cabin for your cat before booking your flight, for many airlines restrict the number of pets allowed in the cabin. Try to get a direct flight if at all possible, for transfers and lay-overs will only add to the cat’s stress and increase the chances of something going wrong.

Ask about the space under the airline seat to make certain your carrier will fit. Also ask about what paper work you will need; many airlines ask for health certificates and/or veterinary records.

Schedule a visit with the vet shortly before the trip to make sure Fluffy is up to date on her shots and you have the needed certificates and records.

Get your cat acclimated to the carrier beforehand. Leave it out and open so Fluffy will get used to it. Feed her in the carrier so she will associate it with good things.

Practice entry and exit from the carrier to make it a routing process, for you will have to take the cat out of the carrier during the security screening.

The Day of Your Flight

Traveling on an empty stomach reduces the chances of nausea and vomiting. Therefore, don’t feed you cat four to six hours before the flight. You should, however, give her small amounts of water. Also, put ice cubes in the carrier’s water tray; a full water dish will only spill and make for an uncomfortable flight. Try to make it as comfortable experience as possible for your furry friend!

The cat’s carrier will have to go through the security screening. You may be able to request a special second screening so you don’t have to take the cat out of the carrier. If not, take your cat out of the carrier and hold her while the carrier goes through the X-ray scanner. Your kitty will have to be leashed so you can keep her under control while you travel with your cat. Meeow!

Pet Carriers

Pet carriers for cats can be hard or soft. The hard ones will be made of plastic and have holes for ventilation, and the soft-sided carriers have metal mesh panels for ventilation. Depending on your airlines policy my personal favorite is the mesh pet carrier if your furry friend is allowed to stay in the same seat as you when you travel with your cat.

The carrier must be able to fit under the seat in front of you, and it must be large enough to let the cat stand, turn around and lie down in a natural position. The cat must stay in the carrier for the whole flight.

The carrier must be clean, leak-proof and escape-proof. It should have absorbent bedding that is non-toxic and safe for the cat. If you have the space you can use a cat cage for travel use.

Airline Guidelines

Different airlines have different rules about transporting cats. Most airlines will allow only so many animals to be transported in the cabin. Similarly, many airlines have “one carrier per customer” rule, and many have weight restrictions.

Some airlines allow people to check cats as luggage, but many do not. Practically everybody agrees that the cat has to be fully weaned and at least eight weeks old, in order to travel with your cat.

Check out the various policies for some of the more popular airlines below:

Safety Tips

  • Do not give the cat tranquilizers unless prescribed by their veterinarian. Make very certain the vet knows the cat will be traveling by airplane.

  • Consider non-medical alternatives for keeping a cat calm like Feliway® pheromones or the Thundershirt® which swaddles the cat like a baby.

  • Clip the cat’s claws beforehand, so they won’t get caught on the carrier’s door, holes or other crevices.

  • When boarding the plane, tell the captain and a flight attendant that you have a cat on board. They may make special arrangements.

  • Try not to fly with your cat during busy times like the holidays, for the staff may be too hurried to handle your pet gently.

  • Attach a travel label to the cat’s carrier that includes contact information like your name, phone number and destination.

  • Keep a current photo of the cat with you, so if the airline does lose her during the flight, the employees will have an easier time searching for her.

  • Once you’ve reached a safe place at your destination, open the carrier to examine your cat. If something seems to be wrong, take her to a veterinarian immediately. Ask the vet to give you the examination results in writing. 

Travel with Your Cat by Car

While traveling by car is generally safer and provides more flexibility, there are still concerns that need to be addressed to make the trip a successful and pleasant one. There are many details to consider while you prepare.

Prepare For the Trip

Consider having your cat microchipped. Microchipping is a quick procedure that can be done at a vet’s office. The veterinarian will use a needle to implant the microchip under the cat’s skin between the shoulder blades. The procedure is about as painful as having blood drawn.

The microchip has a unique number that can be read by a scanner. That number is then matched with information about the cat and their owner. Many shelters and veterinary clinics have scanners, so if a lost cat is brought to them, they can use the microchip to track down their owner.

Take your cat to the vet shortly before leaving. Make certain Fluffy is up to date on all of her needed shots and that you have all of the necessary health certificates and proofs of vaccination when you travel with your cat. This will certainly give you peace of mind while you travel with your cat.

Safety Tips

Cats are generally not comfortable with car rides. It is therefore safer for everybody to keep them in a carrier. Secure the carrier by fastening a seatbelt around it to keep it from bouncing around the car when you travel with your cat. Put the carrier in the back seat. Otherwise, if an airbag deploys, it could injure Fluffy.

