Kali White VanBaale is an Iowa-based novelist, creative writing professor, and mental health care advocate. Find more of her work at kwhitevanbaale.substack.com (where this essay first appeared) and www.kaliwhite.com.     

In late January, the Treatment and Advocacy Center released an annual report, “Prevention Over Punishment: Finding the Right Balance of Civil and Forensic State Psychiatric Hospital Beds.” It says in part:

The number of state psychiatric hospital beds for adults with severe mental illness has continued to decline to a historic low of 36,150, or 10.8 per 100,000 population in 2023, with a majority of state hospital beds occupied by people who have been committed to the hospital through the criminal legal system. This strategy of prioritizing admission of forensic patients effectively creates a system where someone must be arrested to access a state hospital bed in many states.

Other key findings:

Iowa’s Republican leaders have few checks remaining on their power. But one law approved during the 2023 legislative session appears unlikely ever to go into effect.

Federal judges in four states have blocked the government from enforcing bans on gender-affirming care for minors.

U.S. District Court Judge James Moody issued the most comprehensive ruling on the matter on June 20, when he permanently enjoined an Arkansas law enacted in 2021. Moody found the law violated the Fourteenth and First Amendments of the U.S. Constitution. Three other judges, including two appointed by President Donald Trump, have issued preliminary injunctions on similar laws in Indiana, Alabama, and Florida while litigation proceeds.

Although Arkansas Governor Sarah Huckabee Sanders has said she will appeal the ruling in Brandt v Rutledge, Judge Moody’s extensive findings of fact could influence the outcome on the Eighth Circuit Court of Appeals, where a challenge to Iowa’s ban on gender-affirming care may eventually be heard.

Tony Leys is Rural Editor/Correspondent for Kaiser Health News, where this story was first published. Follow him on Twitter @TonyLeys.

KNOXVILLE, Iowa ― Bette Helm was glad to have someone to talk with about her insomnia.

Helm lives in a nursing home in this central Iowa town of about 7,500 people, where mental health services are sparse. On a recent morning, she had an appointment with a psychiatric nurse practitioner about 800 miles away in Austin, Texas. They spoke via video, with Helm using an iPad she held on her lap while sitting in her bed.

Video visits are an increasingly common way for residents of small-town nursing homes to receive mental health care. Patients don’t have to travel to a clinic. They don’t even have to get cleaned up and leave their bedrooms, which can be daunting for people with depression or anxiety. Online care providers face fewer appointment cancellations, and they often can work from home. While use of some other telehealth services may dwindle as the COVID-19 pandemic winds down, providers predict demand for remote mental health services will continue to increase in rural nursing homes.

You have to hand it to Deidre DeJear.

Governor Kim Reynolds has all the advantages of incumbency. She has spent most of the year avoiding unscripted questions and taking credit for projects that President Joe Biden and a Democratic Congress made possible. While the challenger has struggled to get her message in front of voters, Reynolds enjoys free media coverage almost daily and has blanketed the state with (sometimes racist) television commercials for the past six weeks.

The day before the only scheduled debate between the candidates for governor—Reynolds would not agree to the traditional three—the Des Moines Register published a new Iowa Poll by Selzer & Co showing the incumbent ahead by 52 percent to 35 percent among likely voters.

In other words, the odds facing DeJear could hardly be longer.

Nevertheless, the challenger spoke with clarity and confidence throughout the hour-long “Iowa Press” appearance, using facts and personal stories to great effect. She refused to take the bait when Reynolds fell back on divisive talking points about what “they” (Democrats) supposedly want to do.

I hope voters will take the time to watch the whole program, or read the transcript on the Iowa PBS site. Eight exchanges struck me as particularly revealing.

Melissa Halverson, DNP ARNP is a Des Moines area nurse practitioner specializing in gastroenterology.

This November, Polk County voters will fill three seats on the Broadlawns Board of Trustees.

When I heard my friend and former colleague Kacey Davis was running for Broadlawns Board of Trustees, I must admit I was a little surprised. After all, she had a toddler, and a demanding job. That seemed to be a lot to handle even without a campaign in the mix.

But I should not have been so surprised. As a family nurse practitioner in community health, Kacey knows firsthand the barriers to finding medical care and mental health services for our most vulnerable residents. Helping to break down those barriers motivates her to serve on the Broadlawns Board of Trustees.

Steve Corbin is emeritus professor of marketing at the University of Northern Iowa and a freelance writer who receives no remuneration, funding, or endorsement from any for-profit business, nonprofit organization, political action committee, or political party.

