What Makes America the Greatest Country in the World?

In the very first scene in the award winning show, “The Newsroom,” Jeff Daniels, who is playing a cable newscaster, is appearing as a guest speaker at  Northwestern University. A young college student asks him the following question, “Can you sum up in one sentence or less ... what makes America the Greatest Country in the World?” After first dodging the question, he is pressed for an answer by the moderator of the event. His candid response follows:

And you—sorority girl—yeah—just in case you accidentally wander into a voting booth one day, there are some things you should know, and one of them is that there is absolutely no evidence to support the statement that we're the greatest country in the world. We're seventh in literacy, twenty-seventh in math, twenty-second in science, forty-ninth in life expectancy, 178th in infant mortality, third in median household income, number four in labor force, and number four in exports. We lead the world in only three categories: number of incarcerated citizens per capita, number of adults who believe angels are real, and defense spending, where we spend more than the next twenty-six countries combined, twenty-five of whom are allies. None of this is the fault of a 20-year-old college student, but you, nonetheless, are without a doubt, a member of the WORST-period-GENERATION-period-EVER-period, so when you ask what makes us the greatest country in the world, I don't know what the fuck you're talking about?! Yosemite?!!!

We sure used to be. We stood up for what was right. We fought for moral reasons, we passed and struck down laws for moral reasons. We waged wars on poverty, not poor people. We sacrificed, we cared about our neighbors, we put our money where our mouths were, and we never beat our chest. We built great big things, made ungodly technological advances, explored the universe, cured diseases, and cultivated the world's greatest artists and the world's greatest economy. We reached for the stars, and we acted like men. We aspired to intelligence; we didn't belittle it; it didn't make us feel inferior. We didn't identify ourselves by who we voted for in the last election, and we didn't scare so easy. And we were able to be all these things and do all these things because we were informed. By great men, men who were revered. The first step in solving any problem is recognizing there is one—America is not the greatest country in the world anymore.

That scene is one of the most impactful opening scenes of any television show in recent memory. And although fictional, is there any legitimate doubt as to the accuracy of those remarks ringing true today? Especially in the field of mental health and more specifically in the eating disorder industry.

But, we are not here today to bury America. Instead, we are here today to praise Australia.

On Sunday, December 9, 2018, Christine Morgan, the CEO of the Butterfly Foundation issued a press release stating that the Prime Minister of Australia announced an amendment to Australia’s Medicare Benefits Scheme designed to improve access and affordability of appropriate eating disorder treatment across Australia. One executive stated, “The socio-economic impact of eating disorders on a person’s life is one of the most severe and enduring in Australia. The introduction of a Medicare response into the health system is the most significant and necessary reform. Without a Medicare response other system reforms that are still needed could not be considered.” [emphasis added]

Australia’s new benefit scheme in part provides:

 · A dedicated single Medicare Benefits Scheme item number for eating disorder treatment for those with severe and complex illness, delivering up to 60 Medicare funded sessions of treatment – 40 psychotherapeutic and 20 dietetic across the range of eating disorders – anorexia nervosa, bulimia nervosa, binge eating disorder and atypical presentations.

· Diagnosis by a GP and mental health practitioner recognizing that these psychiatric illnesses have a significant physical impact and integrated treatment is essential.

The Press Conference announcing this new law was momentous as well. It included politicians, foundations, counselors, and family members all united as one. The transcript from this Press Conference can be found here:

https://www.pm.gov.au/media/press-conference-butterfly-foundation

Standing by itself, this achievement is incredibly note worthy. But,  this is only the latest event in what now appears to be a concerted government – private enterprise collaboration to address this insidious disease. Australia along with New Zealand has a recent history of being progressive, of confronting a problem head on and objectively seeking to find solutions. In 2014, The Royal Australia and New Zealand College of Psychiatrists issued new Clinical Practice Guidelines for the treatment of eating disorders. These Guidelines included policies and procedures for the admission of children and young adults, guidelines addressing in-patient management and outpatient care, hospital care, residential care. It was free of corporate bias with no specific economic agenda. Treatment will be made available for groups of people who previously would not have been able to obtain help.

Australians have been given hope. They know that their government listened to their concerns and fears and took affirmative, strong action. Research and treatment are not being driven by private corporations whose interest begins and ends with their profit margin.

Meanwhile, back in the United States

Status quo ante reigns, no progressive, affirmative bold conduct is being undertaken and our children continue to die. In the halls of Congress, strengthening and increasing the financial gains of the private equity overlords predominates lobbying efforts. Nowhere is this more obvious than in analyzing the 2018 payments to the eating disorder lobby and the specific bills being lobbied.

