2019 is upon us. In some ways, it only seems like yesterday when the fear of an apocalyptic Y2K meltdown was staring us in the face. What was to become of these relatively new personal computers upon which our lives were becoming more dependent? Federal sources estimated that in the United States alone, year 2000 preparations cost approximately $100 billion, 8.4% of which was spent by the US government. CNN estimated that worldwide, approximately $200 billion was spent in preparation.

Although there were very few glitches reported, purportedly the expenditure of money was regarded as valuable since it resulted in a heightened level of knowledge among higher-level executives of the importance and vulnerabilities of information technology.

Facing purported dangers and challenges. Addressing issues. Recognizing that problems exist. Not backing down from adversity. And finally, identifying chaos where it exists so that it may be brought to light and then, discussing it openly so that order can be injected into a chaotic equation. Without a sense of order, chaos reigns, randomly and notoriously and people are inevitably the victims of these disordered circumstances.

Eating Disorder Industry

When one is a frequent critic of an institution, person, entity or industry, it is almost human nature to be dismissive of the “plaintive cries of a seemingly lone wolf.” In some instances dismissiveness may be justified. For others, to be dismissive one does so at their peril.

Perhaps now more than ever, the eating disorder industry is immersed in fractured chaos. And yet, who are the victims? Parents and our loved ones who suffer from this disease are paying the price for this chaos with their dearest blood.

Residential treatment programs are now almost uniformly owned and operated by private equity entities. Expansion of these programs is not based on medical need but instead is based on financial need to meet future multi-million dollar debt requirements. Rapid expansion also means these facilities are not being staffed by employees and professionals who have been thoroughly vetted, trained and educated. And these treatment programs are not supported by independent, objective third party, scientific studies.

The term “evidence-based treatment” has become almost a punch line instead of a reliable, dependable, objectively based term of art that parents can rely upon when making one of the most important decisions of their lives. For example, the National Eating Disorders Collaboration includes the following as examples of “evidence-based treatment:” Family based Therapy; Cognitive Behavioral Therapy; Dialectical Behavioral Therapy; Self-help approaches; Nutritional management; Medication and Complementary treatment. In 2016, BMC Medicine posted the following: “Evidence-based practice in eating disorders incorporates three essential components: research evidence, clinical expertise, and patient values, preferences, and characteristics. Conceptualized as a ‘three-legged stool’ by Sackett et al. in 1996 (BMJ), all of these components of evidence-based practice are considered essential for providing optimal care in the treatment of eating disorders.” Equine therapy, art therapy, yoga therapy, dance therapy have all been referred to as being “evidence-based” treatment. It is becoming ever increasingly difficult to differentiate the charlatans from the champions. 

A federal district court judge in Texas recently ruled The Affordable Care Act (“Obamacare”) to be unconstitutional. This ruling, which has not been stayed pending appeal, would throw out the entire act. Pre-existing conditions, a cap on the amount an insured would have to pay in uninsured costs, and other protections for those suffering from this disease could be eliminated.

Any person, counselor or treatment center is allowed to concoct approval ratings, satisfaction rates, or artificially inflate their “success” and advertise on the internet without repercussion.

Incompetent and untrained counselors are interacting with our children. Sexual predators have access to the most vulnerable and trusting souls. A vetting process designed to increase the likelihood of safeguarding our children and finding these predators before they are employed is not being utilized.

Cost of treatment continues to escalate as parity laws are being ignored or blatantly disregarded. Insurance entities openly take advantage of their insureds by including guidelines in policies which are not sanctioned by the American Psychiatric Association and which are not included in the DSM-V.

Congress has turned its back on those suffering from this disease. Other mental illnesses far less prevalent are receiving federal funding which far exceeds that which is being doled out for eating disorder research. Coalition entities which funnel money from private equity firm owners to lobbyists have their own agenda which is reflected in the specific bills being addressed by those lobbyists. In the past, some parent groups which have approached those entities with their concerns and ideas, have been politely listened to, then disregarded.