Most people have memorized their Social Security number, cell phone number, anniversary, birthday and the 911 emergency medical, fire and police protection services number. On July 16, the number “988” became an easy-to-remember crisis hotline number we should log into our memory bank.

Anyone who needs support for a suicidal, mental health, substance use crisis, or other emotional issue can dial or text 988. The nationwide set-up should strengthen and expand the existing Lifeline system, which is a national network of more than 200 local, independent and state-funded crisis centers.

Both the new 988 hotline number and the previous ten-digit number (800-273-8255) will remain in operation, providing 24/7 free and confidential support for people in distress.

David Farwell of Spillville, Iowa is a service-connected PTSD disabled veteran and activist for veteran health services as owed to them by law.  

I’ve moved 49 times in 50 years, which is not surprising for a military brat and former global project leader at an international corporation.  

What may be surprising is why my last move was from a Chicago high-rise to Spillville, Iowa, and how an invisible epidemic shattered my life, ended my career and brought me to the tiny town in Iowa where Dvorak completed his New World Symphony.

The Linn County Board of Supervisors voted on June 13 to “prohibit any efforts by service providers to change sexual orientation and/or gender identity of minors, including conversion and reparative therapy,” in unincorporated areas of the county.

“Conversion therapy” refers to efforts to change a person’s sexual orientation or gender identity and has been widely discredited as ineffective and traumatizing for youth. Associations representing medical professionals, counselors, and therapists have denounced the practice for many years.

Supervisor Stacey Walker led efforts to pass the ordinance, and Supervisor Ben Rogers (also a Democrat) provided the second vote in favor. When the board considered the third and final reading, Walker said the policy “will save lives” and described it as “a moral imperative for all policymakers who take seriously their job of protecting the health and welfare of the people.”

Self-awareness has never been Governor Kim Reynolds’ strong suit.

So it was that just this week, Reynolds asserted in an interview with the Des Moines Register that mental health “has been so important to me.” The governor lamented the pressures kids have faced over the past two years, “the depression, the anxiety,” adding, “We’ve seen suicide rates among young girls up over 50 percent” during the COVID-19 pandemic. She bragged about “working on mental health for five years” and “standing up a children’s mental health system.”

You’d never guess she just signed a bill that is guaranteed to increase depression, anxiety, and suicidal ideation among some of Iowa’s most vulnerable youth.

Ira Lacher: We need to pursue hope, and we must prioritize it over our other base emotions such as doubt, fear, and anger.

On a day when the news is filled with record COVID-19 infections, the anniversary of a revolt against American democracy, societal lawlessness, and myriad other ills of our time, it would be facile to begin 2022 with a screed about how lousy it sucks to be us.

Not going to happen.

Rather, on this occasion, at least, I leave it to others to begin 2022 by submerging their keyboards in despair. To paraphrase a speech from Captain James T. Kirk, “We can admit we’ve been doomsayers, but we’re not going to doomsay today.”

Today, let’s speak of hope. Of optimism. Of ways to take comfort of the undeniable miracle we call existence.

One in four American adults believe the 2020 presidential election was “stolen.” One in four say they won’t get a COVID vaccine. About one in five Americans believe one or more QAnon conspiracy theories.

But it is interesting how closely those numbers correlate with this one: Nearly one in five Americans (52 million) “live with a mental illness.”

The evidence is mounting that our dysfunctional politics are the result of mass mental illness.

Brandi Webber is a local artist, volunteer, mother, and candidate for Des Moines City Council in Ward 3. -promoted by Laura Belin 

A community’s priorities can be made visible by looking at the breakdown of the city budget. Looking at Des Moines’ city budget, you see that our largest single priority, at roughly 39 percent of spending, is policing.

With such a large portion of our budget devoted to policing, examining the effectiveness of police and their role in our community should be non-controversial. When we talk about “defunding the police,” many will conjure an image of a city in disarray as the pillars of society crumble to the ground. The reality is, our society relies too heavily on a policing system.

UPDATE: The U.S. Senate passed the Sgt. Ketchum Rural Veterans Mental Health Act of 2021 by unanimous consent on June 24, and President Joe Biden signed it into law on June 30. Original post follows.

From the earliest Memorial Day observances organized by freed slaves following the Civil War, this holiday has focused on remembering military service members who died in wars. More than 26,700 Iowans have died in wartime service, with the Civil War accounting for nearly half of the fatalities.

Far too many Americans with military backgrounds die by their own hands. Hundreds of active-duty troops and more than 6,000 veterans take their own lives every year. That death toll exceeds the total U.S. military fatalities in Iraq from 2003 to 2020.

