Thursday, February 7, 2013

CBO: Debt Spiral Deepening, Health Care Costs Soaring

Townhall has;
CBO: Debt Spiral Deepening, Health Care Costs Soaring

Behold, the projected consequences of four more years.  Philip Klein surveys the wreckage described in the latest comprehensive budget report from the nonpartisan Congressional Budget Office (most of these estimates assume an unrealistic "baseline" in which the "doc fix" doesn't happen and various unpopular cuts to Medicare actually go into effect):

So between now and the end of the decade, the national debt will explode, at least seven million people will be denied keeping their current plan even if they like it (other estimates are considerably higher), federal healthcare spending is poised to swamp the rest of the federal budget, and unemployment is likely to remain dismally high.  After 2023, the picture gets much worse.  Former CBO director Douglas Holtz-Eakin runs through some of these numbers in chart form in this user-friendly report, which is worth a read.  The actuaries also expect sluggish growth in the near and medium-term future, stunted by the growing debt burden.  Tepid growth would still beat Q4 of 2012, in which the US economy actually contracted for the first time since 2009.  Jim Pethokoukis adds a critical piece of information that contextualizes the anticipated debt boom:
The flood of new debt comes despite tax revenue from 2015 through 2023 being higher than the historical average. We have a spending problem.

In spite of higher than average 
expected revenues -- thanks to President Obama's various tax hikes and some moderate GDP growth -- the CBO nevertheless foresees nearly $9 trillion in publicly-held red ink staining our books in the next decade alone.  One trenchant snapshot of this phenomenon comesin 2023, when the CBO sees the government collecting double the tax dollars that it did in last year, yet the annual deficit will still hit $978 billion.  As Pethokoukis summarizes, we have a spending problem, no matter what the president may believe.  I encountered a similar head-in-the-sand mindset on Fox Business Network the other night, as Democratic strategist Malia Lazu echoed the White House's continued obsession with "more revenues:"

Her only passing nods to fiscal reality were platitudes about both sides needing to "come together" (and Democrats all cheered Paul Ryan when he did precisely that with his latest Medicare reform plan,right?) and the fresh idea of cutting defense spending -- the only federal dollars outlays seem willing to do without.  The media, meanwhile, has its Obama pom-poms at the ready, cheering the fact that next year's budget deficit will "only" be $845 billion.  I'll leave you with this observation from Klein: "Obama's first budget projected a $533 billion deficit in FY 2013.  Now we're supposed to celebrate $845 billion as great progress?"  Incidentally, the title of that budget?  "A new era of responsibility."  

Thank You Townhall, Mr Benson, Mr Klein, and Fox News

 Psychiatry's Raid On America's SSI & SSDI

Now, On To Mad In America for;
DSM-5 Boycott Launched!

February 5, 2013

Ordinarily, we Should post the author, Mr Carney's piece first, But Dr. Paula Caplan's Response is so good that we've repositioned it up first with Dr. Carney's response following.

I am sure Jack Carney’s intentions are good, but sadly, to urge a boycott of the DSM while urging people instead to use the ICD if they are going to use psychiatric labels reflects an overlooking of the fact that the authors of the DSM and the ICD have said repeatedly and publicly that they work hard to make sure that the contents of the DSM are as close to the contents of the mental disorders portion of the ICD as possible. It is actually dangerous to give people the impression — as Jack’s petition and this article do — that the appalling risks of serious harm caused by the use of DSM diagnoses (which have also characterized the unscientific editions of the DSM produced by both Robert Spitzer and Allen Frances) will be avoided by use of the ICD.

As for the price of DSM-5, why is charging $199 in 2013 suddenly shocking, when there was no such outcry for Allen Frances’ current edition, DSM-IV-TR, which a call to Barnes and Noble just revealed a price of $142 plus tax? After all, DSM-IV went on the market nearly two decades ago, and the “TR” version has only a tiny number of changes and went on the market in 2000.

Those who know my work know that I have been a critic of the DSM since serving on two of Allen Frances’ committees to plan DSM-IV from 1988 till I resigned in 1990 because I was so horrified to see how they used junk science, ignored good science, and falsely and publicly claimed that their work was scrupulously scientific (as Frances continues to do, allegedly in contrast to the DSM-5 people, who are also appallingly unscientific) and not harmful. So I, too, wish people would boycott the DSM but also that they would not assume anything about the ICD psychiatric section is either scientifically grounded, helpful in reducing human suffering, or less risky for patients than the DSM.