Up until now, the research doctors, scientists, and university based medical professionals, those persons who constitute our best hope for progress through research and then implementation of actual “scientifically based” treatment modules have been for the most part, isolated in their “silos of knowledge.” Mass collaboration of our greatest minds to address this insidious disease has been illusive or non-existent.

Multi-million dollar grants awarded for international research and greater understanding of this disease are sparsely doled out.

And our children, our loved ones, continue to die at the rate of one life claimed every 62 minutes.

Address the Issues

What are the solutions? What are the possibilities? Where is the courage of our convictions to take strong action? Answers to those questions are left to those far wiser and more insightful than me. But, unless there is an open dialogue, unless we raise our voices, until there are more understanding ears, and hearts, and minds, and souls, chaos will continue to reign and lives will continue to be taken. And so, future articles will be dedicated to addressing concerns with the hope that discussion is spurred, and perhaps, renewed inspiration and passion will spring forth.

In the coming weeks, this site will address, among other issues:

Analyzing Eating Recovery Center’s “ground breaking” study on binge eating disorders;

Analyzing the Residential Eating Disorder Consortium’s four-part STEP program which was announced in November 2018. A preview … there are some positive attributes set forth in the STEP program and will certainly be noted along with perceived deficiencies and recommendations for improvement;

Review of the ED Coalition’s past lobbying efforts, money spent and what the recent Court ruling means to those efforts;

Review of recent court cases highlighting battles against insurance entities and their handling eating disorder claims;

Proposals for joint collaboration amongst interested organizations to establish an Ethics Review Board to review and process complaints against unscrupulous counselors or programs and to take affirmative action against those persons. Reprobates like Jason Scott Calder, who plead guilty to five (5) felony counts involving sexual activity with a patient at the New Haven residential treatment center in Utah and Michael Jacksa, who is accused of sexual activity with at least five (5) different patients at Timberline Knolls must not be allowed into our community only to destroy our loved ones who are suffering from this disease;

Bringing to light other issues or concerns which families or advocates may have.

The chaos which defines the eating disorder industry cannot be allowed to fester. When the quest for the almighty dollar exceeds the needs of those suffering from this insidious disease, we pay with our lives, the lives of our children, the lives of our loved ones. Standing on the sidelines is no longer an option. The shame and guilt associated with this disease must be addressed directly and openly. Eating disorders can no longer remain in the closet, in the darkness with its past hidden brethren.

2019 and the future await. Let’s get to work.

Christmas is upon us. Homes aglow with twinkling lights. Holiday music playing in the background. Christmas trees ablaze with so many lights they resemble thousands of stars on a clear night. The smell of food cooking. A crackling fire ablaze in the hearth. The laughter of innocent children echoing through the house. Carols sung in church … Surely, a time for the rebirth of our faith and hope for the future. We are reminded so vividly of the very first Christmas present… that is, a parent’s love for their beloved children.

2018 has marched on and a new year is upon us. As we think back upon this past year now is the time for joy, and love and yes … reflection. And once more on Christmas Day, I ask you to light a candle, a candle to bring light to darkness.

The past two years on Christmas Day, candles were lit literally around the world… California, Oregon, Indiana, New York, Virginia, Florida, Oklahoma, many other states and of course, our own Great State of Texas.  Germany, England, France and Australia checked in and lit candles which burned brightly on that day bringing the light of love and hope to otherwise darkened hearts and in remembrance of not just my beloved daughter, Morgan, but others whose hearts, minds and souls were taken from us by this insidious disease. And this year, so many others to remember … Maggie Gross … Javiera Munoz … too many others to list.

The memories of those who were taken are daily reminders of the trials and tribulations which not only test our will, but groom us, prepare us for an ultimate challenge that could by its immensity, otherwise break us. Our hearts are challenged. Our intellects are challenged. Our very souls are challenged. The conflict is before us. If we are resolute, if we find a way to just stand, fighting through these trials could reveal the essence of our very soul.

When your soul’s purpose and its journey are made clear, God will find a way. When this transpires, you do not have the luxury of giving up. You cannot relent.   There is too much work to do. There are too many lives to save. The mission that Morgan started as set forth in her journals will be carried forward not just by me, but by you, all of you who share a vision that we must be bold and forward thinking.