Iowa’s members of Congress have tried again this spring to improve mental health services for veterans. Unlike in previous years, legislation named after Sergeant Brandon Ketchum made it through the U.S. House and now awaits action in the Senate.

Ira Lacher considers whether “the only way to heal is to treat our society the way we would treat traumatized individuals: small-group therapy.” -promoted by Laura Belin

America has a mental health crisis.

Not the type conservatives insist makes someone turn a movie theater, shopping mall, or hotel parking lot into a kill zone. A mental health crisis that is contributing to a monumental, perhaps unprecedented loss of ability to connect with reality. The reason is extreme trauma on a national scale.

Governor Kim Reynolds is one step closer to getting the massive broadband expansion she asked Iowa lawmakers to fund.

Whether Iowans in underserved communities will be able to afford new high-speed internet is an open question, however.

Amber Gustafson is a progressive activist and was the 2018 Democratic candidate in Iowa Senate district 19. -promoted by Laura Belin

Dear Fellow Iowa Democrats,

It’s a new year and with that comes new perspectives and new outlooks.

In November of 2020, I put my name forward to run for Iowa Democratic Party chair and with it I shared a plan to help our party regain our footing in our state. It was with determination and optimism that I stepped forward to offer my services to our party. But since my initial announcement, my family’s circumstances have come to bear on my plans for 2021.

It is with great regret that I have chosen to withdraw my name for consideration as chair of the Iowa Democratic Party.

Leslie Carpenter: Eliminating inpatient psychiatric beds has dire consequences for people with serious brain disorders. -promoted by Laura Belin

Mercy Iowa City recently announced that it will be closing its inpatient psychiatric unit, due to “the financial impact of COVID-19.” Hospital officials confirmed that the unit (recently staffed for ten inpatient beds) will close by the end of the calendar year, “in favor of expanding our outpatient service where there is greater community need.” 

However, outpatient care is no substitute for patients who need inpatient care. In fact, there’s no state in our country that needs to expand inpatient care more than Iowa.

Brad Zaun’s fifth campaign for the state legislature will be his toughest yet.

Like affluent suburban areas around the country, Iowa Senate district 20 has been trending away from Republicans. Democrats in the northwest suburbs of Des Moines did well in the 2019 local elections and more recently surpassed the GOP in voter registrations.

Zaun has adapted to the new environment with messaging that doesn’t mention his party affiliation, his votes for many controversial laws, his numerous attempts to ban abortion, or his early support for Donald Trump’s candidacy.

On the contrary, he is campaigning as an “independent voice” and leader on improving education and mental health services.

Bleeding Heartland welcomes guest posts advocating for Democratic candidates for Iowa offices. -promoted by Laura Belin

My name is Jeffrey Cárdenas. I’ve been volunteering to elect Rhonda Martin to Iowa Senate district 20 and to defeat Brad Zaun.

On Friday I attended a protest against anti-Black violence in Des Moines. There a young African American male speaker asked, “…my grandparents turned the other cheek and walked away. N*ggah, I won’t. And if you think that’s wrong, what am I supposed to do? Please tell me, what am I supposed to do?!”

His question immediately reminded me of President Barack Obama’s eternal call to action: “I don’t know what party these men and women belong to. I don’t know if they’ll vote for me. But I know that their spirit defines us. They remind me, in the words of scripture, that ours is a future filled with hope. And if you share that faith with me, if you share that hope with me, I ask you [to vote].”

A little more than two months after Iowa recorded its first death attributed to novel coronavirus, the number of reported COVID-19 deaths in the state has surpassed annual deaths by suicide in recent years.

Ira Lacher: “For better, or God forbid, much worse, America has decided on a path: Reopen, urge common-sense caution, and come what may.” -promoted by Laura Belin

My friend’s daughter caught COVID-19. Experiencing high fever and labored breathing, she visited an emergency room of a New York City hospital, where she spent several days in intensive care, before finally being allowed to go home, where milder symptoms continued for weeks. But physical symptoms gave way to mental health symptoms, specifically, severe panic. Those same symptoms have befallen her father, hundreds of miles away from her.

The effects of the pandemic have been duly reported: physical symptoms, sometimes leading to death; economic symptoms, careering the world toward financial collapse; societal symptoms, including increasing disregard for civil authority. Now, the United Nations is adding another effect: mental health symptoms.

Deb Scharper launched her campaign today in Iowa Senate 26, one of two Obama/Trump state Senate districts where no one filed to run in the June 2 Democratic primary.

While outside the top tier of Democratic pickup opportunities in the upper chamber, this district was decided by a narrow margin in 2012. Scharper’s race against first-term State Senator Waylon Brown is also worth watching for clues on whether Republicans, who now hold a 32-18 Senate majority, can maintain their advantage in the part of Iowa that swung most heavily to Donald Trump in 2016.

