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Had I known I’d had a stroke, I would have gone to the hospital. But shouldn’t part of my body have gone limp, or my face drooped? Shouldn’t I have slurred or had blurred vision? Despite the moderate buzz in my head and ears, I was 100 percent. (D. Michael Whelan, 5/31)

The term “medically necessary” is the yardstick by which insurance companies, including Medicare and Medicaid, decide if they will pay for a particular treatment. For the millions of Americans living with rare diseases, most of which do not have FDA-approved treatments, identifying a treatment as medically necessary can be a lifeline — or the end of the line. A white paper released in April by the influential Institute for Clinical and Economic Review offers several misguided proposals that attempt to balance public interest in incentivizing innovation with payer cost containment goals in rare diseases. The proposals are unlikely to benefit people living with rare diseases, clinicians like us who care for them, or those trying to bring rare treatments to market. (Darcy Krueger and Emanual Maverakis, 6/1)

A time-honored political trick is to pass a “temporary” subsidy that people get used to and then cry hardship when the emergency program ends. The latest example is the Democratic scramble to make permanent a huge ObamaCare subsidy expansion passed during the pandemic. ... The Congressional Budget Office predicted the pandemic subsidy provisions would cost about $34 billion, but that is only the beginning if the spigot stays on. Last week CBO increased its estimate of spending on ObamaCare subsidies this year by 15%, or $11 billion, over last year’s forecast, thanks to higher enrollment and higher premiums than anticipated. Companies would likely respond by sending more of their employees to the exchanges for coverage. (5/30)

Young people in the United States are experiencing a mental health crisis. Warnings from the surgeon general, the American Academy of Pediatrics, the American Psychological Association and other prominent organizations, as well as regular news reports, highlight the catastrophe, with parents struggling to help their children, and students lined up in school halls to get even a few minutes with counselors, psychologists or social workers who are overwhelmed with young patients seeking services. (Mitch Prinstein and Kathleen A. Ethier, 5/31)

More than half of people with mental illness receive no treatment at all. Oftentimes, people avoid or delay seeking support and other forms of treatment due to concerns that they will be treated differently once they come forward. They may fear losing their job, alienating family or friends, or even fear for their safety. It’s time to face the facts; this is not equitable or sustainable access to care. A proven barrier to equitable care is the pervasiveness of stigma, prejudice, and discrimination. (Scott Brabant, 6/1)

One week after an 18-year-old gunman murdered 21 people, including 19 children, opponents of reasonable gun restrictions continue to shift the focus to other possible causes, including a lack of mental health services. “We need to look at what is causing these attacks,” said Rep. Vicky Hartzler of Missouri. “Are there mental health problems that we can address?” she asked. “We need to continue working to ensure anyone who has a mental or behavioral health issue can get the treatment they need, when they need it,” Sen. Roy Blunt of Missouri told the PBS NewsHour. “We as a state, we as a society, need to do a better job with mental health,” said Texas Gov. Greg Abbott. Americans should not be misled. The problem is individual access to high-powered weaponry, not just mental illness. (6/1)

As the murdered children of Uvalde are laid to rest this week, our nation needs to muster the courage and political will to treat rising gun violence and mass shootings as an acute public health crisis. When auto accidents claimed a large number of lives, government and industry dollars funded research to make cars safer, leading to seat belts, airbags and other now standard safety features. Public health studies that linked smoking to cancer, lung disease and other health risks changed smoking habits. Subsequent legal action held tobacco companies responsible for having hidden the health risks associated with their products. (6/1)