Regardless of how cute it looks, don’t let a cat stick her head out of the window. She could get hurt by flying debris, and the cold air forced down her lungs could make her ill.

Take plenty of pit stops to give Fluffy a chance to stretch her legs and go to the bathroom. Make sure she is properly leashed and has a collar and ID tags before letting her out of the car.

Consider bringing a human traveling companion to help with the driving and pet-minding. A human friend can also watch your car and cat when you have to visit a restroom or shop while you travel with your cat.

Never leave a cat in a car unattended when you travel with your cat. A car’s interior can become dangerously hot very quickly, even if it’s mild outside. For example, if the temperature outside is 72 degrees Fahrenheit, the car interior can soar up to 116 degrees in an hour. If the outside temperature is 85 degrees, the temperature in the car can reach 102 degrees within ten minutes, even if you leave the windows cracked open. Such temperatures can cause organ damage or death.

Regardless of the temperature, people who leave their cat in a car unattended also risk having it stolen, especially if the cat belongs to a popular or expensive breed. Some pedigreed cats can cost hundreds or thousands of dollars.

Try and keep your cat cool by cracking the windows in the car or providing some relief with air-conditioning.  Also, bring plenty of water to prevent against dehydration.  Factor in how much you need based upon the length of the car trip.

Cats Who Don’t Like Car Rides

Cats are notorious for not liking car rides. In some cases, the problem turns out to be physical: like humans, cats can get car sick. A cat with motion sickness will display the following symptoms when you travel with your cat:

  • Excessive drooling

  • Seemingly unable to move

  • Constant meowing

  • Urinating or defecating

  • Vomiting

This is yet another reason to take the cat to the vet before going on a trip with her. There are several ways to handle car sickness when you travel with your cat. One way is to desensitize Fluffy by taking her on short car rides.

Car sickness can be linked to stress, and getting the cat acclimated to car rides may calm her down enough to reduce her symptoms.

Preparing your cat for stress free travel is a great way to ensure smoother travel.

Ginger is a holistic treatment for nausea, and it can take the form of pills or cookies. Giving it to the cat 30 minutes before the car trip may soothe her stomach. Ask your vet about the appropriate dosage.

Over-the-counter medications like dimenhydrinate and meclizine can also soothe a nervous stomach and reduce nausea and vomiting. Antihistamines like diphenhydramine have a sedative effect, and they also reduce drooling. In severe cases, the veterinarian may prescribe stronger sedatives like acepromazine.

Always consult a veterinarian before giving your cat any kind of medication. They can tell you if the dosage is correct, and they can also warn you if a given medication might have unpleasant side effects.

In other cases, the problem is purely psychological. Many cats hate cat carriers and car rides because they typically experience them during only one situation: a trip to the vet. No self-respecting feline enjoys going to a stranger who manhandles them, gives them shots, and takes their temperature with a rectal thermometer.

In this case, you have to educate Fluffy and teach her that cat carriers and car rides do not always equal “trip to the vet.” The only way to do that is to take her on car rides with some other, more pleasurable destination and get her acclimated before you travel with your cat.

Spraying the interior of the carrier with a pheromone-based product like Feliway® can also help the cat relax while you travel with your cat.

Cats and Car Rentals

Most rental car companies do allow domestic pets in the car. Their main stipulation is that that the car be returned clean with no cat hair. A renter who fails to comply will probably have to pay an extra cleaning fee. To locate car rental agencies that accept cats, go here:

Just for Fun…

Apparently, there are now pockets or hammocks that can be attached to car windows, so the cat can sleep and watch the world go by.

How to find Cat Friendly Hotels?

A growing number of hotels, bed & breakfasts, and other accommodations are accepting cats and other domestic pets. Accommodations range from basic to luxurious. The prudent traveler will do research ahead of time, for there are still places that won’t accept animals at all, while some will accept only dogs. Similarly, some hotels only allow pets to stay on the premises, while others have extra amenities for them.

Hotel Policies

While more and more hotels are forgoing the extra fee for a pet, others still charge, and the price can vary widely. Moreover, different hotels within the same chain can have different pet policies and fees, so call ahead to make certain that a hotel has policies and fees you can accept when you travel with your cat.

Where to Stay

Best Western Hotels. Over 1600 hotels in the US, the Caribbean and Canada accept pets. The pet policies do vary from hotel to hotel, so the wise traveler should call ahead. There is a maximum daily charge of $20.00 for each room with a pet or a maximum weekly charge of $100.00. The hotel may also require a refundable deposit of $50.00.  Learn more here.

EconoLodge. About 600 hotels welcome pets. Policies like weight restrictions depend on the hotel. Most allow one or two pets and charge $10 per night. Learn more here.