Heather Strachan is a mental health professional, criminal justice reform advocate, and a former rural organizer for Barack Obama’s 2008 campaign. -promoted by Laura Belin

Throughout caucus season I have fielded questions from advocates and professionals alike asking why mental health has gone largely ignored in the presidential race. All eyes are on Iowa at a time when we have reached the bottom of the pile in terms of the number of available beds, the number of psychiatric providers per capita, and the availability of community-based services. One in five Iowans will experience mental illness in their lifetimes, and this has far-reaching effects throughout families and entire communities, including my own.

The candidates are not solely to blame: the media are mostly not asking the question.

Janice Weiner is a city council member in Iowa City and a retired U.S. Foreign Service Officer. -promoted by Laura Belin

I’m someone who makes decisions with a combination of head and heart. I learned during my Foreign Service career that I needed both, and I applied that when considering the impressive field of Democratic presidential candidates. Do they speak to me personally? Do their policies make sense? We in Iowa are so fortunate to have this opportunity – not just to see candidates at a rally and read their platforms and policies – but to get to know them as people. And they us, as well.

Like so many others, I trekked to events for countless candidates. Last May, as a part of that process, I attended the Klobuchar campaign’s mental health/addiction panel in Iowa City, screwed up my courage, and told the senator my story. I’m a retired Foreign Service Officer, and I’m raising my granddaughter because my daughter cannot, because of her struggles with dual diagnosis – mental health and addiction, rolled into one. We are not unique – how I wish we were.

Scott Carpenter is a co-founder (with his wife Leslie Carpenter) of Iowa Mental Health Advocacy, which works to improve the broken treatment system for people with serious brain disorders in Iowa and across the country. -promoted by Laura Belin

Prior to the last mid-term election, I described the characteristics I wanted to see in my ideal candidate. Since then, my criteria haven’t changed, and they’re applicable to the 2020 presidential election.

First and foremost, my ideal candidate is a kind, caring, and thoughtful person who is comfortable interacting with people. I want to see empathy and compassion. My ideal candidate is someone who sincerely cares about and genuinely supports the things that are important to their constituents. My ideal candidate is passionate about working to help people. I want that caring to be obvious in all aspects of their campaign.

I often ask candidates several questions. What motivates you each morning when you wake up? What drives you? What’s your passion? The answer to such seemingly simple questions should be obvious for most candidates. If it isn’t, then they should consider a different profession.

You don’t have ask Cory Booker those questions. It’s on display once he starts to speak.

An under-reported Iowa politics story this year has been strong Democratic recruiting for the 2020 state Senate races. Even though recapturing the Iowa Senate is likely to take at least two election cycles, given the current 32-18 Republican majority, Democrats have declared candidates in five out of six Senate seats the party lost in 2016.*

Other Democrats are actively campaigning in three Senate districts that were only nominally contested in 2016.**

As of this week, Democrats also have a challenger in an Iowa Senate district that is so heavily Republican the party did not field a candidate for the last election.

Imagine you’re a newly-elected legislator. Your party leaders think highly enough of you to make you a committee chair right away. It’s a good committee, handling important bills on subjects you care about.

Would you walk away from that post, less than a year into a four-year term, to spend more time running for another office? State Senator Mariannette Miller-Meeks just did.

Two Democrats are now running in Iowa Senate district 20, likely to be one of next year’s most competitive state Senate races.

Information technology professional Charlie Hodges of Urbandale will seek the Democratic nomination in a district covering the northwest suburbs of Des Moines (see map below). Johnston City Council member Rhonda Martin has been campaigning here since May. The winner of the June 2020 primary will face four-term Republican State Senator Brad Zaun.

Iowa House Republicans meet in Des Moines this morning to elect new leaders for the 2020 legislative session. Linda Upmeyer announced on September 30 that she will step down as House speaker when the legislature reconvenes in January and will not seek re-election next November. She said in a written statement that she wants to spend more time with her husband, children, and grandchildren.

Speaking to WHO Radio’s Jeff Angelo on October 1, Upmeyer said she was also influenced by her predecessor Kraig Paulsen’s decision to leave the post long before an election. A new speaker is “well-served” by having a session under their belt, which helps them with fundraising and recruiting candidates, she explained. “I wanted to make sure that whoever was going to be leading the caucus in the future had those tools at their disposal going into this next election.”