In 2018 alone through the end of October, the Eating Disorder Coalition, the Residential Eating Disorder Consortium (“Consortium”) and the National Eating Disorder Association (“NEDA”) paid their now unified lobbyist a combined $250,000.00. This number is expected to exceed $325,000 by years end. And what did the eating disorder industry buy with this money? The specific bills and resolutions the lobbyist was instructed to lobby involved:

1.             On behalf of NEDA, H.R. 1625, the “Consolidated Appropriations Act of 2018,” related Labor and Defense Appropriations Acts and House Resolution 428 and Senate Resolution 419 both of which recognize February 26, 2019 – March 4,2018 as “eating disorder awareness week.” NEDA paid the lobbyist $60,000 for this work.

2. The Consortium paid the lobbyist $100,000 to lobby on the following matters:

S. Amdt. 2222 "Bipartisan Health Care Stabilization Act of 2018" to H.R. 1625 "Consolidated Appropriations Act, 2018," all provisions. H.R. 4666 "Premium Relief Act of 2017," all provisions. S. 1835 "Lower Premiums Through Reinsurance Act of 2017," all provisions. Issues pertaining to Association Health Plans- 29 CFR Part 2510, RIN 1210-AB85, all provisions. Issues pertaining to Short-Term, Limited Duration Insurance- 26 CFR Part 54, RIN 1545-BO41, all provisions. P.L. 114-255 "21st Century Cures Act," all provisions. H.R. 6311 "Increasing Access to Lower Premium Plans and Expanding Health Savings Accounts Act of 2018," all provisions. S. J. Res 63 "A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Secretary of the Treasury, Secretary of Labor, and Secretary of Health and Human Services relating to "Short-Term, Limited Duration Insurance", all provisions. H.R. 6898 "Maintaining Protections for Patients with Preexisting Conditions Act of 2018", all provisions. [emphasis added]

3. The ED Coalition paid $90,000 on the following issues: Senate Bill 3158, deemed the 2019 Department of Labor Appropriations Act and the aforementioned H.R. 1625, the “Consolidated Appropriations Act of 2018.

That is the totality.

That is what almost 1/3 of a million dollars in lobbying bills gets you. No additional treatment funding. No additional university based research funding. No mandatory increase in training on eating disorders in medical schools and internships. No new laws policing the out of control private equity firms who are running amuck in the eating disorder industry. 

So what do you receive? Lobbying to cut off much needed help for families.

Short-term, limited-duration insurance is a type of health insurance coverage that is primarily designed to fill gaps in coverage that may occur when an individual is transitioning from one plan or coverage to another plan or coverage, such as when they are between jobs.

The Rule proposed by the Secretary of the Treasury, Secretary of Labor and Secretary of Health and Human Services provides consumers with more affordable options for health coverage. Under this Rule, consumers would have the ability to purchase short-term, limited-duration insurance policies that: 

1.    Are less than 12 months in duration;

2. Contain important language to help consumers understand the coverage they are receiving, and;

3.   May be renewed for up to thirty-six (36) months.

Parents, moms, dads, families … The Residential Eating Disorder Consortium paid the unified lobbyist to oppose short term, limited duration insurance policies. You read that correctly. To reiterate, the Consortium paid the lobbyist to oppose short term, limited duration insurance policies.

These insurance policies could provide the ability to pay for life saving treatment for our loved ones. And yet, the Consortium opposes it? To double check, I looked at the specific language utilized in the Senate Joint Resolution 63. The totality of the language states:

Resolved by the Senate and House of Representatives of the United States of America in Congress assembled, That Congress disapproves the rule submitted by the Secretary of the Treasury, Secretary of Labor, and Secretary of Health and Human Services relating to “Short-Term, Limited Duration Insurance” (83 Fed. Reg. 38212 (August 3, 2018)), and such rule shall have no force or effect.

To triple check, I then looked at the language of the Rule submitted by the Secretaries and recorded at 83 Fed.Reg. 38212. The exact language  summarizing this rule states:

This final rule amends the definition of short-term, limited- duration insurance for purposes of its exclusion from the definition of individual health insurance coverage. This action is being taken to lengthen the maximum duration of short-term, limited-duration insurance, which will provide more affordable consumer choices for health coverage.

And all of the treatment centers who are included in the Residential Eating Disorder Consortium not only oppose this provision, but are paying a lobbyist to oppose short-term, limited duration insurance policies which would potentially provide payment for life-saving treatment.

Is it because if this type of insurance passed and became law, it would reduce the profits for the insurance providers while increasing their costs? Is it because it could make treatment decisions in accordance with insurance policy language and the DSM V more problematic for treatment centers? Is it because the private equity firms which now control the Consortium and ED Coalition are in bed with the insurance industry?

Whatever the reason, the daunting obstacles confronting families who suffer from eating disorders are being exacerbated by the greed of the private equity firms which own the treatment centers and the insurance industry. And the cost to pay for this greed? The lives of our loved ones at the rate of one death every 62 minutes. At this point, you may use whatever word you wish … reprehensible, unethical, disgusting, or vile to define the state of the eating disorder industry in the United States.

As the mantle of leadership and insight into treating and researching eating disorders is firmly grasped by Australia, they are to be commended and even admired for their vision and wisdom. And as for us? The reality of why America is not the greatest country in the world comes more into focus.