Kimpton Hotels. All Kimpton Hotels welcome pets of any type, breed or size. Kimpton does not charge extra for pets, and many of the hotels provide such amenities as pet beds, treats and food dishes. Kimpton also maintains a list of pet-friendly businesses near the hotel.  Learn more here.

La Quinta Inns. Many La Quinta Inns in the US and Canada accept pets, and the pets can stay for free. No more than two cats are allowed per room, and you have to supply the litter box. Cats are only allowed outside the room if they’re in a carrier or on a leash. Except for authorized service animals, cats are not allowed in the breakfast room, laundry room, fitness center or pool area.    Learn more here.

Loews Hotels. Many Loews Hotels accept pets and allow up to two cats per room. Pet fees, which start at $25 per stay, vary between hotels. Cats cannot be left unattended and should be in a carrier or on a leash when outside the room. Pet-friendly hotels have a “Loews Loves Pets Program” and offer such amenities like a bowl and treats. They provide pet-sitting and pet-walking services and keep a list of nearby pet-friendly businesses. They will also lend scratching posts, litter boxes and cat beds.  Learn more here.

Motel 6. Motel 6 describes itself as “America’s original pet friendly hotel chain.” All cats can stay for free, but no more than two cats are allowed in a room. There are no breed or weight restrictions. Owners need to declare all pets and service animals when they check in. Motel 6 does have a rule that you can’t leave your cat alone in the room.  Learn more here.

Red Roof. All 350+ locations accept pets, but only one “well-behaved family pet” is allowed per room. Cats can stay for free, but you are responsible for any damage it causes. You are also not allowed to leave the cat alone. You also need to inform the front desk when you check in.  Learn more here.

General Hotel and Safety Tips

Even the most placid and easy-going cats will be on edge during a stay in a hotel. It is unfamiliar to them and therefore threatening. Thus, many problems will be caused by a cat’s desire to hide.

Never open the cat carrier outside the hotel room. You may want to do nothing more than give Fluffy a few reassuring chin scratches—but she may decide to bolt.

Once you’re in the hotel room, “cat-proof” it before letting Fluffy out. Block all entrances to unreachable places like under the king-sized hotel bed. Also check for wires and other potentially dangerous items.

The best place for a cat to spend the night is often the bathroom. Leave the carriers in the bathroom, so the cats have the option of staying in a familiar place. Put the litterbox in the tub, so it will be separated from the carriers and food dishes. Don’t worry about being “mean”; Fluffy will probably feel safer and more secure in the smaller space.

The bathroom also has the advantages of not containing anything a cat is likely to destroy, and it is much easier to clean in the bathtub than on a carpet.

Get your cats microchipped, and make sure the information on the microchips is up to date. It doesn’t do anybody any good if the information includes an old phone number you haven’t used in two years.

Deal with any damage your cat causes immediately; don’t wait until checkout.

Where to Find Cat-Friendly Hotels

There are many websites that can help a cat-owner look for the perfect hotel for themselves and Fluffy to stay at while they travel with your cat.

HotelGuides.com has a page devoted to pet-friendly hotels and motels in the US. It also provides a free pet check service in which they will check a hotel’s pet policy for you to make sure you have the most up-to-the-minute policy. They also provide an online reservation form, and advise describing your cat in the “Special Requests” section.  Learn more here.

OfficialPetHotels.com lists pet-friendly hotels in both the US and the UK. Learn more here.

PetsWelcome.com lists bed & breakfasts, cabins, inns, motels and cottages as well as hotels. They also enable you to create a “Passport Account” detailing your needs and preferences and allowing you to save directions and routes. Information about a given hotel is divided by state.  Learn more here.

TripWithPets.com lists 30,000 pet-friendly rental accommodations including hotels, vacation rentals and bed & breakfasts in the United States and Canada. Learn more here.

Alternatives: Shelters, Sitters & Cat Hotels

Temporary Shelters

If you know that Fluffy cat absolutely hates travel, freaks out at strangers and would otherwise be miserable during a trip, your only option is to leave her home. That means making arrangements to have someone look after her.

Many veterinarians offer pet boarding services, and these can range from basic to luxurious. Ask your vet what their boarding services and/or what they recommend. Your friends may also have recommendations. Visit the boarding service beforehand to get a feel for how well it takes care of its charges.

The pet store PetSmart has a PetsHotel program that enables pet owners to track down accommodations for Fluffy or Fido. It also includes a list of requirements like needed shots and list of medications.

Cat Sitters

Cat sitters are another option, and they are usually cheaper than boarding the cat. In many cases, you can have a friend, neighbor or relative look after Fluffy. If they aren’t willing or available, professional sitters might be able to help.

Make sure to check out Pet Sitters International with over 7000 members of professional pet sitters. There are members that specialize in Cat sitting like Cats at Home Pet Sitting that are trusted and passionate about cats!

One example of such a service is Fetch! Pet Care that looks after cats and dogs. Clients can choose the type of service they want ranging from 30-minute-long visits to overnight stays. The sitter will feed and water the cat, clean their litter box, and play with them. Fetch! Pet Care operates in 24 states and Washington, DC.

If you are in Pennsylvania make sure you check out the Pet Nanny for pet sitting needs.

PawPals is a great sitter in the Northern Virginia Area

If you are in the Long Island, New York area check out our friends at Love & Care Pet Professionals

Cat Spa/Hotel

If you want the absolute best for your feline friend, consider a cat hotel or cat spa. As might be guessed, a cat hotel is designed to a resemble a high-end boutique hotel or spa resort. The pampered kitties enjoy such amenities as gourmet food, heated floors, “bespoke” climbing trees, flat-screen TVs depicting fish or birds, exercise wheels, and an attentive human staff willing and eager to cater to their feline guests.
Here’s one in the UK: The Ings Luxury Cat Hotel

why is my cat peeing on my clothes

 Jersey says 

Meeow! Please….Please can we go to this luxury hotel?

Cat Cafés

cat café, as the name suggests, provides both coffee and an opportunity to cuddle with the resident felines. They appeal to human visitors who are unfortunate enough to live in apartments that don’t permit pets.

Unfortunately, cat cafés usually do not babysit cats. Many of them get their cats from nearby animal shelters and are trying to get them adopted out. Cat cafés choose their cats for their good health and friendliness.

There may be exceptions, though. Many cat cafés post their policies on their website and/or within their building. Look for those policies before asking about letting your cat stay at the café.

Adventures for You and Your Cat

Cat Hikes

A growing trend is the “adventure cat.” Increasing numbers of people take their cats on hikes or on boat rides – and then post the results on Youtube or Instagram. After thinking long and hard about whether your cat has the “right stuff” in terms of temperament to be an “adventure cat,” you need to make the appropriate preparations. The website AdventureCats.org includes some helpful advice on how to train your cat to walk on a leash, how to clicker train them, and how to safely take them on walks in urban areas.

AdventureCats strongly stresses that a hiking cat needs to have a properly fitting harness and leash. She should also have a collar with ID. Ideally, Fluffy should also be microchipped. The website also advises people to start small and take things slowly: Let Fluffy get used to wearing the harness, then the leash, then walk her around a bit while still indoors, and then take her outside for a brief stroll.

After properly training Fluffy to walk on a leash, you now need a place to take her. If you need to drive her to a park or something, she should be kept in a carrier or specially designed backpack. You also need a place to take her. PetFriendlyTravel.com keeps lists of national, state, county and city parks that welcome pets.

Each park has its own pet policy, so you should check that policy first, for some parks may allow only dogs. Many parks regulate leash length; they typically say that the leash can’t be any longer than six feet. Many parks will also have rules about where pets can and can’t go. For example, pets are usually not allowed in many of the buildings.

PetFriendlyTravel also lists beaches, campgrounds and shopping malls that accept pets. Pets like adventure too just check out this adventure in Europe with great tips

Around the World

There are many places to travel in the world, check out some of the local information regarding bringing your pet across borders. For information on exploring Indonesia or moving to Thailand with your cat or other parts of the world let us know so we can share.

More information

Here are few more things to keep in mind to make sure both you and Fluffy have a safe and enjoyable vacation.

Keep a Routine

Cats are creatures of habit and therefore do not always do well with changes. Traveling can make sticking to a routine difficult, but you should still try to provide your cat with regular meal times.

Sticking as close as possible to meal times back home will help keep Fluffy happy. Similarly, try to get her the same sort of food she gets back home. If you do have to make changes, introduce them gradually.

Emergencies

Look up vet clinics and other emergency services before you go on your trip. That way, if something does happen, you will at least know where to take Fluffy for help.

Be Responsible

If you’re taking your “adventure cat” to the great outdoors, follow this guide for doing so in a way that minimizes your environmental impact.

Have Fun!

Many people view cats as part of their family and therefore want to include them in all aspects of their lives. That includes taking them on their vacations. It can take more preparation and work, but there are definitely ways to take a cat along on a vacation and make certain everybody has a good time.

Finally, if you are thinking of taking an ocean voyage with your furry buddy check this out!