Sources close to the legislature indicate that current House Appropriations Committee chair Pat Grassley is likely to become the next speaker, with Matt Windschitl moving up from House speaker pro-tem to majority leader. Current Majority Leader Chris Hagenow may not be part of the new leadership team, for reasons that remain unclear. UPDATE: The caucus selected Grassley as speaker, Windschitl as majority leader, and State Representative John Wills as speaker pro tem.

I’ve been thinking about Upmeyer’s legacy and how she influenced the chamber.

Former State Senator Jack Hatch will run for Des Moines mayor, he announced on WHO-TV on September 19, the last day for local candidates in Iowa to file nominating papers. A few minutes later, his campaign released a statement and a video, both enclosed below, and launched a website at JackHatchforMayor.com.

Key issues for Hatch will include fixing roads and neighborhood infrastructure, addressing “the urgent mental health care crisis that has been ignored,” protecting drinking water, improving area schools, and public safety measures including steps to reduce gun violence. All of those topics were mentioned in a telephone poll Hatch commissioned earlier this month, which Bleeding Heartland summarized here.

Defeating sixteen-year incumbent Mayor Frank Cownie will not be easy, and Hatch will have only six and a half weeks to build his case with voters. However, unlike most challengers, he already has very high name recognition. Hatch represented parts of Des Moines in the Iowa House or Senate for more than 20 years, was the 2014 Democratic nominee for governor, and is a well-known property developer.

Hatch told WHO-TV’s Dave Price he started thinking about running for mayor after Cownie “decided not to protect our drinking water when he had a chance to,” adding that Cownie “was silent” as Republican legislators tried to break up the Des Moines Water Works in 2017. Hatch acknowledged he was starting his campaign late, saying others had considered running against Cownie but backed off. He’s in the race because sees the future of Des Moines “being blurred” without strong leadership.

Turnout on November 5 may be higher than usual for a city election, because Des Moines has multiple competitive city council races, and this is the first year school board elections will be held concurrently with elections for municipal offices. Early voting begins on October 7.

Leslie Carpenter of Iowa City is an advocate for people with serious brain disorders and works to improve the broken treatment system in Iowa and across the country. -promoted by Laura Belin

Here in Iowa, we have heard for several years that we should realize the mental health crisis “isn’t about the beds.”

The argument was couched in a way to say it wasn’t about the beds, but the type of beds. The goal was to divert our attention from the fact that our state has the worst proportion of state bed numbers per capita: just two beds per 100,000 people. The Treatment Advocacy Center ranked Iowa dead last, 51st in the country on this metric. We have only 64 adult beds and 32 child beds at our state-run Mental Health Institutes in Independence and Cherokee.

Industry-funded groups have recently spent more than a million dollars on television and online advertising in Iowa opposing Democratic plans to expand access to health insurance.

Some ads primarily focus on single-payer plans (often known as Medicare for All), which more than half a dozen presidential candidates are supporting. But Partnership for America’s Health Care Future has used its hundreds of thousands of dollars in the Des Moines market targeting more modest proposals to offer a “public option” on exchanges selling private health insurance policies.

Many central Iowa Democratic activists were surprised and upset to see Loretta Sieman, a longtime West Des Moines city council member, in one of the partnership’s commercials. Sieman spoke to Bleeding Heartland on September 11 about why she opposes the public option and why she agreed to appear in the ad, now in heavy rotation on YouTube as well as Des Moines broadcast and cable stations.

A third candidate is seeking the Democratic nomination in Senate district 22, which is likely to be among Iowa’s most competitive state legislative races in 2020.

All four Iowans voted yes as the U.S. House sent a new five-year Farm Bill to President Donald Trump on December 12. A day after passing the U.S. Senate with overwhelming bipartisan support, the conference committee agreement sailed through the lower chamber by 369 votes to 47 (roll call).

Farm Bills have typically received strong support from both parties, thanks to a grand bargain struck decades ago, putting food assistance and agriculture-related subsidies and programs in the same legislation. This year’s initial House bill was an exception, as Republicans tried to impose work requirements on Americans in the Supplemental Nutrition Assistance Program, more commonly known as food stamps. House and Senate negotiators wisely removed that language from the final version.

The U.S. Senate approved a new five-year Farm Bill today by 87 votes to 13, sending the conference committee compromise to the U.S. House. The final version rejected efforts to undermine food assistance programs, which House Republicans had approved this summer. Provisions affecting conservation, the environment, and rural communities were a mixed bag; the National Sustainable Agriculture Coalition and Center for Rural Affairs summarized the key points.

Iowa’s senators have rarely voted differently in the past four years, especially on major legislation. But today Senator Chuck Grassley was among the thirteen Republicans to oppose the new Farm Bill. Though he acknowledged some positive features, Grassley could not get past the failure to impose “hard caps on what any one farmer can get,” a reform he’s advocated for many years. He also blasted a “new gimmick” that “makes more subsidies available to the wealthiest farmers and many non-farmers.”