Morgan’s Christmas gift to me the last few years and which only now is being realized more with each passing day is a child’s unconquerable, unstoppable, unconditional love for their parents.  For truly, if a parent’s love for their child is the very first Christmas gift, then surely, a child’s love for their parent… that candle of life, burning so brightly in a parent’s heart and soul, a light that can never be extinguished, is the perfect way to say “thank you” for that first Christmas gift.

And so I call upon all who read this … parents, children, family members, doctors, counselors, business people, to remember and to rejoice. On Christmas Day, light a candle of love, a candle of hope, a candle of remembrance, a candle of joy. Let that one flickering flame bring comfort to a dark room, a darkened heart, a darkened soul. Embrace those who have survived. And remember those who have been oh so cruelly taken.

Remember that Army of Warrior Angels:

Morgan Dunn

Kelly Burk

Elisa McCann

Anna Westin

Maggy Gross

Karla Alvarez

Karen Carpenter

Isabella Caro

Margaux Hemingway

Christy Henrich

Anne Sexton

Christine DeMasse

Dr. Kamala Dansinghani

And millions of others.

Once again on Christmas Day or Evening, 8 weeks and two years to the moment she left me, I will light a candle to honor my beloved daughter. I will remember Morgan’s passion, strength, fighting spirit, and inspiration, will say a prayer and will look to our tomorrows with hope, with faith, with strength, with resolve and with love.

I invite all of you for just one moment, one single, perfect moment on one silent night…not just in your head, but in your heart and in your soul, rejoice that you are loved and that you love others. Hug your children, tell them you love them, and know … know for an absolute certainty, that the love you feel is unconditional and all powerful. And light one candle.

One candle to light the way.  To illuminate the darkness.

The “Christmas Blues” suffered by many people can be acute. This is especially true for those who had a child, a spouse, a loved one, taken by eating disorders. You see the Joy of the Season experienced by society and you wonder, will you ever feel this again. There are days where the very act of waking up and getting out of bed and merely existing, seems so incredibly difficult. And one can’t help but wonder … Is life meant to be so very hard?

For the vast majority of people who share this 3^rd rock from the sun, I believe the answer is a resounding “No.” They are born, go to school, are generally happy, face the every day trials and tribulations that most people have, they may or may not go to church, they have their hearts broken by their first loves. They go through high school and leave in one form or fashion, most graduating.

If they are lucky or smart or come from a family of some wealth, they may go to college, where they either graduate or not. They eventually find a partner or spouse, they may have children, they find a job or career … and the cycle repeats itself. The obstacles placed before them seem large… insurmountable, too daunting and the obstacles define their very existence.

As their life enters its twilight and nears a close, some may  wonder if the world is a better place because they were in it. Did they leave a lasting impression that generations which follow will know about or study? And again, for the vast majority, the answer is a resounding “No.”

For most of our lives, we are content. Or if we are not content, we may feel hopeless, unaware of how to make a true difference. And, that is before we even get to the issue of “why” we are going to make a difference. For most of us, life is not hard. We may aspire to some sort of greatness that we cannot even see let alone possibly understand and we pray for greater  insight obtained by looking ever deeper. But, oh those obstacles! We cannot get past them. They are Olympian in height, as vast as the limitless void of space. And this is generally true for automobile mechanics, janitors, sanitation workers, teachers, attorneys, business people of all stripes. Many may wonder, is this all there is to life? The obstacles become our natural boundaries and borders. Our obstacles define the boundaries of our very existence.

It does not matter how high our IQ, it does not matter the size of our bank accounts … we live, most will love, most will have children, some may even say they “need to make a difference.” And yet, after we die, at most our names will be remembered on a tombstone by loved ones for a generation.

Most of us believe in a higher power, a God. Some will embrace the dogma of an organized religion. Some will read a copious number of books in pursuit of insight into their soul or spirituality.