 

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‘No moderating tendencies’

David Leonhardt

Op-Ed Columnist

First, H.R. McMaster and John Dowd are out. John Bolton and Joseph diGenova are in. The common theme: President Trump is replacing advisers who tried to moderate him with those who play to his worst impulses.
Dowd’s resignation as one of Trump’s lawyers “is yet more evidence that the president will continue to approach the Mueller investigation not as a legal problem but as a PR problem,” Paul Waldman writes in The Washington PostThe New Yorker’s Jeffrey Toobin argues that, “Dowd’s departure substantially increases the chances that the President will move to fire Mueller — perhaps very soon.”
Kelly Magsamen, a former government official, called Bolton’s job — national security adviser — “by far the most important national security position in our government” because “this person is the one in charge of shaping and framing national security decisions for the President.” She added that “Bolton has no moderating tendencies.”
Republicans vs. democracy. The biggest problem in American politics is the extremism of the Republican Party.
The Democrats certainly have their problems, but they pale by comparison. Large numbers of Republican voters hold beliefs that are simply false (climate change is a hoax, Barack Obama is a Kenyan, Robert Mueller is Democratic partisan). Trump, meanwhile, flouts the rule of law, while Republican leaders in Congress try to pass major legislation largely in secret.
I’ve argued that conservatives aghast at these developments should vote against their party in order to reclaim it. Republican leaders won’t abandon their extremism if they keep winning. In a mini-essay on Twitter, Noah Smith of Bloomberg View takes on the same issue but from a different angle: He says that the answer is expanding voting rights so that more Americans have the opportunity to vote against Republican extremism.
“The #1 policy priority for Democrats at both the state and federal levels should not be universal health care, gun control, climate change, etc.,” Smith wrote. “It should be democracy.”
By democracy he means laws that remove obstacles to voting: making registration automatic, for example, and expanding the hours — and the ways — that people can vote. Several states are already taking steps in this direction, but there is much more to do, as Wendy Weiser and her colleagues at the Brennan Center explain.
Smith argues that voting restrictions have been crucial to the Republican Party’s extremist success. “Since the 90s, as Hispanics (and Asians) grew as a % of the U.S. population, one faction of the GOP wanted to court them. A second faction wanted to keep the party a white ethnic party. The second faction, sadly, won,” he writes.
“Instead of toning down white identity politics to court Hispanics and Asians, the GOP decided to: 1) turn up the identity politics; 2) deport as many nonwhite immigrants as possible; 3) use voting restrictions and gerrymandering to win with a minority of votes.”
But this strategy won’t continue to work if larger numbers of minorities begin voting. To Smith’s good points, I’d add that laws aren’t the only problem. Voter turnout among Latinos and Asian-Americans is low for a complicated mix of reasons, some of which are unrelated to Republican malfeasance.
Whatever the cause of the current situation, though, a rise in minority turnout could transform politics. In that case, “the GOP will be forced to reboot itself with a new ethos and a new message that appeals to Hispanic and Asian voters (black voters probably being out of reach for them no matter what),” Smith writes. “Ultimately, the reason to focus on democracy is to help the Republicans go sane again.”
Programming note. I’ll be away next week, but the newsletter will continue. My colleague Ian Prasad Philbrick will give you a couple of reading suggestions based on the day’s news. I will also have an item in each day’s newsletter, writing about a topic that I find important but haven’t found room to mention in the newsletter so far, given the pace of news.
The full Opinion report from The Times follows.

 

 

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Mental Illness in Children

 Mental illness in children facts
  • Mental disorders in children are quite common, occurring in about one-quarter of this age group in any given year.
  • The most common childhood mental disorders are anxietydisorders, depression, and attention deficit hyperactivitydisorder (ADHD).
  • Although less common, developmental disorders and psychotic disorders in children can have a lifelong impact on the child and his or her family.
  • As in any age group, there tends to be no single cause for mental illness in children.
  • In addition to the specific symptoms of each mental disorder, children with a psychiatric illness can exhibit signs that are specific to their age and developmental status.
  • Establishing the diagnosis of a mental illness in children usually involves the combination of comprehensive medical, developmental, and mental-health assessments.
  • There are a variety of treatments available for managing mental illness in children, including several effective medications, educational or occupational interventions, as well as specific forms of psychotherapy.
  • Children with mental-health problems can have lower educational achievement, greater involvement with the criminal justice system, and fewer stable placements in the child welfare system than their peers.
  • Attempts at prevention of childhood mental illness tend to address both specific and nonspecific risk factors, strengthen protective factors, and use an approach that is appropriate for the child’s developmental level.
  • Research on mental illness in children is focused on a number of issues, including increasing the understanding of how often these illnesses occur, the risk factors, most effective treatments, and how to improve the access that children have to those treatments.

Quick GuideWhat’s Your Biggest Fear? Phobias

What's Your Biggest Fear? Phobias

 

What are the most common mental illnesses in children?

Mental disorders in children are quite common and sometimes severe. About one-fourth of children and teens experience some type of mental disorder in any given year, one-third at some time in their lives. The most common kind of mental disorders are anxietydisorders, like overanxious disorder of childhood or separation anxiety disorder. Other common types of mental illnesses in childhood include behavior disorders like attention deficit hyperactivity disorder (ADHD), mood disorders like depression, and substance-use disorders like alcohol use disorders. Statistics indicate how relatively common these disorders occur. ADHD affects 8%-10% of school-aged children. Depressionoccurs at a rate of about 2% during childhood and from 4%-7% during adolescence, affecting up to about 20% of adolescents by the time they reach adulthood. In teens more frequently than in younger children, addictions, bipolar disorder, and less often early onset schizophrenia may manifest.

Although not as commonly occurring, developmental disabilities like autism spectrum disorders can have a significant lifelong impact on the life of the child and his or her family. Autism spectrum disorder is a developmental disorder that is characterized by impaired development in communication, social interaction, and behavior. Statistics about autism include that it afflicts one out of every 88 children, a 78% increase in the past 10 years.

What are causes and risk factors for mental illness in children?

As is the case with most mental-health disorders at any age, such disorders in children do not have one single definitive cause. Rather, people with these illnesses tend to have a number of biological, psychological, and environmental risk factors that contribute to their development. Biologically, mental illnesses tend to be associated with abnormal levels of neurotransmitters, like serotonin or dopamine in the brain, a decrease in the size of some areas of the brain, as well as increased activity in other areas of the brain. Girls are more likely to be diagnosed with mood disorders like depression and anxiety compared to boys, while disorders like attention deficit hyperactivity disorder and autism spectrum disorders are more often assigned to boys. Gender differences in mental illness are thought to be the result of, among other things, a combination of biological differences based on gender, as well as the differences in how girls are encouraged to interpret their environment and respond to it compared to boys. There is thought to be at least a partially genetic contribution to the fact that children and adolescents with a mentally ill parent are up to four times more likely to develop such an illness themselves. Teens who develop a mental disorder are also more prone to having had other biological challenges, like low birth weight, trouble sleeping, and having a mother younger than 18 years old at the time of their birth.

Psychological risk factors for mental illness in children include low self-esteem, poor body image, a tendency to be highly self-critical, and feeling helpless when dealing with negative events. Teen mental disorders are somewhat associated with the stress of body changes, including the fluctuating hormones of puberty, as well as teen ambivalence toward increased independence, and with changes in their relationships with parents, peers, and others. Teenagers who suffer from conduct disorder, attention deficit hyperactivity disorder (ADHD), clinical anxiety, or who have cognitive and learning problems, as well as trouble relating to others are at higher risk of also developing a mental disorder.

Childhood mental illness may be a reaction to environmental stresses, including trauma like being the victim of verbal, physical, or sexual abuse, the death of a loved one, school problems, or being the victim of bullying or peer pressure. Gay teens are at higher risk for developing mental disorders like depression, thought to be because of the bullying by peers and potential rejection by family members. Children in military families have been found to be at risk for experiencing depression as well.

The aforementioned environmental risk factors tend to specifically predispose individuals to childhood mental illness. Other risk factors tend to predispose people to developing a mental disorder at any age. Such nonspecific risk factors include a history of poverty, exposure to violence, having an antisocial peer group, or being socially isolated, abuse victimization, parental conflict, and family dissolution. Children who have low physical activity, poor academic performance, or lose a relationship are at higher risk for mental illness as well.

woman thinking

 

What are symptoms and signs of mental illness in children?

Children with mental illness may experience the classic symptoms of their particular disorder but may exhibit other symptoms as well, including

  • poor school performance;
  • persistent boredom;
  • frequent complaints of physical symptoms, such as headaches and stomachaches;
  • sleep and/or appetite problems like sleeping too much or too little, nightmares, or sleepwalking;
  • behaviors returning to those of a younger age (regressing), like bedwetting, throwing tantrums, or becoming clingy;
  • more risk-taking behaviors and/or showing less concern for their own safety.

Examples of risk-taking behaviors include running into the street, climbing too high, engaging in physical altercations, or playing with unsafe items.

How is mental illness in children diagnosed?

Many health-care professionals may help make the diagnosis of a mental illness in children, including licensed mental-health therapists, pediatricians or other primary-care providers, emergency physicians, psychiatrists, psychologists, psychiatric nurses, and social workers. One of these professionals will likely conduct an extensive medical interview and physical examination or refer the child for those assessments as part of establishing the diagnosis.