In contrast, Senator Joni Ernst hailed a “farmer-focused” bill containing several bipartisan provisions she co-sponsored.

I enclose below a video and transcript of Grassley’s speech explaining his vote, as well as Ernst’s full written statement on the bill.

Leslie Carpenter is an advocate for improving the treatment of people with serious mental illnesses in Iowa and across the country. -promoted by desmoinesdem

While speaking at the National Alliance on Mental Illness Iowa Annual Conference on November 16, Iowa Department of Human Services Director Jerry Foxhoven advised the attendees that it was a good thing that two of the state’s four in-patient mental health institutions (MHIs) were closed, and that we have moved to community-based care. He further shared that it was a good thing to go from more than 700 beds to the current level of 64 beds for adults in the whole state.

We should recall that this reduction of state-operated acute care beds has caused Iowa to be ranked 51st by the Treatment Advocacy Center.

Matt Chapman had a “visceral reaction” to the governor’s campaign ad about mental health. -promoted by desmoinesdem

If you watch Jeopardy! or the local news, you have been seeing a lot of campaign commercials for Governor Kim Reynolds. The first three were biographical in content, and the latest attacks Fred Hubbell over his leadership of the Younkers department store chain. (Iowa Starting Line pointed out that ad featured local GOP activists posing as people affected by store closures.)

The fourth Reynolds campaign spot, “Leader,” gaslights Iowans on our state’s inadequate mental health system.

Peggy Huppert is the executive director of the National Alliance on Mental Illness in Iowa. -promoted by desmoinesdem

Governor Kim Reynolds signed two mental health bills on March 29 in an emotional ceremony in the capitol rotunda. I was one of the hundreds of legislators, lobbyists and advocates who witnessed the event.

The two bills are quite different. What they have in common, in addition to dealing with mental health and being signed into law on the same day, is that they passed both chambers of the Iowa legislature unanimously. That in itself is extraordinary.

Governor Terry Branstad and Republican leaders in the Iowa House and Senate are finally poised to eliminate Planned Parenthood’s state funding, a cherished goal Democrats had repeatedly blocked in recent years.

Branstad said during his Condition of the State address on Tuesday that his budget “redirects family planning money to organizations that focus on providing health care for women and eliminates taxpayer funding for organizations that perform abortions.” House and Senate leaders likewise depict their plan as a simple change to reimburse different health care providers, creating “better options for more women.”

What Iowa Republicans don’t broadcast: they are setting the state up to spend ten times more on family planning services, without a reliable funding stream.

{Originally posted at my blog Senate Guru.}

First thing’s first.  I’m not a doctor.  I’m not suggesting that Republican Chuck Grassley has any particular illness.  Simply, I have noticed that Chuck Grassley, over the last many months, has been making increasingly bizarre, aggressive, explicit, and violent remarks – and that such comments coincidentally happen to be early symptoms of dementia, particularly frontotemporal dementia.  It stands out to me because, as a political junkie, I have long considered Grassley to be among the most mild-mannered denizens of the Capitol.  2009 has apparently become the year that the 75-year-old Grassley (he turns 76 next month) has shed his mild-mannered image, perhaps by choice, perhaps not.

In response to the story this Spring about AIG executives receiving exorbitant bonuses after the company was rescued by a massive infusion of public dollars, Grassley said on March 16, 2009:

“I suggest, you know, obviously maybe they ought to be removed, but I would suggest that the first thing that would make me feel a little bit better towards them [is] if they would follow the Japanese example and come before the American people and take that deep bow and say I’m sorry and then either do one of two things: resign or go commit suicide.”

Grassley added, “In the case of the Japanese, they usually commit suicide before they make any apology.”

The comment was rude, racist, and extremely aggressive, even violent.

The next day, still critical of AIG executives, but in an attempt to tone down the violent “suicide” comment from the previous day, Grassley went the more sexually explicit route:

“From my standpoint, it’s irresponsible for corporations to give bonuses at this time when they’re sucking the tit of the taxpayer,” Grassley explained.

When talking about government spending, “sucking on the teat” is not in and of itself bizarre rhetoric, but that Grassley used the more sexually explicit “tit” instead of “teat.”  In fact, such a nuanced difference might have flown under the radar entirely if not for a sexually explicit comment Grassley made at a budget hearing toward the end of the same month as his earlier comments, on March 26, 2009:

But yesterday he [Grassley] regained his bounce on the Senate floor, livening up an otherwise dull budget hearing with a joke about banging another senator’s wife. His opening came after he pressed Budget Committee chairman Kent Conrad to include an amendment of his to a budget resolution by bringing up the fact that Conrad owed him a favor.