And for them.. for the 99.999% of the people who occupy this 3^rd rock from the sun will experience that type of life, the obstacles will define the boundaries of their existence and a simplicity of spirit and existence keep them within those boundaries. And truly, that type of life is simple. It is not hard. I am acutely aware that for most of my existence, I was certainly included in that 99.999%. And life seemed and was simple.

But … what of the .001%. Does anyone think George Washington was in that 99.999%? He was from a farming family. He was a surveyor. Do you think he envisioned himself as a Father of a Nation? No, probably not. But, somewhere along the way, some divine intervention happened, he instinctively got out of its way and let Divinity guide him as he managed to lead a ragtag militia to the defeat of the world’s then greatest military force. This gave birth to the greatest nation this 3rd rock had seen. That was not supposed to happen And yet, once he started that journey, he could not stop. The path was laid before him.

Abraham Lincoln. He was from a poor family. Became a lawyer. Served in Congress and lost. Then… divine intervention got in the way. When he saw that western states and territories were being opened to slavery, an institution so repugnant to him, that inspired him to reenter politics. You know the rest. Was his life easy? Was life made easy for him?

In Washington’s case, the Freedom of a People. In Lincoln’s case, the Freedom of a Class of People from Oppression. Life for both Washington and Lincoln was surely a daily trial.

Nelson Mandela. Imprisoned for decades. Enduring unimaginable hardships. And through it all … his soul found its path. The hard journey he encountered steeled his soul and became his platform from which he could lead and inspire. And a new nation, a better evolved nation was born. He had the vision of being able to be the conduit through which a people could find freedom… a chance of life.

We all know the case of Martin Luther King.

The list of leaders is well known and I submit that those people have something in common … the obstacles that are placed before them, those obstacles that otherwise would define their existence and for the vast majority of people lead to ordinary, simple lives … are broken down NOT because of what they do or what they believe … but by the causes their soul’s journey encounter and draw them toward. Freedom of a People. Freedom from Oppression. Freedom of the Soul.

I submit that those few people don’t knowingly or necessarily even choose their paths through life. They cannot. The every day hardships those persons with great souls surely endured nonetheless molded them. They survived their trial by fire.

An author named Sherrilyn Kenyon is quoted as saying: “Strength through adversity. The strongest steel is forged by the fires of hell. It is pounded and struck repeatedly before it is plunged back into the molten fire. The fire gives it power and flexibility, and the blows give it strength. Those two things make the metal pliable and yet able to withstand every battle it’s called upon to fight.”

I believe that one cannot choose the path his or her soul must take. No. Instead, I believe that a soul chooses it’s own path for all of us. And that path is rarely the easiest path. It is not smooth, devoid of cracks. We learn very little of ourselves by treading an easy, smooth path.

And until October 30, 2016, I was defined by my well-defined boundaries and obstacles.  Life was simple. Very few challenges of the soul. And but for that dark Sunday night, I would have lived a simple life and died a simple, shallow, superficial man.

And then …

I was not ready, and believe I am still not ready to shoulder the burden of my soul’s journey. I do not even know where that journey is leading. I only have what meager gifts have been bestowed upon me to try to figure it out. And those gifts are not nearly enough. The burden of unimaginable and unspeakable anguish weigh so incredibly heavy on all aspects of my existence… the head, the heart, the soul. Yet something is still guiding me, telling me that something in the future already exists, something that must be discovered, found and brought forward. I do not know if I am that person who is supposed to find it, especially since I don’t even know what is to be found. My place may be merely to clear a few boulders off a soulful path for others, others who are far greater or more insightful than me, someone with more insight or soulfulness to take the next, perilous steps.

The burden on many days seems too much to bear. And yet, if I do not keep an open heart, and open mind and open eyes … if I turn away from my soul guiding me, I will surely lose more than just physical things, I will lose more than just money … I will lose my very soul. I will lose my daughter’s legacy. Even still, most days I still so wish I was defined by my boundaries and obstacles. I wish life was simple. It is not. It cannot be. 

