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View Diary: American Psychiatric Association approves vast numbers of changes to the new DSM-5 (52 comments)

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  •  I've got a son with ASperger's (7+ / 0-)

    dx'ed a year ago; his problem is largely social; his academics lately could be better but basically he has made honor roll every marking period for years, even if lately it is by a hair. I really don't think, in my social worker opinion ( and I do work in schools with this population ) that Aspies really should be lumped in with people that can't communicate.  I have seen some HFA kids who look a lot like Aspies in their behaviors and conversation, only more extreme, but when it come to academics they are completely on a different level, often requiring a self contained class or an autisitic class for academics. In my experience, Aspies don't need that. I'm thinking people will look at this in 25 years and say this was a mistake.

    •  I'm guessing you are right (8+ / 0-)

      about the change. I really am not thrilled with the "Let's lump everyone together" thought, as well.

      My nephew is a young man with Asperger's. He is working to finish an Associate's Degree in Computer Science. His sensory needs, make it hard for him to sometimes attend, and he must move. The university has been wonderful with him, as have his professors. They know his unbelievable brilliance will eventually serve him well with what he wants to do. I wonder if his diagnosis had been straight Autism, if they would be so accommodating.

      There are truly differences between the 2. And there are differences in specific needs for the 2, especially when children reach middle school and high school.

      I'm on the side of worry that the kids with Asperger's will either be completely overlooked down the line, or they will be lumped in with others and their needs will not be addressed.

      The kids I worry about most are those whose parents are not savvy concerning their children's rights for education and mental health services. Even my sister, a nurse practitioner, was hesitant to challenge the school district about services--she didn't want to "rock the boat".

      I'm really hoping these new diagnoses won't be used to keep services away from the children who need them.

      Peace, Hope, Faith, Love

      by mapamp on Sun Dec 02, 2012 at 08:36:50 AM PST

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      •  I hope we all agree with this. (4+ / 0-)
        Recommended by:
        4Freedom, remembrance, corvo, mapamp
        I'm really hoping these new diagnoses won't be used to keep services away from the children who need them.
        But, if our Democratic leaders agree with Republicans to reduce funding for Medicare and Medicaid even further we should expect it.

        There  is only so far we go with this idea that we are "only reducing funding to providers" so we eliminate waste and fraud before real services are reduced. Beneficiaries already feeling the de facto "rationing" that is going know this is often BS.

        The means is the ends in the process of becoming. - Mahatma Gandhi

        by HoundDog on Sun Dec 02, 2012 at 10:11:42 AM PST

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        •  so far what has been proposed for Medicare by (2+ / 0-)
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          HoundDog, mapamp

          Obama is pretty much okay -- but I agree that it probably goes as far as it can without cutting into benefits. (one part of his proposal is increased Medicare premiums for higher income seniors which makes sense, IMO).
          I know that one thing that makes the White House a little more optimistic is the hope, with some justification, that when Obamacare is implemented it will cut health care costs in general and that's good for Medicare.
          What needs to be done in Medicare is
          1) negotiate for better drug prices, and
          2) expand the base (the exact opposite of what the Republicans want). Younger healthier people in the system will help balance things out. And in fact I heard Howard Dean make an extremely good point -- that raising the eligibility age the way McConnell is suggesting saves very little money because you're dropping people at the healthier end of the spectrum (because they're younger). And the burden for their coverage is transferred to the individuals who will end up with expensive premiums (because they are at the older end of the non-elderly population and now will be stuck with buying private insurance) that will probably have to be subsidized in many cases by the government. More profits for insurance companies, increased expenses for government some of which will go to those profits, and no real savings. A perfect Republican plan.

          We're not perfect, but they're nuts! -- Barney Frank

          by Tamar on Sun Dec 02, 2012 at 11:53:07 AM PST

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          •  I could probably leave with higher premiums (1+ / 0-)
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            for the most wealth, or giving Medicare the ability to negotiated with big Pharma, but I strongly oppose raising elegibility age, are more of this across $700 billion cuts under the premise they are all just fraud, or over billing.

            I didn't fight it out of Party loyalty but I'm still cheese off and lost respect for a lot of people in our Party, because once one looks at the details about about a third was hospital reimbursement at a time when the Mayo Clinics of AZ are not even accepting Medicare patients any longer.  

            And, a lot of us have difficult getting appointments.  It was probably the primary reason the Democrats lost in 2010, and many seniors do not trust the Democrats as ironic as that is.

            Anyone are any Party who goes after Social Security or Medicare will pay a serious price.  

            The means is the ends in the process of becoming. - Mahatma Gandhi

            by HoundDog on Sun Dec 02, 2012 at 02:06:02 PM PST

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            •  I worked on health reform as my job for a couple (2+ / 0-)
              Recommended by:
              sydneyluv, mapamp

              of decades. While Bush was still in office, our organization was fighting the insurance companies on the so-called Medicare Advantage. Medicare was paying these companies something like a 12% bonus for no good reason. When there was discussion in Congress about ending that over-payment, the insurance companies came up with a completely fraudulent table that supposedly showed Medicare Advantage disproportionately served minority seniors. Actually, the percentage of Medicare Advantage enrollees who were minority was exactly the same as the percentage in the rest of Medicare.
              So cutting that over-payment to insurance companies is really not cutting into the meat of anything. It's just like (as someone else pointed out, I think) getting rid of the middle-men financial for-profits in the student loan program.
              Other cuts are not so clear but I'm keeping an open mind. I think it's fine to have wealthier seniors pay more in premiums -- I believe premiums are already on a sliding scale so it's not violating any principle.

              We're not perfect, but they're nuts! -- Barney Frank

              by Tamar on Sun Dec 02, 2012 at 03:04:59 PM PST

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              •  I'm just about to get a Medicare Advantage plan (1+ / 0-)
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                as its is seems to be the best way to protect against uncapped 20% hospital co-pays in the even of hospitalization.

                Also, they are popular because many include dental, gymnasiums, and preventive care.

                I don't know what the truth of the matter is Tamar, perhaps, there was some extra profits for providers in these plans, but I know for sure we Democrats blew the public relations on this move.  

                One CBO study I read said that the Medicare Advantage Plans were only 1/3 of of the original $500 million taken out.

                And as someone said recently, as far as voters are concerned perceptions are reality.  Several studies I've read indicated this was the main reason we lost in 2010, and many seniors who feel confident we were lying about it still don't trust us.

                After polling on this Mitt Romney through Paul Ryan under the bus, and changed his position to say he would put the $700 billion Obama took out back.  

                I'd be willing to do that if we could take it out of military instead.  We wouldn't have to put it back into Advantage plans, necessarily if there is or was something really wrong with them, but trust is low and anger and suspicion is high..  There are some Democrats I will never trust again for what seem to me to be lies about this.

                I held my tongue through out the election, but if any major Democrats try to do this again I will have to speak out aggressively as will many others dedicated to keeping faith with our Social Security, Medicare and Medicaid recipients and at I time when we've added hundreds of billions a year to relatively useless military spending.

                The means is the ends in the process of becoming. - Mahatma Gandhi

                by HoundDog on Sun Dec 02, 2012 at 03:37:01 PM PST

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                •  I have no problem with the Medicare Advantage (2+ / 0-)
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                  mapamp, HoundDog

                  program, just the over-payment. No reason to end the program at all since it has been good for some people.
                  And yeah, I don't think we got the message across well including that Ryan planned on the exact same "savings" ($716 billion) but he wasn't going to use it to help out with health coverage.
                  My understanding is the $716 billion Obama took was used for a combo of things including increased benefits for seniors: helping with the donut hole in prescription benefits and making preventive care under Medicare free (no copayments). The rest, IIRC, was used for funding in Obamacare. So it was excessive profits to insurance companies being pulled to improve health coverage for Americans.
                  Ryan would take that money away completely from anything that benefited regular people.

                  We're not perfect, but they're nuts! -- Barney Frank

                  by Tamar on Sun Dec 02, 2012 at 06:01:28 PM PST

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                  •  This is partially true. I strongly favor the ACA (0+ / 0-)

                    and yes, we transferred to fund to good, perhaps, even better use there.  But, as a Party we appear to have lied to to do it.  

                    The CBO study I read indicated that only 1/3 of if was from Medicare the rest was from Hospitals reimbursement.  Hospitals may have been happy to rob Peter to pay Paul, but I fear Medicare seniors and disabled have and will pay a price.  And, I know for sure many of us perceive that to be true, and I lost respect for some of our Party apparatchuks (sp?) who went around making this bogus claim and many here, including myself compromised our integrity to Party loyalty to win this election and prevent the President's favorable from plummeting two year ago, when it was in serious jeopardy.

                    I'm actual quite angry about it and expect many others are as well, meaning that the next Democrats to do something like this may pay an extra price due to pent up "accountability."

                    If we believed funds could be better used in such a transfers we should have been honest about it, rather than be duplicitous. I personally know several seniors who will never trust Democrats again.  And, when I remind them that Paul Ryan and many Republicans want to kill these programs some say "well at least they were honest about it, while others don't believe it and point to Romney's position.

                    But, the most outrageous thing is that we've added trillions to comparatively worthless military expenditures without so much as a blink.  

                    And, we the reason we choose to take the ACA money out of Medicare rather than trim back military expenditures was pure political expediency.

                    And, I believe there are more than a few Democrats planning at this very moment to do the exact thing over again.

                    If they do, I have already vowed to spend the remainder of my life holding them accountable.

                    The means is the ends in the process of becoming. - Mahatma Gandhi

                    by HoundDog on Sun Dec 02, 2012 at 07:49:20 PM PST

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                    •  on the hospitals -- they actually agreed to it on (0+ / 0-)

                      the basis that they will have fewer uninsured patients.
                      The money came from what's called DSH payments -- I know of that from my Medicaid work which also has DSH payments. DSH is Disproportionate Share Hospital payments that the federal government gives to hospitals that have a disproportionate share of indigent/uninsured patients. The ACA is good for hospitals because it reduces the # of no-pay patients hospitals will have to treat. So the idea is that they forgo the DSH payments in return for a better insured (read: more likely to pay) population of patients.
                      I don't know where but I remember reading that the hospitals found that acceptable. Believe me, they have a very strong lobby so I think we would have heard a lot of screaming if they weren't okay with this shift in funding.

                      We're not perfect, but they're nuts! -- Barney Frank

                      by Tamar on Mon Dec 03, 2012 at 02:30:47 PM PST

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    •  if you read Hans Asperger's original writings (6+ / 0-)

      they are very insightful and many of his observations are still valid for this population. But I think the issue is, it's well-known that few people really have exactly all of the symptoms he describes, or at least they are going to have them in varying degrees. So it's not one syndrome but a spectrum, and in that respect the new DSM is more accurate.

      One of the variables is how much language difficulty someone has. My state has criteria for getting autism-related services that focus on language delay among other factors, and HFA/Aspies don't qualify in many cases. So they're already falling through the cracks because the system is more set up for a different part of the spectrum.

      Another concern is that my daughter is just getting around to understanding a bit and accepting her own diagnosis (which has been variously Asperger's and PDD/NOS). So she's not happy about having it morphed now into "autism spectrum disorder." I explained that laypeople are probably going to keep on saying Asperger's, but psychiatrists will call it something different now.

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