“Oh, you are good,” Conrad responded.

To which Grassley replied: “Well, your wife said the same thing.”

Sure, this comment, in a vacuum, could be one Senator good-naturedly ribbing a colleague.  But a joke intimating sex with a colleague’s wife, told, again, at a budget hearing, seems like bizarre behavior.  Further, when you add up these comments, what you have is a pattern of behavior.

Last week, Grassley’s pattern of behavior was reinforced by his take on health care reform:

We should not have a government program that determines if you’re going to pull the plug on grandma.

In fairness, this one comment has become a sick talking point of many Republicans shilling for corporate interests.  Nevertheless, it particularly stands out for Grassley given that, when he is not flying off the cuff, he is one of the GOP’s key negotiators on health care reform.  He should have had the self-control to avoid such aggressive rhetoric.  But that’s been Grassley’s pattern lately.

So what we have seen from Grassley in 2009 – and this is just in public; no telling what his comments and actions are in private – is a pattern of bizarre, rude, physically aggressive, sexually explicit, and even violent remarks.  Such a pattern even led The Iowa Independent to the headline: “Grassley: Strategic or just eccentric?”  Eccentric may be putting it mildly.

Grassley is not the first Republican Senator in recent years to have his mental health questioned.  During his 2004 re-election bid, the Kentucky media began openly questioning Jim Bunning’s mental health after a similar pattern of bizarre comments and actions.  Also, in 2006-2007, Pete Domenici’s mental health was questioned after a pattern of erratic behavior including reportedly walking around the Capitol in his pajamas.  Subsequently, in late 2007, Domenici revealed that he had a degenerative brain disease and opted against a 2008 re-election bid.  Domenici was 75-years-old at the time of his 2007 diagnosis, the same age Grassley is now.

Now for the coincidental symptoms.  If you hop over to WebMD.com, best friend of the armchair hypochondriac, you can find a page that lists symptoms of dementia.  Such symptoms include “having trouble finding the right words to express thoughts,” “having trouble exercising judgment,” and “having difficulty controlling moods or behaviors” while noting that “agitation or aggression may occur.”  What especially caught my eye was the following passage:

The first symptoms of frontotemporal dementia may be personality changes or unusual behavior. People with this condition may not express any caring for others, or they may say rude things, expose themselves, or make sexually explicit comments.

Agitation or aggression?  Check.  Personality changes or unusual behavior?  Check.  Saying rude things?  Check.  Making sexually explicit comments (again, at a budget hearing!)?  Check.  Lack of inhibition?  Check.

Again, I’m not suggesting that the 75-year-old Chuck Grassley has frontotemporal dementia.  I am, however, noting that Grassley’s pattern of behavior over the last six months coincidentally happens to match the early symptoms of frontotemporal dementia.  With Grassley turning 77-years-old before Election Day 2010, it would not be unfair or unwise for Iowans to get a clean bill of health from Grassley before signing him up for another six-year term (at the end of which he will be 83-years-old).

Doctors go through a lengthy period of education and training before they are certified to practice medicine.

So why are insurance company bureaucrats routinely able to second-guess or overrule doctors’ orders?

Rekha Basu’s column from the Sunday Des Moines Register provides another shameful example of this common practice. Last December, Angela Ira’s 18-year-old son Nicholas, who had a history of depression, severe anxiety and borderline agoraphobia, was suicidal.

Scared and desperate, she said she persuaded him to go with her to the hospital emergency room, though he fears leaving the house. The doctor threatened to have him involuntarily committed if he didn’t agree, said Ira. She finally talked him into it. But half an hour later, the doctor returned to say the insurance company refused to pay. […]

Magellan’s clinical director, Steve Johnson, said he couldn’t discuss individual cases. But in the letter to Nicholas mailed last Dec. 10, Magellan cited as reasons for the non-authorization:

– “You do not appear to be a danger to yourself or others, and you are capable of activities of daily living.”

– “The information provided supports that other services will meet your treatment needs.”

– “You no longer have the symptoms and/or behaviors you had on admission, and you have shown progress in meeting your treatment goals.”

How could the company determine, when Nicholas’ doctor was saying he was suicidal, that he was making progress toward goals? The letter said, “If we disagreed with your provider’s clinical decision, we consulted with a licensed psychiatrist or other qualified professional and recommended an alternate service.”

As if someone who hadn’t met or spoken to the patient could better understand his needs than the doctor treating him.