I do not want this. I have no choice. My soul won’t let me. And the burden seems oppressive.  If I don’t shoulder it, if I do not find a way to get stronger, who will pay the price. What lives could be taken if I turn my back on my soul? What lives could be saved if I stay on that soul’s journey and keep walking down that path? And if I caved, if I succumbed to the hardship, could I live with myself? Would my soul let me?

A simple life was not meant for the twilight of my life. Now, make no mistake, there are days when inspiration comes and when people come to me and tell me that I have made a difference, and it fills my heart with renewed strength and allows me to take the next steps on my soul’s journey.

And so, the journey continues. Let the Fires of Hell do their worst. An uncertain future is before me. And I surely must and will stay on the path, no matter how painful, no matter how complex. There is an Army of Warrior Angels who demand nothing less. My beloved daughter’s mission, her message demand nothing less.

And the next steps await.

On Sunday, December 9, 2019, I attended church services at Highland Park United Methodist Church in Dallas, Texas. The sanctuary was awash with vibrant, red poinsettias. Long strands of garland interspersed with large red ribbons were draped over the choir loft and majestic, organ pipes. The world-class choir was elevated to an even greater level by a soprano soloist whose angelic version of “O’ Holy Night” brought many to tears.

The lead pastor is Reverend Paul Rasmussen. Reverend Paul is not one of these television evangelist type ministers screaming fire and brimstone, urging one and all to, “LET THE DEVIL COME OUT! REACH DEEP IN YOUR POCKET FOR THE LOOOORD!!” No instead, Reverend Paul’s sermons are impassioned, they weave in every day life experiences with biblical references and one can readily sense that his message is not just coming from his head … but his heart and soul as well.

On this day, he held up a plastic baggy filled with a broken light bulb. He noted that at one point, we all have dropped a light bulb and watched it break into many pieces. We then routinely get a broom and dustpan, sweep the broken shards of glass away, grab another bulb and go about our day. After all, how can we be expected to fix a shattered light bulb? It is broken beyond repair. In any event, most people wouldn’t even know where or how to begin to repair it. Do you start with the base? What about the wiring? Do you assemble the larger pieces of glass first? Even trying to come up with a plan to repair this fragile, broken item is daunting. It is much easier to simply replace it.

Reverend Paul then poignantly described to some extent, we humans are all broken light bulbs  We all have flaws. But, God doesn’t simply discard us because we are fractured. As a Loving Father, God has the recipe for salvation and it is up to us to find that journey of healing.

And at that point, the analogy and message became quite clear. I read on a number of Facebook groups, on other internet groups, through social media and through speaking with doctors, counselors and professionals in the eating disorder industry, of the fear, the hopelessness, the grief, the anger, the frustration and the helplessness felt and expressed by parents whose beloved children are afflicted with this damnable, insidious disease. They see their child, their very heart, slowly wasting away, self-harming, acting out, abusing drugs or alcohol speeding what they fear will ultimately result in the death of the most precious thing they hold dear. They are shaken to their very core. Their light, their love, their hope for the future lay at their feet, unworkable shards of glass, fractured to a point beyond measure or repair. They also know that this is a light bulb that they cannot merely sweep up, discard into the trash bin and then replace. And yet, many don’t even know where to begin to try to repair this fragile, broken life. Fear and despair cloud their vision and falsely point to a path that leads to even greater catastrophe. Where does one begin?

Parents, I so wish I could give to you as a Holiday Present, a copyrighted repair manual complete with blueprints for a successful reconstruction of a human life being torn apart by this disease. Alas, I cannot. In fact, in some ways, I feel like the mythical character Jacob Marley. We know Marley as Ebenezer Scrooge’s deceased business partner, now a chained and tormented ghost, doomed to wander the earth forever as punishment for his greed and selfishness when he was alive. Marley roams restlessly, witnessing the hardships others suffer and lamenting that he has forever lost his chance to help them. But then, in an ironic twist of fate, Marley arranges for the three spirits to visit Scrooge and gives his friend an opportunity for redemption, which Marley tells him was “… a chance and hope of my procuring.” Until I breathe my last, my reality is that it is too late for me. But, it is not too late for you.

Moms … Dads … parents, I urge you to simply start with a beginning, any type of beginning. It doesn’t matter if it is the base, the electrical wires or the shards of glass that you address. But, address it you surely must. I can suggest that perhaps a starting point may be found by steeling up your courage, staring at yourself in a mirror and then, look within yourself. Right now, you may be overwrought with fear, despair and yes, perhaps anger. If those emotions dictate your every waking thought, if they dictate your decisions, there is very little doubt that the path upon which your journey will take you will be filled with mistakes, negativity, false hope and dead ends.

We also know that the manner in which we deal with fear and despair is as individual as the person experiencing it. So, where is a starting point? Perhaps for many, a starting point could be … educate yourself! Read vociferously. Actively join and participate in parent support groups. Start support groups in your community if you are able. Read academic research papers and studies. When you speak with treatment professionals, ask as many questions as you deem necessary. Arm yourself with knowledge. “Ipsa scientia postesta est.” [Knowledge itself is power.] That way, when you confront doctors, counselors, insurance claims representatives you will know much more than they believe they know and you can argue with more authority for more effective treatment protocols. You will be able to cite independent studies. You will empower yourself. As you learn, as your strength grows you may learn to take those negative emotions of fear and despair, and instead of them defining you in a negative manner, you use them to motivate you, to inspire you. Do not ignore those emotions. They are currently present in your life. However, the only place that fear can exist is in our thoughts of the future. It is a product of our imagination, causing us to fear things that do not at present and may not ever exist. And isn’t that near insanity?

Moms … Dads … You can save your beloved child. You will find your voice. And maybe along the way, you may find, or you may rediscover your very soul.

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:

1. 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.

On late Friday afternoon, December 14, 2018, United States District Court Judge Reed O’Connor struck down Obamacare, a/k/a the Affordable Care Act ruling that it was unconstitutional. Let us explore the reasoning behind the opinion and the possible ramifications and implications, both short term and long term of that decision.

Summary of Decision

Judge O’Connor issued a 55 page opinion which granted summary judgment for the plaintiffs in the case entitled Texas, et al v. United States, et al, Civil Action No. 4:18-cv-00167-O. (The case is generally known as “Texas v. Azar”) The plaintiffs were Republican State Officials from twenty (20) different states. The case was filed in February of 2018. The reason this date is significant will be discussed later in this article.

First, a summary judgment is a motion filed by a party which asserts that there are no disputed material facts in the case and that they are entitled to judgment as a matter of law. If the court agrees that there are no material facts, the judge then applies the law as established by prior cases, interprets the Constitution or statutes involved in the case and makes its ruling.

Judge O’Connor, predicting his ruling would be controversial started his historic opinion with these words: “The United States healthcare system touches millions of lives in a daily and deeply personal way. Health-insurance policy is therefore a politically charged affair – inflaming emotions and testing civility. But, Article III courts, the Supreme Court has confirmed, are not tasked with, nor are they suited to policymaking.”

The Court then struck down the entire Affordable Care Act (“ACA”) on the grounds that its mandate requiring people to buy health insurance is unconstitutional and the rest of the law could not stand without it. Judge O’Connor specifically held that the individual mandate requiring people to have health insurance “can no longer be sustained as an exercise of Congress’s tax power.”

The importance of Congressional taxing power

Judge O’Connor focused on Congress’s taxing power as the key issue because it was the issue the United States Supreme Court relied upon in upholding the constitutionality of the ACA in 2012. In the 2012 case, the Supreme Court said that Congress legally could impose a tax penalty on people who do not have health insurance.

In the 2012 case, the Justice Department under President Obama maintained that the individual mandate went hand-in-hand with the rules protecting people with pre-existing conditions and the insurance subsidies the law provides, and the individual mandate could not be eliminated without scrapping the entire law. This mandate was controversial and in a close 5 -4 decision, the Supreme Court placed great importance on this provision. The mandate provided that if an individual or family did not have health insurance, they would be subjected to a financial penalty of the greater of $695 per person per adult, or 2.5% of household income.

The Supreme Court, in its 2012 opinion written by usually conservative justice, Chief Justice John Roberts held that this “penalty” as referred to in the ACA was not in actuality, a penalty, but instead was a tax and as such, was a lawful, constitutional application of Congress’s taxation power. However, and in a significant glimpse of future battles, Justice Roberts also stated, “The Federal Government does not have the power to order people to buy health insurance.”

The Tax Reform Act of 2017

Enter President Trump and the Tax Reform Act of 2017. In this broad and sweeping reformation of the tax code, Congress eliminated the ACA’s individual mandate’s “penalties” as part of the new tax law. Because there are no tax penalties associated with the ACA and because, in part the Obama Administration argued the totality of the ACA must stand or fall on that basis, the plaintiffs in Texas v. Azar successfully argued that the basis for the Supreme Court’s decision in 2012 had been eliminated.

With the individual mandate now removed, the basis relied upon by the Supreme Court to uphold the constitutionality of the ACA became moot and the ACA was now susceptible to new attacks. These attacks came to fruition in February 2018 when Texas v. Azar was filed in the traditionally conservative Northern District of Texas.

With the reasoning of Judge O’Connor’s decision being explained in “civilian language” (hopefully), we can now examine the implications and ramifications.

Short-term impact?

The short-term impact of Judge O’Connor’s ruling is likely to be negligible. First, Judge O’Connor did not issue a “stay” order or grant injunctive relief to the extent that his ruling would be “stayed” pending final appeal. But, he also did not enter an injunction blocking its continued operation. So, technically, while the ACA is no longer the law of the land, it is likely to stay in force and effect pending final appeal through the Fifth Circuit Court of Appeals and then ultimately, the Supreme Court.

Further, Trump Administration officials who oversee the ACA exchanges went on record Friday night that the federal government will continue to enforce the ACA while the order is being appealed. Seema Verma, administrator of the Centers for Medicare and Medicaid Services tweeted, “The recent federal court decision is still moving through the courts, and the exchanges are still open for business and we will continue with open enrollment. There is no impact to current coverage or coverage in a 2019 plan.” Verma also stated earlier this month that CMS had a plan to protect pre-existing conditions if the law was struck down.

Democratic State Officials from sixteen (16) states vowed to immediately appeal Judge O’Connor’s decision. Ordinarily, a case cannot be appealed until a final judgment is rendered in a case. Some dispute exists as to whether the summary judgment order from Judge O’Connor resolves all issues and disputes in the case. If so, appeal will be immediate and the defendants in Texas v. Azar undoubtedly will petition the Fifth Circuit Court of Appeals in New Orleans to issue a stay of the ruling pending all appeals.

Therefore, until a final decision by the Supreme Court, or until a new law is passed by Congress, the provisions of the ACA are likely to stay in force and effect.

Long Term Possible Impact and Ramifications

Assuming Judge O’Connor’s ruling is not overturned by the Supreme Court, and the ruling that the ACA is unconstitutional is allowed to stand, the long-term ramifications are potentially catastrophic for mental health. The ACA provided coverage regardless of pre-existing conditions. It provided financial assistance for private insurance. The ACA established rules which set forth a basic minimum set of benefits insurance policies must cover. Finally, the ACA provided health coverage for millions of Americans who previously could not qualify under privately operated insurance plans. These issues and concerns, and many others are back on the table and are jeopardized.

The Urban Institute, a left-leaning organization and think tank estimated that up to 17 million Americans could lose their health insurance. This includes the millions who gained coverage through the ACA’s expansion of Medicaid and millions more who received subsidized private insurance through the ACA’s online marketplaces. Insurers would no longer have to cover young adults up to age 26 under their parents’ plans. Insurers could place annual and lifetime limits on coverage. The cap on out-of-pocket costs would be taken away.

Arguably the most catastrophic loss would be coverage for people with pre-existing conditions, a condition which is prevalent with those suffering from eating disorders. More often than not, an eating disorder is a long term disease requiring years of counseling and treatment. Recovery is dependent on medical stabilization, addressing any environmental component, psychological and behavioral treatment, work and resiliency. Recovery for each person is as individual as the person him or herself. It is not unusual for treatment to take a number of years. All of this information is well known to insurance providers. With no legislative oversight or federal law in place, insurance providers could again rely upon the “pre-existing condition” exclusion to deny coverage for residential treatment, outpatient treatment, PHP, IOP … in short, all eating disorder treatment.

Treatment centers and counselors would necessarily become even more dependent on private pay patients as insurance coverage would be denied or limited. This could result in the growing manifestation of the self-fulfilling perception that eating disorders are merely a “rich little, white girl’s disease.”

Residential Treatment Centers could be impacted the most

Despite the passage of the ACA and Mental Health Parity Act of 2008, insurance providers have been carefully scrutinizing residential treatment for eating disorders for medical necessity. Weekly peer-to-peer reviews are not unusual. Insurance guidelines independent from those set forth in the DSM-V are adopted in insurance policies. In November 2017, the Milliman Group found that behavioral health care was four to six times more likely to be provided out-of-network than medical or surgical treatment. This study also found that insurance providers paid primary medical care professionals twenty percent (20%) more for the same types of care than they paid mental health care specialists, including psychiatrists.

After the ACA was signed into law and became effective in 2010, private equity companies went on a feeding frenzy of acquisition of residential treatment centers. Between 2011 and 2018, there were at least seventeen (17) different transactions in which residential treatment centers were bought by private equity firms. Most of the members of the Residential Eating Disorder Consortium (“Consortium”) are owned by PE firms. The acquired facilities include the Eating Recovery Center (twice), Timberline Knolls, Castlewood, Monte Nido, The Emily Program, Remuda Ranch and many others.

The take-over of residential care by PE firms was predicated upon both the Mental Health Parity Act of 2008 and the ACA. PE firms saw an economic opportunity arise from the absence of federal regulation and oversight of the mental health industry. They were emboldened by legislation requiring parity between mental health treatment and medical treatment. The ACA removing pre-existing conditions from the purview of insurance providers and mandatory insurance for all Americans resulted in a perfect storm in the mental health industry and the private equity firms capitalized.

Acquisitions were structured in a manner attempting to avoid corporate practice of medicine doctrines and doctors and owners of treatment centers listened to the seductive “Call of the Sirens,” and sold their practices to PE firms. However, these transactions are structured to be dependent on aggressive expansion and growth. This growth is necessary to increase the asset base of the treatment provider so that future debt obligations can be met. The transactions are also presumably dependent on the belief and necessity that the ACA would remain in place.

With the harsh reality that the ACA has now been ruled unconstitutional, the PE firms and their treatment centers face a new reality … that is, insurance providers will increase their scrutiny of claims for treatment, that they will rely upon the Court’s holding that the ACA is unconstitutional and will phase back in their denying claims because of pre-existing conditions or and will remove the cap on the maximum amount of out-of-pocket expenses incurred by insureds. This will require residential treatment centers to increase their dependence on private pay patients. These treatment centers may also be forced to need to increase their costs and expense to patients. They could also be forced to implement large cost reductions including laying off staff and professional personnel in order to meet their debt obligations.

In short, financial Armageddon could be at hand.

Possible Solutions

The Texas v. Azar decision constitutes a grave crisis impacting all Americans. This crisis could shake the very foundation of the Republic at a time when both major parties are more intent on promulgating the power of their own party and tearing apart the other party. Confidence in our political leaders is low. As for loyal opposition? Respect for those across the aisle? Working together in the spirit of compromise and collaboration while maintaining one’s own dignity and self-respect? These are all attributes which have become foreign to our so-called political leaders on the Hill and in every state capitol.

And yet, the only possible long-term solution is to rediscover that collaboration and come up with a bipartisan plan that results in health care being made available to all Americans at a cost which is affordable. Unfair insurance practices must be curtailed. The most vulnerable of our citizens must be provided with health care which is both substantive and affordable.

The crisis is here. At the same time, the opportunity for a greater future is similarly here.

Crisis or Opportunity? Our future depends on the answer to that question.

for joining me!

Good company in a journey makes the way seem shorter. — Izaak Walton