Childhood mental illnesses may be associated with a number of other medical conditions or can be a side effect of various medications. For this reason, routine laboratory tests are often performed during the initial evaluation to rule out other causes of symptoms. Occasionally, an X-ray, scan, or other imaging study may be needed. As part of this examination, the child and his or her parents may be asked a series of questions from a standardized questionnaire or self-test to help further assess symptoms. The use of screening tools is particularly important for detecting early signs of mental illness in infants and toddlers, due to their being largely preverbal in their communication.

 

What is the treatment for mental illness in children?

There are a variety of treatments available for managing mental illnesses in children, including several effective medications, educational or occupational interventions, as well as specific forms of psychotherapy. In terms of medications, medications from specific drug classes are used to treat childhood mental illness. Examples include the stimulant class for treating ADHD, serotonergic medications for treating depression and anxiety, and neuroleptic medications for management of severe mood swings, anxiety, aggression, or in the treatment of childhood schizophrenia.

For individuals who may be wondering how to manage the symptoms of a childhood mental illness using treatment without prescribed medications, psychotherapies are often used. While interventions like limiting exposure to food additives, preservatives, and processed sugars have been found to be helpful for some people with an illness like ADHD, the research evidence is still considered to be too limited for many physicians to recommend nutritional interventions. Also, placing such restrictions on the eating habits of a child or teenager can prove to be difficult at best, nearly impossible at worst.

Psychotherapy

Psychotherapy (“talk therapy”) is a form of mental-health counseling that involves working with a trained therapist to figure out ways to solve problems and cope with childhood emotional disorders. It can be a powerful intervention, even producing positive biochemical changes in the brain. Two major approaches are commonly used to treat childhood mental illness, interpersonal psychotherapy and cognitive behavioral therapy. In general, these therapies take weeks to months to complete. Each has a goal of alleviating symptoms. More intense psychotherapy may be needed for longer time periods when treating very severe mental illness.

The behavioral, educational/vocational, and psychotherapy components of treatment for childhood mental illnesses are usually at least as important as the medication treatment. Dealing with the specific challenges that mentally ill children present takes patience, understanding, and a balance of structure and flexibility. One kind of psychotherapy used to treat children with mental illness is cognitive behavioral therapy (CBT). This form of therapy seeks to help those with many different kinds of psychiatric disorders identify and decrease the irrational thoughts and behaviors that reinforce maladaptive behaviors. This therapy can be administered either individually or in group therapy. CBT that seeks to help the sufferer of many childhood mental illnesses may decrease the tendency of the depressed or anxious child to pay excessive attention to potential threats, while helping the child with ADHD appropriately refocus their attention.

Behavioral techniques that are often used to decrease symptoms in children with behavioral disorders like ADHD, oppositional defiant disorder, or conduct disorder or to help children with anxiety disorders like separation anxiety disorder or obsessive compulsive disorder involve the parents, teacher, and other adult caretakers understanding the circumstances surrounding both positive and negative behaviors and how each kind of behavior is encouraged and discouraged. Specifically, learning when and where specific behaviors occur can go a long way toward understanding how to encourage the behavior to happen again if it’s positive or extinguishing it if the behavior is negative. Being aware of how the reactions of others contribute to a behavior’s continuing or not continuing tend to help the child with a behavior disorder shape their behaviors more positively. Also, developing a fair, meaningful, and effective repertoire of ways to encourage positive behaviors and provide consequences for negative behaviors is a key component of any behavior-management plan and therefore in parenting children with behavioral disorders.

Often, a combination of medication and nonmedication interventions produces good results in helping the child with a mental illness. Depending on the illness, the length of time it existed before treatment starts, as well as the course of treatment deemed most appropriate, improvement may be noticed in a fairly short period of time, from two to three weeks to several months. Thus, appropriate treatment for mental illness can relieve symptoms or at least substantially reduce their severity and frequency, bringing significant relief to many children. There are also things that families of children with a mental illness can do to help make treatment more effective. Tips to better manage symptoms of most childhood mental-health problems include getting adequate sleep, having a healthy diet, and having the support and encouragement of parents and teachers.

If symptoms indicate that your child is suffering from mental illness, the health-care professional will likely strongly recommend treatment. Treatment may include addressing any medical conditions that cause or worsen the psychiatric symptoms. For example, an individual who is depressed and found to have low levels of thyroid hormone might receive hormone replacement with levothyroxine (SynthroidLevoxyl). It may be found that a hyperactive, anxious, or psychotic child is having a reaction to a medication. Other components of treatment may be supportive therapy, such as changes in lifestyle and behavior, psychotherapy, and may include medication for moderate to severe mental illness. If symptoms are severe enough to warrant treatment with medication, symptoms tend to improve faster and for longer when medication treatment is combined with psychotherapy.

Interpersonal therapy (IPT): This helps to alleviate symptoms of mood disorders like anxiety and depression and helps the sufferer develop more effective skills for coping with relationships. IPT employs two strategies to achieve these goals:

  • The first is educating the child and family about the nature of their illness. The therapist will emphasize that depression is a common illness and that most people can expect to get better with treatment.
  • The second is defining problems (such as abnormal grief, interpersonal conflicts, or having significant anxiety when meeting new people). After the problems are defined, the therapist is able to help set realistic goals for solving these problems and work with the child and his or her family using various treatment techniques to reach these goals.

Cognitive behavioral therapy (CBT): This has been found to be effective as part of treatment for childhood mental illness. This approach helps to alleviate depression, anxiety, and some behavioral problems and reduce the likelihood that symptoms will come back by helping the child change his or her way of thinking about or otherwise reacting to certain issues. In CBT, the therapist uses three techniques to accomplish these goals:

  • Didactic component: This phase helps to set up positive expectations for therapy and promote the child’s cooperation with the treatment process.
  • Cognitive component: This helps to identify the thoughts and assumptions that influence the child’s behaviors, particularly those that may predispose the sufferer to having the emotional or behavioral symptoms that they have.
  • Behavioral component: This employs behavior-modification techniques to teach the child more effective strategies for dealing with problems.

Most practitioners will continue treatment of a mental illness for at least six months. Treatment for children with a mental illness can have a significantly positive effect on the child’s functioning with peers, family, and at school. Without treatment, symptoms tend to last much longer and may never get better. In fact, they may get worse. With treatment, chances of recovery are much improved.

Medications

The major type of antidepressant and anti-anxiety medication prescribed for children is the selective serotonin reuptake inhibitors (SSRIs). SSRI medications affect levels of serotonin in the brain. For many prescribing doctors, these medications are the first choice because of the high level of effectiveness and general safety of this group of medicines. Examples of medications in this class that are approved for use in children are listed here. The generic name is first, with the brand name in parentheses.

The medications available for attention deficit hyperactivity disorder (ADHD) can have slightly different effects from individual to individual, and currently no way exists to tell which will work best. Medications indicated for ADHD are thought to work by improving the imbalance of neurochemicals that are thought to contribute to ADHD. Some commonly prescribed medications include the following:

Treatment of bipolar disorder with medications tends to address two aspects: relieving already existing symptoms of mania or depression and preventing symptoms from returning. Medications that are thought to be particularly effective in treating manic and mixed symptoms and have been approved by the Food and Drug Administration (FDA) for use in children (in children 10 years of age and older) include

For treatment of irritability in individuals with autism spectrum disorder, Risperdal has been FDA approved in children 5 years of age and older, while Abilify has been approved in children 6 years of age and older.

Where can parents find information or support groups for mental illness in children?

American Academy of Child and Adolescent Psychiatry
http://www.aacap.org

American Association of Suicidology
http://www.suicidology.org
1-202-237-2280

American Foundation for Suicide Prevention
http://www.afsp.org

American Psychiatric Association
http://www.psych.org

American Psychological Association
http://helping.apa.org

Autism Society of America
7910 Woodmont Ave. Suite 650
Bethesda, MD 20814
Phone: 301-657-0881 or 800-3AUTISM
Fax: 301-657-0869
http://www.autism-society.org/

Children and Adults with Attention Deficit Hyperactivity Disorder
http://www.chadd.org/

Depression and Related Affective Disorders Association
2330 West Joppa Road, Suite 100
Lutherville, MD 21093
Phone: 410-583-2919
Fax: 410-614-3241
http://www.drada.org
drada@jhmi.edu

FEAT Families for Early Autism Treatment

Lifetime Advocacy Network

National Alliance for the Mentally Ill
2101 Wilson Boulevard Suite 302
Arlington, VA 22201
HelpLine: 800-950-NAMI [6264]
http://www.nami.org/

National Autism Association
20 Alice Agnew Drive
Attleboro Falls, MA 02763
Phone: 877-622-2884
Fax: 774-643-6331
http://nationalautismassociation.org/

National Federation of Families for Children’s Mental Health
9605 Medical Center Drive
Rockville, MD 20850
Phone: 240-403-1901
Fax: 240-403-1909

National Society for Children and Adults with Autism
1234 Massachusetts Avenue N.W., Suite 1017
Washington, DC 20005
Phone: 202-783-0125

 

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