Conservatives love to demagogue about “government-run health care,” but I notice that they don’t seem bothered when insurance company employees deny access to treatment recommended by the patient’s own doctor.

Basu’s column is a reminder that even Americans who have private health insurance are often forced to go without medical care they need.

Barack Obama and the Democratic Congress need to stop insurance companies from substituting their judgment for that of doctors. This needs to be part of a broader universal health care package.

The Des Moines Register’s editorial board again called for single-payer health care reform in an unsigned editorial today:

Our view: What’s needed is a government-administered health-insurance program – similar to Medicare, which covers seniors and disabled people – available to all Americans.

A single system could reduce administrative expenses associated with facilitating thousands of different private health-insurance plans in this country. It could increase leverage for negotiating lower prices. It could facilitate the expansion of electronic medical records, which would streamline paperwork and help prevent costly medical errors. It would boost the country’s economy in the long run.

Every health care delivery system has its flaws, but on balance I agree that a Canadian-style single-payer system would serve this country well. A few days ago DCblogger chided me for my “defeatism” about the prospects for enacting single-payer. I stand by my assessment, though. Even if President Obama were fully committed to “Medicare for all,” getting HR 676 through Congress would be extremely difficult. But Obama has not endorsed single-payer and is not going to put his political weight behind it, even if 93 members of Congress have co-sponsored the bill.

This is an open thread for any comments related to health care or health care reform proposals.

UPDATE: The latest from nyceve continues to make the case for single-payer, with lots of statistics on the high cost of our for-profit health insurance industry. Naughty Max Baucus: “The only thing that’s not on the table is a single-payer system.”

It’s the eleventh hour of the eleventh day of the eleventh month. Ninety years ago, the Armistice between Germany and the Allies went into effect and the Great War (which later became known as World War I) ended.

NavyBlueWife has a nice piece up at MyDD on the history of Veterans Day and what it means to honor our veterans.

Via BarbinMD I learned that the Iraq and Afghanistan Veterans of America (IAVA) and the Ad Council have launched a “national multimedia public service advertising (PSA) campaign.”

The campaign aims to address the mental health consequences of combat, which threaten to overwhelm a new generation of veterans. The 1.7 million men and women who have served, or are currently serving, in Iraq and Afghanistan are facing an increased risk of mental health issues. Nearly 20 percent of military servicemembers who have returned – 300,000 in all – report symptoms of post traumatic stress disorder (PTSD) or major depression, yet only slightly more than half have sought treatment, according to a RAND Corporation study released in April 2008. Untreated mental health conditions can cause or aggravate other debilitating problems in the veterans’ community including high rates of unemployment, suicide, homelessness, substance abuse, divorce and child abuse.

Created pro bono by ad agency BBDO New York, the campaign seeks to increase the number of Iraq and Afghanistan veterans who seek treatment for mental health issues by connecting them with other veterans with whom they can discuss the issues they face as they readjust to civilian life. The campaign includes television, radio, print, outdoor and Web advertising. The TV spots feature Iraq veterans who are Purple Heart recipients.

You can view the ad here or at the new Community of Veterans website, which is designed for veterans of Iraq and Afghanistan.

Here is the home page of Iraq and Afghanistan Veterans of America.

The “IGTNT” team of diarists at Daily Kos write tributes to all American troops who have died in Iraq or Afghanistan. Today’s edition of this series contains links to many organizations that support and honor veterans.

Thanks to all veterans who have served in peacetime or wartime.

Thanks also to all the members of Congress who voted for the “new GI Bill” in May (you can find the roll call votes for the U.S. House and Senate here). My dad went to college on the GI Bill in the 1940s, and his family would not have been able to afford the tuition otherwise.

This is an open thread for any thoughts you have related to Veterans Day, or anyone you are remembering today.

UPDATE: I learned something new today in this letter to the Des Moines Register: Remember veterans: Fund ALS research

Very few people, including those serving in the military today, know that veterans are twice as likely to die from ALS – the deadly disease known as Lou Gehrig’s Disease.

We don’t know why vets are more likely to develop ALS. But we do know that the disease takes the strongest among us – our military heroes – and robs them of the ability to walk, move their arms, talk, eat and even breathe on their own. They are isolated and awake, alive with the knowledge that they are trapped inside a body they no longer can control.

As the disease progresses, there is little they can do, for there is no treatment for ALS. It is fatal in an average of just two to five years.

Urge elected officials to support funding for ALS research at the Department of Defense so we can learn why the disease is stealing our heroes and take action to protect them. Recently both Congress and the Veterans Administration have supported ALS research and provided benefits to veterans with the disease, but more must be done.