I created the first anti-DSM petition in the late 1980s, which drew signatures from individuals and huge organizations (including NOW, the Canadian Psychological Association, and others) representing more than six million people, and I created a year ago last December the first “Boycott the DSM” petition at because I was so alarmed by how many people would continue to suffer from the DSM-IV-TR (as indeed they do right this minute) while Spitzer and Frances and others have focused all of their attention on trashing the DSM-5 editors for doing the same kinds of ignoring of science and harm and making of false claims of which Spitzer and Frances themselves were guilty). Hence, I did not limit my petition to boycotting the next edition of the DSM only. I wish that Jack had accepted my offer to work together on his new project, and it is unfortunate when the few people who want to take action in this movement cannot see their way clear to working together, but I hope his petition will be wildly successful. Not having volunteers or funding to pay people to help get the word out about my “Boycott the DSM” petition, I hope that he will get many more boycott pledges than I have done. But I hope that he will revise his petition to remove the misleading urging to use the ICD instead, because that is just urging people to flip their patients out of the frying pan and into the fire. Remember: unscientific and harmful labels were plentiful when Spitzer created DSM-III and then DSM-III-R, and then Frances freely acknowledges that he got rid of almost none of that when he created DSM-IV and DSM-IV-TR, and it is a good bet that most of that garbage will also appear in the DSM-5…and thus in the next ICD.
  • Thank you, Paula, for your generosity. We’ll get together one of these days and continue what you began many years ago. Thank you.
    We don’t claim anywhere in the text of any of the documents we posted that the ICD is the superior document — equally reductive and degrading. We added the recommendation that practitioners resort to the ICD as a bureaucratic alternative to the DSM. You’d be surprised how few folks in the mental health system know that the DSM is superfluous to the billing system — and, in practice, totally superfluous. We’re stuck with ICD by law and international treaty; so, until the system dramatically changes, better the ICD than the DSM! I know that’s not a terribly satisfactory response, but it’s the most apt for this moment in time.
Now, here's Mr Carney's piece:

Believe it or not, there’s some confusion about what “boycott” means. Bluntly, it means “Don’t purchase or use the object being boycotted.” Remember the United Farm Workers and table grapes and iceberg lettuce? I remember walking a picket line daily for weeks in front of my neighborhood supermarket carrying a sign urging customers entering the store not to buy grapes and lettuce. It must have worked – this was back in the 1970’s – because the grape and lettuce growers in California’s Salinas Valley were obliged to sign contracts with the UFW and its members.
The Committee to Boycott the DSM-5 is comprised of regular, not-so-famous mental health professionals, users of psychiatric services and their family members and those who’ve managed to survive many years as patients in the mental health system. In short, folks like many others, who’ve grown to mistrust and/or been adversely affected by the psychiatric establishment and its series of “bibles” or DSMs, and who anticipate even worse experiences with the new DSM-5. Our objectives are to trigger the memories and sensibilities of those – professionals, patients, family members and survivors – who’ve had similar unhappy experiences; convince the professionals neither to buy nor use the new DSM; encourage current patients to urge their psychotherapists and psychiatrists to neither buy nor use the DSM-5; and ask the survivors to do what they do best, viz., reach out to those they know still caught up in the system and support their efforts to press those who treat them to neither buy nor use the DSM-5.
I think you get the message.
The Boycott statement below contains a series of brief rationales for our opposition to the DSM-5: that it’s unscientific, unsound and ultimately unsafe; that it continues the DSM tradition of pathologizing ordinary behaviors – the new DSM will contain over 300 diagnostic categories, up from DSM-IV TR’s 250; that it narrows “treatment of choice” to the prescription of psychoactive medications despite their known toxicity and suspect effectiveness; that the APA has undermined its own credibility by disregarding the many criticisms of the DSM’s nosology.
If you’re so inclined, additional and more detailed critiques can be obtained on this very website in the several articles about DSM-5 written by me and others over the last 12 and more months. My last post was on December 10, 2012 and entitled “Boycott The DSM-5: Anachronistic Before Its Time.”
If we succeed in getting a sizable number of the millions of prospective DSM buyers to sign on to our Boycott statement, a copy of which you’ll find at the end of this post, we’ll put a sizable dent in the sales needed by the American Psychiatric Association to recoup its investment in the development of the new DSM.
Allen Frances, the most well-known critic of the DSM-5, has estimated that the new DSM cost the APA $25 million to bring to press, which explains the hefty price for each volume — $199 per – the APA is charging. Which translates to a break-even figure of 12.5 million buyers world-wide. The APA is already soliciting pre-orders of on its website, nearly four months before the new DSM’s scheduled mid-May publication.
One final point. We realize that all professionals employed in the public mental health system, indeed any professional or agency seeking third party reimbursement for services rendered, must use diagnostic codes. Accordingly, we are recommending that, if you must use diagnostic codes, use those contained in the ICD-9. Please be advised that you do not need to rely on the DSM’s codes – they are entirely superfluous to billing procedures, which, by U.S. law and international treaty, must employ ICD codes. Our recommendation should not be construed as an endorsement of the ICD – we consider all diagnoses reductive and demeaning to the persons so diagnosed. Rather, our recommendation to use the ICD codes is meant as a bureaucratic expedient for those obliged to use them. In short, anything but the DSM-5.
The Boycott statement itself can be found and signed by those who agree with its contents and intent at Boycott the DSM-5 ( on I realize that our Boycott statement is far from perfect – frankly, it’s impossible to address or anticipate all the concerns of prospective supporters in a brief document. But, as I like to say, any rock that’s handy, I’ll toss it at the behemoth.
And that’s also why we have a companion information website — Boycott DSM-5— ( where additional information will be posted by the Committee and where those who wish to can post comments. Should any reader wish to join the Committee and do some work on its behalf or should you belong to an organization that might be interested in co-sponsoring the Boycott, please contact me via MIA e-mail, via our support website or directly to me at
I trust that most readers will find themselves able to support the Boycott and sign the Boycott statement. Feel free to cut and paste it, send it on to friends and colleagues, post it on your Facebook pages or websites. Thanks.
Remember, “Don’t mourn, organize! We are all prisoners of hope.”
For the Committee, Jack Carney
Carney, J., “Boycott The DSM-5: Anachronistic Before Its Time,” December 10, 2012,
Frances, A., Price Gouging: Why Will DSM-5 Cost $199 a Copy?
* * * * * *
Boycott the DSM-5!
We, the undersigned, will not purchase nor will we use the new DSM-5 when it is published by the American Psychiatric Association. Further, those of us associated with professionals who use the DSM – as persons receiving services from them or as family members, friends or advocates – will urge service providers not to use the DSM-5:
• DSM-5 is unsafe and scientifically unsound.
Its categories or diagnoses, including newly introduced diagnoses, are not supported by scientific evidence. These diagnoses will pathologize rather than bring relief to persons in distress.
• DSM-5 will drastically expand psychiatric diagnosis, mislabel millions of people as mentally ill, and cause unnecessary treatment with medication.
All references to psychosocial, environmental and spiritual factors have been removed from DSM-5. This sends a clear message to clinicians that treatment for persons judged to have psychiatric disorders can be reduced to the prescription of psychoactive medications, despite growing concerns of their dangers and skepticism about their effectiveness.
• The APA has been unresponsive to widespread opposition.
The APA has been unresponsive to criticism received from professional, advocacy and lay public stakeholders during the three public reviews of its proposals. The concerns expressed by over 14,000 signatories to the “Open Letter to the DSM-5” and the request for independent, scientific review of proposed changes to the DSM have been ignored.
• The APA has undermined it own credibility, choosing to protect its intellectual property and publishing profits, not the public trust.
Accordingly, we agree to boycott the DSM-5 and to urge service providers and others not to use it. If we find ourselves obliged to employ diagnostic codes, we agree to disregard the new DSM and utilize the codes listed in the ICD-9 and the next edition of ICD, when the latter is implemented in October, 2014.


Thank You Mad In America, Dr. Carney, and Dr. Caplan

No comments: