Because powerful moneyed interests have convinced many of them that we have the best healthcare system in the world and any change would make it worse.
True, but though this may sound arrogant, this reinforces my belief that people are generally too stupid to think about cause and effect rationally. Nearly every time I or my family have to deal with the US healthcare system I end up lamenting it's insanity, from lack of transparent pricing, lack of care follow-through when my elderly relatives are treated, the super high expense for simple visits or procedures, etc. And I'm someone with good health insurance.
To go through this system and think "well it couldn't possibly get any better than this" makes me think one's capacity for either self delusion or idiocy knows no bounds.
A big problem is that healthcare isn't often truly debated rationally.
When the ACA was going through Congress, there were accusations of "death camps" flying around that the new healthcare system was going to round up and exterminate old people. These rumors were sometimes pushed by congressional candidates and high-level party officials.
Fast-forward to today, and you see opponents of the ACA claiming that they're trying to protect preexisting conditions coverage too, when they're absolutely not.
Our political system rewards lies and disinformation, and when a significant portion of the population believes these lies without any skepticism, then we're no longer debting rationally.
> Our political system rewards lies and disinformation, and when a significant portion of the population believes these lies without any skepticism, then we're no longer debting rationally.
I know it's the topic under discussion, but today your statement applies to virtually everything under debate. We are in a very bad situation, that only seems to be spiralling downward, to what end is anyone's guess.
Not to devolve the conversation into a partisan debate, but when you have the former speaker of the house telling a reporter that how people feel is as logically true as hard data, we have a problem. And it's not going away any time soon.
> A lot of people are making a lot of money. Either through positions that shouldn't exist or taking advantage of inflated prices.
Yep. Just look at health care and related salaries in other countries. There are many fewer people in pharmaceutical sales in the EU or in Asia. Likewise, while being a doctor is a comfortable career in EU countries, no doctor earns $400k+ per year, like some surgeons/specialists in the US do. The problems aren't unique to any specific role in the US system, they are ubiquitous.
I am generally opposed to any major health care reform that the AMA, the AHA, PhRMA, or AHIP is in favor of.
They work in both systems, but make the big money in private practice, which is often paid by insurers, but sometimes as cash. For instance Google Cyrus Abbasian; he works in both systems and I recently paid cash for a consultation with my son.
This is a loaded question with many different factors. One factor is privatized insurance is only concerned about turning quarterly profits over providing care. Additionally they are not held accountable for unethical practices as they continue to break the law without any ramification.
See Lyotard and his notion of Grand Narratives. The uniquely American Self Made Man conveniently overlooks wealth accumulated by men vis a vis free labour. To constrict these men, to suggest their wealth wasn’t “earned”, is to deny the other men of lesser social position of the “opportunity” to do so themselves.
That is, the myth perpetuates the energy that permits the men running these insurance companies to make billions. All reinforced by the whimsical meth-addled pipe dream that “I could be king too, one day” of the legion of white men of lesser caste.
"John Steinbeck once said that socialism never took root in America because the poor see themselves not as an exploited proletariat but as temporarily embarrassed millionaires. This helps explain why American culture is so hostile to the idea of limits, why voters during the last energy shortage rejected the sweater-wearing Jimmy Carter and elected Ronald Reagan who told them it was still 'morning in America.' Nowhere does the myth of progress have more fervent believers."
<sarcasm>
Because they do not like it when Goverment Regulations work in their favour. They love their right to have freedom to choose guns, big corporate bailouts,poor healthcare.
</sarcasm>
On a seriously everything including regulations have a place in civil society.
None of the responses to your question seem to hit at what I believe the source: racism. Single payer has met resistance from the right because people have this misguided notion that they will have to pay for "other peoples mistakes", which is just dogwhistle.
There's also the fact that while it's going swimmingly (job, healthy, etc), it doesn't seem so bad, so there's little incentive to change it... until it goes wrong, at which point you're too preoccupied to change anything.
At least that's how it seems to me, and why for some people on the left, healthcare isn't the most important issue to tackle. Having humans die in agony or poverty is terrible, but having it happen to your fellow countrymen is unforgivable.
I think this is correct. If we accept that stress causes or exacerbates mental health issues, and if we accept that money can reduce stress to a degree, then it makes sense that the poor will have more mental health issues, and it's one more thing that the wealthy can see that appears to be fundamentally different in outlook or resilience between themselves and the poor, confirming the narrative that it's really their exceptionalism that is responsible for their current situation, and not luck or inherited wealth.[1] Yet another differentiator that prevents empathy.
1: That's not to say there aren't exceptional people that are wealthy, just that being exceptional is not a prerequisite to being wealthy, or even becoming wealthy (but I'm sure it helps in that case).
Because among people's worst traits is the pleasure in knowing someone is worse off than you, especially if they are from an identifiable group you already dislike.
Your life might be miserable due to poverty, but you might still view that as a preferable situation compared to another even poorer group getting the same universal benefit as you, even if that universal benefit would make both of you better off.
This is also the strategy that white former slave owners used to disrupt a more equitable reconstruction in the South after the civil war. They took all the poor white folks who were feeling a certain class alliance with the former slaves and said, "look, we know you're dirt poor, but at least you're not like those people." And created the race divide that's still, of course, prevalent in the US.
Sure the wealthy fostered those feelings but I think the fact that a war was just waged on their land and lead to their economy being upended and blacks were the only ones who seemed to benefit probably had something to do with it. White southerners weren't going to instantly give up all the beliefs that they used to justify slavery just because they lost a war.
It's useful for a politician working for wealthy interests to have the lower class population fragmented and a portion actively voting against their own shared economic interests, rather than a united and motivated voting block. The only war is the class war, and racism is the tool politicians use to mask that fact from the masses. Sadly all to many people on the right buy into racist rhetoric as the substance and fail to see it as the facade that it is.
And it really shouldn't be. A poor white supremacist and a poor minority have a lot more in common than they would like to admit, and the rampant political rhetoric surrounding race is designed to keep the lower classes in constant conflict, fragmented, and in the case of poor republicans, reliably voting against their own economic interests.
Insurance premiums rise to incorporate the costs of these mistakes. We're already paying for other peoples mistakes, plus a healthy profit for a private corporation.
Segregation and redlining have led to people of color living in marginalized communities in "food deserts" where there are few to no fresh food options, so people that live there (who are too money-poor or time-poor to travel for groceries) have to rely on processed and shelf stable food, leading to a very poor diet and the health problems associated with it.
Just because the immediate observation isn't related to racism doesn't mean the root problem isn't racism.
The whole insurance system is that your monthly premium is paying for someone else's treatment. Universal healthcare is just a larger insurance pool that brings costs down for everyone in it.
Way to paint with an absurdly broad stereotypical brush with absolutely no substantiation.
How about small government? Maybe people are worried about turning healthcare in the U.S. into even more of a dysfunctional bureaucratic nightmare like the current VA? What about ideals like self sufficiency? Avoiding centralization of power? Wanting power over one's healthcare and the choice to go without?
No, much easier to dismiss 50% of the population as "racists" without even attempting to understand that they may have perfectly reasonable values that are contrary to your own. Ironic that your own comment is a racist stereotype.
A lot of the small government rhetoric in the present day United States is actually rooted in racism. Google Lee Atwater's n-word quote for a 1980s GOP strategist's perspective. To summarize: overt racism becomes unpopular with some of the electorate so they come up with coded language about small government and taxation to appeal to racists.
Well since small government is apparently racist I'll just pack up my "the government has no business telling you what not to smoke" rhetoric and leave.
I know this might be hard to believe but some people actually believe that all of society would benefit from less government involvement in all manner of things. Calling all that racist looks like you're just trying to find an excuse to dismiss it without having to make an argument for why it won't work.
By pointing out this, I don't believe I called the views themselves, nor any specific adherent to the viewpoint, let alone 100% of them, racist. Just that "a lot" of the rhetoric comes from this. Which it does.
This aligns pretty well with the rise of Reagan (for whom Atwater worked) and the late 20th century to present wave of "small government" politicians who somehow, shockingly, seem to rack up massive debts without a care when they are in power.
Lastly,
> you're just trying to find an excuse to dismiss it without having to make an argument for why it won't work.
Health care is the perfect such argument, actually. Look at the rest of the developed world, or even something low overhead like Medicare [which doesn't need massive advertising budgets or, say, thousands of redundant billing companies], and tell me the US private sector does a better job.
I sincerely wish those people would actually come up with specific workable policies that demonstrated an interest in small government that wasn't race-based.
Like, take small government on a local level. You cut the city budget by a third, which part are you cutting? Do you cut the police budget? Do you cut the parks? Public transportation? Public health services? Some of those will impact communities of color more than others. So be specific and say "yes, I want to cut public transportation, recognizing that it disproportionately hits communities of color." And we can talk about that, instead of just "well small government is better".
Or what would you cut at the federal level, to have a smaller government? Housing and urban development, which again predominantly benefits communities of color? The military? The legendary farm bill?
Depending on how you rejigger the government, I'm all for a smaller one.
Cut the military down to a hundredth its size and institute medicare for all and free higher ed and you're probably still smaller than you started.
But these days, in general, there's a lot of overlap in the venn diagram of "smaller government" and "cut policies that help communities of color," and that's why people are quick to call small government republicans racist.
(That and the racism that a lot of republicans now openly display.)
>A lot of the small government rhetoric in the present day United States is actually rooted in racism
So is it socially acceptable to hold any typically Republican/right leaning position without being dismissed and smeared as a racist? You don't see a problem with this unnecessarily divisive, racist, hand wavey rhetoric?
What's the point in having any kind of political discussion at all if people are just going to make the bad faith claim that any right leaning policy is a secret dog whistle?
The free market thing is useful in the right doses and the right topics, but many people confuse it with their own personal identity and take it much too far, as if it were dogma or religion.
In my personal observation, there often seems to be a lot of unaddressed anger involved in that form of extremism. I am not saying this is everybody with such a view.
But when somebody goes on a tirade that people deserve to die, go bankrupt, or be denied care to protect margins of some private sector behemoth because taxation is theft ... When the evidence suggests the public sector tends to do a pretty good job at this. Yeah, there is something a little weird going on there.
All the horrible things you describe about government run healthcare is the situation literally today.
You would have more freedom in a most liberal people's idea of universal healthcare which basically amounts to "medical professional says it's necessary -- gov't pays the full amount." Does anyone, of any political leaning, really think that politicians or insurance companies -- really anyone other than the individual and their doctor -- making medical decisions is what we should strive for?
You can be insulated from the problems by somewhat by having enough privilege and money which is why it becomes a race and class issue. And it's precisely the people who are largely unaffected or benefits from these policy changes who are making them.
The people who worry about having shortages and wait-lists, or the burecratic nightmare are the people who today can pay to be at the head of the line. Everyone else already is dealing with this.
>All the horrible things you describe about government run healthcare is the situation literally today.
Arguably because of regulatory capture, market collusion, and lack of transparency. There's no way to prove that the system will necessarily be better under single payer, but at least under a loosely regulated free market system with transparency and antitrust regulation, competition can to some degree keep corruption in check. Contrast that with single payer which centralizes power under an already corrupt American bureocracy and is bound to legistion, which is painfully slow to change in comparison to corporations which respond to market forces.
> Does anyone, of any political leaning, really think that politicians or insurance companies -- really anyone other than the individual and their doctor -- making medical decisions is what we should strive for?
Yes. Being against anything on the Democratic Party platform is racist. You got it. If it isn't obviously racist, it's a "dog whistle." It isn't possible that anybody else could disagree with me for reasons that are fair and well reasoned because they see things from a different perspective.
US conservatives. Most attempts to fix this system are stonewalled, blockaded, or hit with waves of propaganda against fixes. Some people are making good money compared to something like single payer. And profit is always more important than people.
Cold war Era propaganda that has many people still believing that "socialism is when the government does stuff" plus a pretty frightening lack of critical thinking skills among many Americans
I don't think there is a obvious answer to the question of what the health care system of the future should look like.
In South Africa, public hospitals are terrible and private hospitals are generally good and operated as far as I understand in a similar fashion to the US counterparts.
This may suggest that our future should look like the US's present. But it is a complicated subject. To start off with, many of the doctors at public hospitals are good doctors, paid well and respected. However, by a combination of being a new nation, having diverse cultures, having a high Gini coefficient (or <insert here coefficient>), having terrible rural schools (and excellent middle and upper class schools), etcetera, our public health care is frankly terrible. The hospitals are not well stocked, you'll wait for hours, they'll amputate your leg unnecessarily.
In our scenario we have both the European "socialist" model, which worked well during South Africa's past. However, once the hospitals had to cater (and rightly so) for the full population, including poor and formerly disadvantaged, the system could not cope. So now we also have the American "money driven" model, but of course it is expensive and you have to have a medical fund or you are out.
I don't think it is a question of idealogy. It's a simple premise. There is the world of sick people (which you are lucky if you join only a few times a year). And there is the world of healthy people. The premise is that sick people need to be treated. However you get there is perhaps politics, but I see it simply as a resource and logistic problem that need to be approached with commitment and expertise.
This simple premise: to heal the sick, is how I see the early doctors that came to Africa [1].
Of course OPs topic is more complex, mental health, but my point is that idealogy is often lost on people (including myself) that have more obvious challenges in their midst. And mental health in South Africa is an even more pressing issue. [2]
[2] Not going to share a link since they all seem written according to rather Trumpian standards. But about 90 mental health patients died in SA in one incident in 2017 due to what can maybe be termed "bureaucratic incompetence".
We don't, but Americans have different answers for how to fix it. Some want to liberalize and deregulate healthcare, allowing the market to actually serve consumers. Some want to make it single-payer or nationalize it, which given the track record of the federal government doesn't sound like a good idea to many.
> given the track record of the federal government doesn't sound like a good idea
For the vast majority of Americans, their only interactions with the federal government are through social security and through medicare--two of the most widely popular functions of government. Government has plenty of failures, but that's the nature of enterprise writ large.
Obamacare was a massive failure for most Americans, and the VA is filled with horror stories. A large portion of young people don't think Social Security and Medicare will be around when they're older. And the financial stability of those systems doesn't look very good.
Government can with the stroke of a pen decide to fully fund any program. Even in the case of social security it's just an accounting mechanism. Anyone who says that social security and medicare depend directly on a larger taxable population today is lying. Young people being told that today are being lied to.
> Government can with the stroke of a pen decide to fully fund any program.
This is largely true.
Notice how easily our government, "with the stroke of a pen", can fully fund state-sanctioned violence and institutions of violence.
And we the people have no problem with this; some of us even cheer it on; some encourage their sons and daughters to join up to these institutions of violence. Others shake the hands of those who already are a part of it, and say "thank you for your service" - in almost reverent fashion.
I'm not saying we don't need these people or those institutions - they do serve a needed purpose - but let's not pretend that need is anything but ultimately for terrible violence.
Yet - we and our government somehow has a problem fully funding things like healthcare, education, infrastructure, and a whole host of other programs, which again could be easily done, "with the stroke of a pen". But we'll hem and haw on that all day long...
...our teachers will never be thanked "for their service" in reverent fashion.
Unless of course they were veterans of those institutions of violence.
What indication, given the current healthcare environment, makes you believe that any health insurance company is ever going to prioritize people and their health over profits?
It's easy to say "it's too hard, and the government will futz it up," but "the free market" produces predatory companies pursuing profit.
This is an oft-repeated sentiment, which I've never seen actually happen. The free market pursues profit. Not customer needs. The most "efficient" thing to do is fleece customers when they're at their most needy: when it's either pay up or die.
How do you explain all of the successful socialized medicine in other countries, if government involvement = healthcare sucks?
We reject the taxation of the common man that socialized healthcare at the rates many of the example countries have. It's less about our healthcare, than it is about the manner in which we pay for it.
Don't get me wrong, it's a young man's system. You pay in when you are young, so you can have it when you are old. This is clearly the UK model after WWII and why its so popular here as an idea as our sister-mother country.
Thanks for quoting 'healthcare'. I make it a point to refer to it only as 'health insurance' because that it what it is.
I think rebranding it as 'care' was a real slick move by some marketeers and absorbed by the media. Every time i see the word repeated i feel like they won their little subliminal game. Recently i read someone using the words "climate disruption" instead of "climate change" which i rather liked.
Would you please not post unsubstantive comments on divisive topics? That's flamebait, and you predictably generated a flamewar. These are tedious, low-quality discussions and we don't want them here.
Edit: this account unfortunately has quite a history of posting like this—and we've warned you before—so I've banned it until we get some indication that you intend to follow the site guidelines in the future. We're happy to unban anyone who gives us reason to believe that they want to use HN as intended: for thoughtful, curious conversation, not political or ideological or national battle. If you'd like to commit to that, you're welcome to let us know at hn@ycombinator.com.
Mental health problems are seen as a weakness in this country. It's very anti the American way to:
1. Have a mental health problem
2. Seek help for a mental health problem
This leads to insures being able to deny this, and it not seen as a negative, because it's denying something that's weak. And weakness in the USA is the ultimate sin. Homelessness/Joblessness also fall under this same belief system.
I'm not from US but I believe this is incorrect. Everytime I visit there, I am always amazed to see how caring the people are. This is a sample size of one though.
It's uneven. There are many who are kind just like you say. But if you have ever seen the savagery in the comments on any HN-linked story on homelessness, that perspective is also well-represented in the US.
Mental illness is absolutely seen as a weakness. You just need to hear how people gossip in quiet about someone who’s having mental health issues. Statements about people needing to “man up” or it being “their time of the month” are far from uncommon.
Growing up, my parents would make fun of my aunt for taking anti-depressants behind her back in front of my sister and I. When I was a kid, I didn't think much of it. Now being older and having gone through some dark times of my own, I am truly sickened by the fact that they see her in this "weakness" light. Imagine all the kids who faced the same thing but never saw the other side and wound up feeling the same way their parents did? My parents taught me a lot of great things but I am glad this was not one of them.
I think when people travel they generally visit the pretty and happy places. Surely people with mental health issues hide those issues while the person is there in order to fit in: else the person wouldn't fit in and would be ostracized and removed. See also anti-homeless laws.
Individuals, sure. But the system? You couldn’t be more mistaken. Your health insurance comes through your employer. When you get sick or depressed, and you start missing work as a result, guess what happens?
Generally, I do agree with this - but outside of anecdotal evidence of public opinion over it, do you have references (scientific) I can find on this in particular?
This may have been true a couple of decades ago (as with the rest of the world), but the world's come a long way since then, including the US. It's no longer stigmatized here or anywhere else developed.
Maybe I should have told the people slamming my back into hooks repeatedly that and they would have stopped. Or the people who refused to hire me. Or the people who refuse associate with me. Maybe you should tell the associates I have who accidentally let slurs slip out of their mouth with me right in front of them. Just look at the slang internet shitheads use. "Retard" and "Autist," are super common.
Just because you're blind to the stigma out there doesn't mean it doesn't exist. Mental illness causes many problems and often the easiest way for somebody to deal with those problems is to not deal with the mentally ill person. Even if its not right. Stigma is practical. People in the developed world give a lot of lip service to how mental illness shouldn't be stigmatised I guess.
I'm curious if you believe the developed world doesn't have sexism or racism anymore.
Having finally gone through the process of getting diagnosed with ADHD, I can't agree more.
I talked with my doctor about a referral, he essentially just said "find somebody in your network" and gave no direction. Of course, finding psychiatric care in my network was a no-go, so I ended up paying out of pocket.
Even with the diagnosis and subsequent medication prescription, the out of pocket price was $189 for 30 days for a generic medication! Only with a coupon app was the price lowered to ~$50.
It's no wonder the black market for drugs is so strong considering the barrier to entry, not just monetarily but logistically.
I am from the US and my perception is that the parent post is true. In reality this is all that matters if someone feels they might have a need in such an area but otherwise can ignore the issue until something catastrophic forces it.
I'd imagine the 'customer service' people at insurances companies would also need mental health care after breaking the news to their clients...must take a toll
In my experience a related obstacle to obtaining mental health services is that the insurance companies require that the records from therapy must be available to the insurance company so they can verify the services they are paying for. Meaning, the notes from deeply personal discussions with your therapist and any resulting diagnosis can end up in the hands of your insurance company. Once this information has left your therapist's office it can end up any number of places. While that might be a risk I am willing to take with my social security number or other personal information the deeply personal topics discussed in therapy are not worth risking.
I don't see how this gets any better with single-payer/government funded funding routes. I don't want anyone to know what I discuss with my therapist much less a soulless corporation or the government. The avenues this could open up for oppression from corporations and/or the government sends a shiver down my spine.
Unfortunately, I can't find documentation of the requirements insurance companies place on therapists for providing coverage. I would be surprised if this is even public information. However, I was able to find a therapist blogger who discusses the topic [0]:
> The insurer can also audit your records at any time they wish, which means they have full access to any details your therapist has, including information the therapist intentionally did not include in the claim submitted to the insurance company. Any and all information, including progress notes, which can include details about what occurred during the therapy session, is technically open to the claims specialist.
>The avenues this could open up for oppression from corporations and/or the government sends a shiver down my spine.
Tons of vets already avoid mental health services because it's a black mark on their career and can hinder their ability to bear arms in civilian life.
I can't go to therapy because of exactly this kind of thing. I have two different fully covering insurances ... plenty of cash... and probably some reallylifetime bothersome things that I would love to deal with...but I've never been able to get past the idea that I can't just go in and talk to a professional without them having to know everything and share and store everything about me I'll never do it.
I hear you. This was an obstacle for me for many years. I even had a hard time opening up to those I am closest too. All I can share is my own experience but I finally tried therapy, and gave it the best effort I could, 3 years ago. It has truly changed my life. I am still working on things but my life, relationships, and mind have never been better.
So go a town over, pay cash, and give a fake name, and get help from a therapist about why having anything written down is so scary for you, until you get past that particular emotional block. (If it's about possible loss of wages/job, that's why there's HIPPA, and malpractice lawsuits.) And then continue paying cash and using a fake name, just closer to home.
It is hard to actually manage to get help for mental health issues in the first place, but if the issue is so great, that you need to share with strangers on the Internet need that you suffer from similar FUD about the process, then it is possible that the issues are a bigger problem than you realize.
Your comment is so insensitive, it is ultimately just flame bait. Do you go around castigating people for being hesitant to talk to cops, as well?
It's fine that you trust the (de facto) government. And I'm certainly not going to convince you otherwise right here. But don't casually brush off the opinions of those of us who don't.
The effective requirement to expose your permanent identity as a condition of receiving medical care is an ongoing travesty. It also is a large component of how the healthcare market is so fucked, in that it fosters extreme price discrimination.
Do it anyway. Do it even if it scares the shit out if you. Say to yourself: I'm not going to let an insurance company tell me what I can or can't do. I'm telling you man, therapy is fucking great!
Edit: btw, talking to strangers on the internet is a little like therapy. It's easier sometimes to talk about yourself when it's to someone you don't know.
Agree with all points made. I inch closer to just doing it. Especially as I'm getting older - 10 years ago i had 'figure it out' runway. Feels less so now.
Last issue is anxious of sitting in session after session trying to a)settle on a particular person b)tracking/having any sense of real progress.
*mainly it's all creative avoidance out of fear, I guess..
Good point re strangers on the internet. I hardly bring this up anywhere, especially not online - not sure what happened this am.
Aviators and others who need to hold a medical to drive trucks, trains, or control air traffic also have incentives to not visit mental health or other healthcare professionals as we have to itemize all healthcare visits since our last medical (or for the last few years at least) at our medical exam that represents our continued ability to fly/work.
It’s a huge problem in the firearms community - most of us are scared to seek even minimal mental health assistance because of the stigma associated with it.
I faced my own issues with depression in my late teens and early twenties. Gun rights are very important to me, and I was extremely hesitant to speak to any mental health professional due to the potential future restrictions it might place on me. I did see someone, and over the course of a few years recovered to the point that I was able to get my life back on track - but even then, it was difficult to find a therapist that wouldn’t immediately demand that I dispose of all of my firearms. I ended up asking around and basically “interviewing” several providers before I chose one. I wasn’t suicidal and didn’t have anything resembling an urge to harm myself or others, for what it’s worth.
I still believe that seeking help may come back to haunt me one day. It’s something I’ve come to terms with and I believe I made the right decision, but I think my ability to introspect and make a rational decision in the face of my illness is... atypical.
I think it’s a consequence of the “do you have firearms in your home” questions during routine checkups. The current push for so-called “red flag” laws seems to validate the concern.
Ditto for the UK. Police will revoke firearms licenses if a holder has mental health issues, and GPs have a duty to inform the police [1]. Typically a UK firearms license will only allow the holder to use a shotgun on their own land if they are a farmer, or a rifle on a certified shooting ground if the holder is a sports shooter. Some, including a friend of mine, have self certifying licenses that allow them to shoot anywhere they deem fit. Such licenses are granted to eg pest controllers who may be called in by landowners who need vermin eliminated. My friend typically drives around with his Blaser hunting rifle with telescopic sight, silencer and a box of ammo. He suffers from depression but has never sought treatment as he'd immediately lose his license.
NB many think firearms are illegal in the UK. They are not! I was surprised to discover this when I moved out of London to the countryside 10 years ago. It's very difficult to get a firearms license in an urban location. But rifles and shotguns are commonplace in rural areas. Handguns have been banned since the Dunblane massacre, and semi automatics since Hungerford. But in rural areas few dispute that shotguns and rifles are legitimate tools.
In Northern Ireland handguns are still legal but you can only have a license if the police service here deems that owning one is reasonable for the protection of your life. [0]
On the other hand, in the US it happens that a disaffected fellow has a dissociative episode and shoots up his former workplace or school. It's a culture-bound syndrome. You need to defend society against it.
When you taught at college and had to deal with a deranged individual who eventually got himself expelled for stalking and attempted rape your opinion about gun rights changes.
"Defending society against it" could mean many things but "disarming everyone" isn't on the table. I'm not even in favor of those Red Flag laws because they destroy our due process. Think about it--due process is something we've had in some form since before the US Constitution even existed. It is a basic component of Western legal tradition. And we're now supposed to give that up out of fear?
I'd rather hang all the mentally ill people, then. That also would defend society if I am not mistaken. For you downvoters, I'm only making a point, I don't mean it.
You're being led by the nose down a dark path and you don't even realize it.
Here's my own anecdotal story; note that it's third hand, I wasn't directly involved, so people should take it as such.
Around the corner from my house one early morning (around 3am?) erupted a 4-alarm fire at a neighbor's home. Several fire trucks, etc later, the fire fighters tried to enter the structure when they were shot at by someone inside. They retreated and the police (SWAT) were called.
They entered the home with the fire fighters; the person inside attempted to fire again, and was shot and killed. The fire was put out, and while I never learned all the details in the aftermath, I learned enough to know something very terrible had happened.
The person that SWAT had shot and killed was the adult son of the family who lived at the home. The parents had kept numerous firearms in the house, and the son had only been living there for a few months before this incident occurred. Prior to that, he'd be virtually homeless, struggling with bipolarism and schizophrenic issues.
These mental health issues were known to the parents and family; they had originally kicked him out of the home years prior, but let him back in trying to get him better help or something like that. But they kept their weapons in the house; at one point, IIRC, they also bought him his own weapon for his birthday.
Apparently there was some kind of an argument, based on what immediate neighbors had heard earlier in the night, but they thought things had calmed down. Unfortunately for the family, they had only started. Sometime during the night, for reasons unknown, their son decided to take one of the family's or his own weapon, shot the mother and father, then his sister, and the family dog, then set fire to the house and waited in his bedroom.
The entire family - including the dog - dead inside a few hours.
It's not known (that I really know of) if the son's mental health issues played any role in the shooting deaths of his family, but they certainly can't be discounted. It's not certain that had there not been guns in the home, if the results would be different, but I tend to think fewer deaths would have occurred.
Note - I'm liberal in my views and political leanings, I also support gun rights as well. But I think that a discussion on how to temper these rights with keeping such weapons out of the hands of potentially dangerous people needs to be had. I don't know what a good solution would be in such cases. There are many issues intertwined, that we have let become a morass in our society, which may make the issue nearly impossible to untangle.
It's the issues and problems we have surrounding mental health, and healthcare/coverage in general, the stigmas and such.
It's issues surrounding guns, our culture of violence, the rights of individuals, etc.
It's our society's tendency to seek to place blame elsewhere, and not take responsibility for our problems (we claim "self-sufficiency!" as "being American" - but forgetting the other side of that coin is also personal responsibility).
It's our weird obsession with violence; how as a culture we've deemed it more fit for people to consume as media and knowledge - almost elevating it as something aspirational, especially when it comes to the military.
Simultaneously, we've deemed sexual knowledge and media to be something shameful - at least on the one hand; yet on the very other, such knowledge and media is blatantly used to sell products - so there's this mixed message "violence ok, sex is bad, but if you want to buy something - here's sex to sell it".
Our media, our politicians, and increasingly each of us - have fostered and promote an "us vs them" dichotomy amongst the population.
All of these things - and many more - are all tangled up. They are all problems we need to solve, but like a box of Christmas lights or a bowl of spaghetti, they are hopelessly tangled up, and one can't be sorted and fixed without causin...
In your story, the closest supervising authority (the parents) had an extreme capabilities of surveillance, attention, and control. They were painfully aware of the details of their son's mental problems, and were applying themselves to helping him. At any point, they could have done some of { get rid of their own guns, seriously lock their guns up, not give their son a firearm, insist on fully supervising his possession/use of the gift firearm, search his belongings for any other weapons }. None of this would have required following a legal process - no crafting laws, respecting rights, nor due process in carrying them out.
And yet they still were unable to prevent this tragedy. The main thing I take away is the ultimate futility of believing that top-down control can prevent tragedies if only it is given more power!
> Our media, our politicians, and increasingly each of us - have fostered and promote an "us vs them" dichotomy amongst the population.
I'm right there with you in seeing this dynamic as ultimately one of decay. In fact I think second amendment culture functions more as a crutch that enables totalitarianism. It fosters a fallacious belief that the fight for freedom is some eventual violent confrontation rather than insidious gradual creeping.
But I maintain the burden of reform is on the government - its institutions, politicians, and the media - as it is the government which is the overwhelming aggressor. An individual that eg fantasizes about defending their family from an overzealous cop isn't actually harming anyone. And tax protesters eventually get the rats on their face.
But once bureaucrats become accustomed to entrenched authority, they succumb to fallacious thinking that they are in charge, rather than servant facilitators. Even little things like all these various "user fees" need to be fully repudiated, as they are ultimately symptoms of government agencies leveraging their power-held-in-trust to generate more revenue for themselves - ultimately that same basic "go ahead and stop us" adversarial dynamic.
> while a smaller minority "fights" among each other for control, both with agendas they believe will fix everything, when the fact is, they won't fix anything - and likely will make it worse. Or at least, that's what they say about the other side.
I'm here with you as well, but I think the statement fully applies to the gun "issue" as well.
The main profiteers of mass shootings are "news" channels, and yet they continue to blamelessly fan the flames. One specific type of weapon being a little harder to get isn't going to reduce the appeal of getting on the prime time scoreboard. But it's a simplistic divisive bikeshed narrative, right up there with how other people pee, so it get focused on.
I'd call the ultimate topic that of societal mental health, from being continually bombarded by bad news. We're getting much safer, yet "so many bad things are happening". It's true we're more connected, but that is only one part of it. Most people aren't actively seeking out tragedies to bathe in the emotion of, but rather are having tragedies pushed at them because the induced panic drives their continued attention.
I don't have an answer to this, besides hoping it's merely a phase that we'll pass out of as people get numb to and check out of mass media (including mass social media). But I'll note that an assumption that a perspective is only worthwhile if it implies a straightforward answer is essentially just another way of looking at our current problems.
>I don't see how this gets any better with single-payer/government funded funding routes. I don't want anyone to know what I discuss with my therapist much less a soulless corporation or the government.
If anything I would expect it to get worse, since the government has an incentive to use this in far more areas than an insurance company.
This is what I don't get about the Stephen Pinker argument that "everything's getting better." To a country experiencing something like a collective mental breakdown, how does the claim that the bad parts are "all in your head" help anything at all?
Mental health is getting worse because the economy is getting worse, simply.
I don't normally go for Marxist or populist analyses of the world, and indeed spend a lot of effort arguing against them, but Stephen Pinker made a lot more sense when someone pointed out that he's basically a shill for globalism, or neoliberalism, or whatever your word for "that thing" is. His whole shtick is going, "Everything's fine! Getting better in fact! No need to examine the current system and all the ways it might be flawed, or change it at all!", since that kind of thinking could hurt entrenched interests immensely.
Your characterization better fits someone like Thomas Friedman, not Pinker. Pinker absolutely acknowledges the many problems of the current system and the need to devise solutions to these problems. His argument is that things have, on the whole, been improving, we've solved big problems in the past, and we can solve current problems so long as we hold with Enlightenment and humanist / liberal values and put the effort in. He's arguing against those who want to throw away liberalism and replace it with some form of mystical authoritarianism, whether that be socialist, fascist, or whatever. And there are many such people, who take the benefits brought from liberalism for granted and would throw them all away for some romantic wishful thinking. His argument reminds me of essays written by Albert Camus defending liberalism against fascism during WWII and against the communism that was en vogue in France after the war among Sartre and others that Stalin referred to as his "useful idiots".
By liberalism here, I mean the original (and only sensible) meaning of a system of individual freedom in social, religious, and economic spheres, equality before the law, and democratic representation, not the New Left's utter misappropriation of the term to represent tribal resentment and mob justice.
I have admittedly not read Stephen Pinker but I have heard him speak. The impression I left with is that the improvements he is discussing are at the macro level. The fact that we now have science based, effective mental health services at all is, in fact, a large improvement over the past.
It is very easy to use statistics to paint whatever picture of the world you want. Steven Pinker highlights aggregate statistics which, intentionally or not, overlooks the negatives, which may sometimes arguably be a direct consequence of the actions that make the "good" statistics possible.
The first talk therapies with any empirical validation are recent inventions. So are the first (relatively) effective and safe psychiatric drugs.
Mental health services in the "good old days" were shrouded in a thick fog of Freudian bullshit and couldn't do much for really troubled patients besides keep them warehoused and docile. Before that, they didn't really exist at all.
The feeling of a collective mental breakdown has been in the public consciousness since at least WWII. The loss of meaning and religious faith after such large-scale horror and the response in postmodern aesthetics and philosophy, the isolation beneath the surface-level perfection of the new suburbs, the invention of mass market consumerism, the constant threat of nuclear annihilation, struggle and upheaval around gender/sexuality/race, the Kennedy assassination, the Vietnam War and Nixon-era loss of faith in institutions, stagflation, you name it.
"...Some practitioners who want to join networks are turned away. Melissa Davies, a psychologist in Defiance County, Ohio, was part of Anthem’s network for years when she worked in a larger medical group. But the insurer refused to contract with her after she started a solo practice in 2012, saying the area was saturated, even though Davies is one of only three psychologists in the county. When Davies examined Anthem’s directory, “I found a great number of their providers were no longer practicing, or were dead,” she says..."
It seems like a widespread issue as well. In my area (pop. ~300,000) there is one child psychologist and one adult psychologists who practices elsewhere half-time. I was not aware of insurance companies refusing to contract with psychologists but that explains the dearth of psychologists. If I was a psychologist I wouldn't want to offer services if I cannot accept the main form of payment patients would use.
In my area there are plenty of mental health care psychologists, but unfortunately none of them take my insurance (UHC, one of the biggest if not the biggest insurers). So I pay out of pocket since my out-of-network deductible is so high I'll never reach it. Neither UHC or my employer care about this.
It's really, really hard to find a good therapist. I've heard so many stories from friends and have direct experience with employees who've had trouble. Kaiser completely screwed over an employee of mine, which led to him being homeless for more than 6 months and abandoning his job. It took him more than a year to get back on track.
IMO, it's criminal what these insurers are doing.
Also, there was a post here, I believe, about a successful therapist (in Australia, I believe) that was quitting because of the BS he was putting up with from the insurers. It was a youtube video where he laid out all the reasons. It was just heartbreaking to watch.
> It's really, really hard to find a good therapist.
And sometimes you can find a good one and watch them, over the span of 5-10 years, turn from good to bad. Then you're back and in the market looking for a new person to divulge your innermost thoughts and intimate experiences to only to realize they're all actually shit now.
One of the "primary care practitioners" in my provider's directory was actually an osteologist. His receptionist informed me of the mistake, and informed me that they've been trying to fix the mistake for a very long time.
Even before the insurance denies, it is basically impossible to get someone that is delusional/psychotic mental health care in the US, unless they go in voluntarily, which they won’t, by the nature of the illness.
A friend that has been certified mentally ill stopped taking his meds and was fantasizing about killing himself, a family member and shooting up religious organizations. His doctor, family, employer and friends all called the police, talked to lawyers, mental health professionals, etc.
The end result was that he was facing sleeping in a car that was about to repossessed, and eating in homeless shelters. At that point he decided to accept free housing in exchange for seeking help.
His family’s only other recourse would have been to pay tens of thousands of dollars in legal fees to petition the court to force the police to uphold the law. This would have had a medium to low chance of succeeding.
Of course, during the months this dragged on, he missed an insurance payment or two (he had also been fired, divorced and evicted), so it lapsed.
There is a 12 (6?) month wait to get government disability insurance to kick in for this sort of thing, and the clock starts after the mentally ill person goes in for scary interviews with the government to establish they’re actually crazy.
The law used to handle this sort of thing properly in California, but Regan repealed the lions share of it as governor, and loopholes that accidentally allowed people like my friend to get health care have been progressively closed since them.
Nurses at the intake office of the appropriate mental health facility in Santa Cruz told me that most of the homeless people in the Boardwalk area there are in exactly the same situation as my friend was in, except they’ve been trapped in it for years.
> it is basically impossible to get someone that is delusional/psychotic mental health care in the US, unless they go in voluntarily
I'm not sure I see a better solution to this that doesn't come with its own set of risks and downsides (involuntary commitment or counseling of someone against their will is not something to be taken lightly in any event, even if their reality diverges from your own).
The current approach is not a solution, it's doing very little and saying you are doing something.
Describing psychotic delusions as 'reality diverges' is something or other, I have to say.
Of course we need to respect the rights of individuals, but it shouldn't be the case that family and friends are the first, second, third, fourth and so on interventions, there can be professional resources available.
- a compassionate aid policy that presumes that people who are asking for help need help, and starts providing help as soon as it is asked for rather than after a year or more.
Those don't seem like they have any major risks other than monetary.
They can foster hope, and try to strive for happiness without struggles of a simple toothache, crippling debt and outright usurious lending practices, while emptying a cold can of chili into chip bag on bus bench for breakfast.
I strongly disagree with the housing first policy. I tried paying for temporary housing for my friend, and things spiraled. The housing has to be conditioned on some sort of recovery plan.
Threat of homelessness is basically the only remaining lever the law allows in these situations.
I don't know your circumstances, and first of all that is a great and generous thing you did for your friend.
The one place I know of where a housing-first policy has been implemented, Salt Lake City (or maybe all of Utah?), doesn't just give homeless people a set of keys. They do assign everyone a social worker at the same time. The goal is to minimize the risk of what happened to your friend; that isn't good for anyone, including the person spiraling.
It's key, though, to start with a home (and a social worker). The wealthiest country in the world can do that for its people -- and it shouldn't be on private citizens, though that was generous of you.
A big advantage of institutions is to collect the long term learning and lessons into more effective actions. Trying to handle it individually is admirable, but it's at a huge disadvantage and without experience with multiple cases to know what might work better or worse for various people.
Folks have different sorts of needs, and those need to be addressed as well.
My ex was schizo-affective (had traits of both schizophrenia and bipolar disorder). He was on disability. His doctors did not want him living by himself. Some things were simply too stressful and he couldn't do all of it. He'd only cook instant food. He wasn't good at budgeting money. And so on. For a while after we split up, he had a social worker coming to his house for wellness checks. My friend worked a similar job for another hospital: SHe'd visit mentally ill patients and help them, sometimes shopping and whatnot.
There was no recovery for him, only meds. That's it. Only meds.
I cannot fathom how stressful it would be to have your housing and your safe space be dependent on taking your meds, especially when your meds need adjustment... and paranoia strikes up again. Every stressor simply complicates things.
Why not add unlimited resources to the list and call it a day? The problem here isn’t a lack of compassion, political will or information. The problem is the costs, largely due to the legal system which incentivizes litigation and high level policy debate for aggregate clinical outcomes that would benefit societies at the cost of individual liberty.
I believe the previous solution was to err on the side of allowing 24-hour involuntary psychiatric holds, with observation by a neutral doctor, and taking abuses of that extremely seriously.
In my friend’s case, he had actually set up permissions for the doctor, his family, and I to initiate such a thing, but after his episode started, he fired his doctor and was quiet for a month, which nullified the paperwork he had done to create a safety net for himself.
The law has a list of things that have to happen before the psychiatric hold if there is not such an arrangement.
Basically, the mental illness has to affect some number of life areas. I think this is the list, I might be remembering wrong:
- work
- finances
- shelter
- self care (eating, etc)
- family life / marriage.
It used to be that one thing on the list was sufficient. I think the current law is that a total of three are necessary, but not sufficient.
Risk of immediate self harm or harming others is a different path, but the person basically has to say “yes, I do plan to kill myself, or that fellow over there, officer” on camera for that to count.
Anyway, my friend ticked all six of these boxes, and that wasn’t sufficient. If the person is borderline coherent, don’t think anything really is.
(Nothing in this message should be considered medical or legal advice. Go talk to a doctor and a lawyer if you might need to know any of this stuff, especially if everyone is healthy at the moment.)
(Edit: upvoted sokoloff because this is exactly what everyone with any power to provide care says.)
> I believe the previous solution was to err on the side of allowing 24-hour involuntary psychiatric holds, with observation by a neutral doctor, and taking abuses of that extremely seriously.
We have a history of using this policy in multiple countries, and in each one the system was abused to torment and commit minorities, people (including children) who were deemed an inconvenience, and political enemies.
I say this as someone with a family member who went through a very similar experience as your friend. I know just how scary and frustrating it is, and the immense burden of care and worrying it puts on people who care about someone going through mental breakdown like that.
I wish there was a solution to this problem, but I don't know what it would look like.
In the US there was an experiment where a bunch of healthy people were sent for a temporary hold and evaluation, and something like half of them were declared insane for refusing to admit they were insane, and trapped until the experimenters intervened.
Yes, it's well established that sane people are routinely labelled as insane when it suits the predispositions of the accusers.
Even more interesting is those that are clearly insane who are never institutionalized. For example, not too long ago there was a man who authorized the vaporizing using nuclear bombs of two Japanese cities consisting of almost entirely civilian targets. If that's not pure insanity what is? Along with all his advisors. Yet rather than acknowledge that this man was clearly a deranged madman, the preponderance of the public celebrates him as a hero and call his critics mad. Leaving no possible conclusion other than that most of the public is mad.
What treatment is possible for madness? None that has been demonstrated. Is mental health treatment a myth? Yes. Is insanity caused by chemical imbalances in the brain? Perhaps, though there is no evidence whatsoever supporting this claim. Are those that continue to promote this hypothesis as fact insane as well? No doubt some of them are.
In so many ways, America needs to start understanding that solutions to these problems have been explored and, just possibly, greater progress achieved in other countries... progress can be gleaned by studying outcomes from those countries.
It's easy to dismiss suggestions as having "its own set of risks and downsides", but in critical areas, America is significantly underperforming other first world countries and we need to get past the Not Invented Here syndrome.
In England you have an assessment with an AMHP (who is there to protect the rights of the patient) and two doctors. One is a specialist MH doctor with training on the law, the other knows the patient. They have to agree that the patient poses a serious risk of harm to themselves or other people, and that they must be detained in hospital for assessment or treatment. The AMHP asks the patient's nearest relative if they object to the section -- if they do object it becomes harder to detain someone.
You then provide free legal advice, and access to mental health act tribunals where people can challenge their detention.
You have independent regulators who provide some oversight, the rpess can report on it all, and of course the courts provide a final backstop.
There are problems with this, but it's pretty good.
We have short detentions for assessment. We have longer detentions for treatment. We have police powers to take someone from a public place to a place of safety for assessment. There's another police power where the police can take someone from their home to a place of safety for assessment, but only if they have a valid warrant.
> Most of the homeless people in the Boardwalk area there are in exactly the same situation as my friend was in, except they’ve been trapped in it for years
Most cities & states just try to fix the symptoms of homelessness (& crime), and not the actual root of the problem. There needs to be a federal mental health program to handle this, and maybe states & cities will stop playing 'hot potato', shipping them back and forth to be someone else's problem
The try to fix the symptoms that inpaxt wealthy people's confort and property values, more specifically. Not the symptoms that impact the poor and homeless.
This isn't the case in all states. I knew a friend who was LGBT and bullied severely where she was falsely arrested by hearsay of the persons bullying her. She ended up being brought to a hospital because of lies and was forcibly committed because of the police report that was written from testimony of the people who bullied her. She ended up committing suicide later in life because of the hospital experience and where none of the doctors listened to her with labeling her delusional. I don't know if they drugged her because she never went into detail about it.
There's a big difference between offering socialized mental health care to anyone who needs it and forcing people to take it. It's like saying we shouldn't offer socialized medical care because the government may drag me in to the doctors office and force me to wear a cast. I do understand the negative connotations and our checkered past with mental healthcare in general though I'd like to think we've come a long way and we should address failures on a case-by-case basis.
The slippery slope is real though. In the UK relatively minor infractions have gotten babies seized from their mothers, not for criminal justification but for health department reasons.
Lots of people do voluntarily check themselves into mental health facilities, but can you really blame those that don't want to be locked in ward with unstable people with nothing to do while being force fed antipsychotics and mood stabilizers.
My father is a clinical psychologist, and he's got a bunch of stories like this. Parents going from doctor to doctor with all of their children's records, begging someone to get them off the street. It really is a tragedy. Often, their only hope is to hope their child commits a minor crime, gets arrested (and hopefully not shot), and is then declared mentally unfit to stand trial.
Reagan left the governorship in 1975. Do you even listen to yourself? Please. Liberals are the ones that got the mental hospitals shut down. Let's not rewrite history. Regardless, there is nothing stopping the California legislature and governor from reversing that 44 year old policy.
I am suicidal and have been off and on for years due to disability/pain from medical mistakes that cut my life short at 30. I am 45 now. That led to immediate loss of quality of life, career, financial security...and a slow painful loss of relationships and self worth. I was told to "get help", and did when I could afford it, but the problem is the root issues were never addressed. All mental health care has for most people is superficial bandaids. You cannot live an entire and healthy life drugged while things fester. You cannot cope every minute of every day. Life also isn't static or always improving and we have to deal with new issues like added health problems, aging, financial pressure weighing us down further. Bail one bucket of water out, two more pour in.
I had to ask family for help and one by one after a time they began to resent me and abandon me. I was denied SSDI. I was denied nearly everything I applied for and buried in bureacracy. I lived abroad for a time and had a much better quality of life and access to healthcare, but I couldn't legitimize permanently (still a fantasy at times) and had to come back to the USA. I now live, and who knows for how long they will allow it, with resentful family, isolated in rural Murica with no transport or access without much more expense and effort. No insurance. Limited income based medical care. Living on 600 dollars a month from a partial pension I was fortunate to have. Hearing every day how it simply has to be my fault and treated as if I am a loser who chose and continues to choose this. I am the same person I was when I was a public servant and seen as doing good in the world, but now that I have lost my autonomy I am lower class and shamed.
There was a time when my root issues would have been addressable and I could have had a decent life, but there was no help and things got worse. There was a time I though if I could just find someone to give me the "right" job that would work around my issues I could have a survivable life, and finally a kind and caring soul did that after years of nothing, but those two buckets I mentioned above poured in and things got worse and I wasn't able to do it. Now I have no idea what if anything can save me. How is one supposed to survive since "suicide is never the answer" when you have a miserable, painful life and no realistic way to dig yourself out? I cannot magically become a citizen of a nation with social support and healthcare. I don't have the bootstraps to pull on and rebuild. I cannot endure decades more of this yet anytime I discuss it I hear "seek help" or other shallow pearls of wisdom. Hotlines and calling the police seems the default response if someone brings up the topic. Everyone feels good like they did something and pats themselves on the back. The patient might get sent to hospital and that results in tens of thousands in medical debt and a worse problem. So it goes. No real solutions happening.
In cases like mine, which are a majority of suicidal people in my experience professionally and personally, it's rooted, situational stuff (often from multiple angles) and not some primary mental illness that Prozac and CBT mitigates. It's not simply about insurance (or the lackthereof) and what it will and will not pay for. I have been to a lot of doctors in my day and not a single one has improved my quality of life, most in fact the opposite. It's about there being no willingness to solve root causes and the eventual response being victim blaming and turning a blind eye when the bandaids don't work. Until society addresses the fact that many people end up in bad situations through no fault of their own (and honestly even those to blame somehow are still human beings who deserve help and not some abstract calculations on a moral or financial ledger) and provides a safety net and path to rebuild as much life as possible (something friends have accomplished in nations with such support), you will find more and more people ch...
I’ve heard variants of your story from so many people here in the midwest. There’s an entire nation of people in the US hurting, and many who could return as first class citizens if we had some more empathy paired with grit.
Some of the best art resonates best with people who have experienced significant suffering, such as yourself. I have recommendations, if you want them, but ultimately, I think there is a way out of your suffering, and it lies within you. I do not mean that it is necessarily possible to change your external circumstances, but I do mean you don't need to change your external circumstances to experience contentment or even happiness.
You seem highly intelligent, so I'm assuming you have explored this avenue thoroughly. But just in case not, have you investigated the immigration terms of all countries that have socialized healthcare? I was thinking there could be a chance that one would be able to give you permanent residency. Honestly, it seems as if there should be a policical asylum (no pun intended) quota for this kind of thing.
I read a local newspaper story of an American who was able to immigrated to Norway some years ago, motivated by the fact that his American insurance didn't cover a very important back operation or something like that.
If you are capable of holding a Norwegian 80% job of 40*0.8 hours per week with the 4 or 5 weeks standard holiday (probably with some local-doctor sanctioned sick leave in there), a working visa would qualify you for medical aid here immediately, and give you permanent residency after 3 years, if I read the regulations correctly. Should probably be double-checked by a local lawyer.
Please feel free to reply if you'd like to investigate this further. I'll give you my contact information. (My profile is normaly pseudonymous due to political comments and other stuff, so the info is not in my profile).
Vote for what? Here in San Francisco we just voted to raise hundreds of millions of dollars in additional funds for homeless and related services. Most of this will be funneled to over 40 NGOs/non-profits by our city officials, the same 40+ organizations that have ineffectively applied nearly $500m a year for the past decade. My hope is that some of this money TRICKLES DOWN, but my hope for change is pretty much gone. Simply raising/spending the money gives incumbent politicians plausible deniability that they are "fixing the problem" even though they aren't. It's an homeless-industrial-complex at this point where major players are motivated to sustain it because it gets them paid well.
We could vote to build more housing. Oh wait, SB50 just got rejected by the appropriations committee - which is full of non-elected government officials.
I know, we could completely re-elect all of our local government officials to shake everything up, oh wait that's the promise of our last N mayors who haven't done anything.
I'm disgruntled, if any of these points are incorrect please let me know - it's very frustrating and I feel helpless as a voter (in SF).
Vote for Medicare for All to build a more solid foundation for healthcare and health services instead of each of our single cities having to patchwork with yet more bandaids.
In my grand ole state of Utah, even our voting doesn't matter [0]! The Utah legislature gutted a medicaid expansion program which the population had passed in a ballot initiative in 2018.
Technically legal? Sure, they're the legislature, they can do whatever they want. Incredibly disappointing as a voter.
That only works when there is an effective provider network exists and the main problems are expanding it and removing cost as a barrier to access.
The problem with mental health care is that such providers either don't exist or are very rare, meaning there is little to no effective care to be had for any amount of money. Simply throwing more money at this problem will not do anything to solve it.
Providers presumably respond to economic incentives; if there are not enough therapists in your area, enticing more people to become therapists really will help. It's a better problem to have.
I don't think my point was clear. I'm arguing that most of the extant providers are at best worthless. Too much of mental health "care" is focused on treating the symptoms, rather than the underlying cause. More money isn't going to fix ineffective treatment; it's just going to multiply the number of practitioners of it.
It's not throwing more money at it per se, it's supplying a reliable funding source. Because insurance companies deny funding so often, and public funding is unreliable patchwork which can ebb and flow with the attention and power of individual politicians, provider services for mental health are much smaller than they could our should be to serve our population.
On the other hand, if an individual provider can rely on getting a fee for service without crazy overheads of private insurance approvals/unapprovals, then they can make a business commitment to supplying that service. This costs far less overall when you don't have to price risk and extra work into the service rendered.
> provider services for mental health are much smaller than they could our should be to serve our population
As I responded to your sibling commenter, I don't think my original point was clear. I'm asserting that those existing provider services suck and are ineffective, and that what is needed is a paradigm shift in how mental health care is formulated and delivered, not a spread of those existing services.
I think poor service and unstable sources of funding are fundamentally linked, and that stable funding is a precursor needed (or at least strongly helping) when considering a paradigm shift in how to deliver mental health care.
The funding societally is so poor now that the common end path is people ending up in prison. And, as the article indicates, it's not like the private insurance companies are picking up the expenditure.
This is exactly why I'd much rather give money to my church which runs an actual program to help the homeless, which I can verify and have input on, than give to the government, which funnels it through cronies and faux-NGO's who have zero accountability, except for votes delivered at election time.
I agree with you that for any given $20, it's probably more effective to give it directly to an outreach program. But this doesn't scale. Consider a charity that wants to build housing for the homeless. Well now they need to buy property. But now they need a holding company or some business structure to legally own that property. That holding's company has fees for bank accounts, po boxes, people to check the po boxes, etc. Now the business decisions matter: how to structure that investment to minimize tax or properly insure it. Then you need to build on that property. That requires permits to be filed, and construction plans to be drafted. now you need educated business people to manage this. Those people don't work for free. So now you're paying salaries. So now you need to manage that situation. Who do those people report to, how much do they get paid, etc. Now you have a corporate structure (and significant overhead).
My solution is to introduce salary caps. So that NGO's cannot compensate any employee more than some modest amount. Bonus if the state or local gov could give people tax breaks (fed would never go for this) for working on an NGO. So, say a lawyer or accountant could take a few months off their high-stress, white-collar job and work for an NGO for part of the year, make enough for rent, reduce their tax bill, reduce their stress levels for a while, and help the community, then go back to "real" work.
"Those people don't work for free." except at my church they do. We've got nearly a thousand people in the congregation, including lawyers, construction business owners, accountants, professionals of all sorts. We have agreements with other churches to share resources. You're right it doesn't scale up to city wide levels, but it's got a whole lot more top talent than you could get paying below market wages at an NGO.
I don’t vote from emotion, I vote based on rational (for me,) thinking. Feeding stray cats can be considered empathetic, but as a social policy, it leads to more stray cats, thus making the problem worse and requiring yet more “empathy” to solve.
It likely will. Not in a direct fashion, but which ever city does the best job solving the problem will create an outlet for other cities to send their homeless/mentally ill towards that city. So on the local level, fixing the problem can end up making it worse.
It is a sort of prisoner's dilemma, and while you can say you will choose to do what you think is the right thing regardless of cost, you will find that most people will only follow that so far (though they will not likely admit it to avoid the social damage admitting such will do).
It won't create mental health problems, it will expose them.
In the cat analogy, not offering services is just pretending the cats don't exist thus solving the problem once and for all. The cats are still there and so are all the negative consequences associated with a large population of feral cats. This is sorta head-in-the-sand thinking, right? The problem needs to be solved nation-wide.
It won't expose them, it will attract them. Colloquially, attracting problems from elsewhere is said to be creating problems for oneself.
In the cat analogy, you are correct because other cities won't go about shipping their stray cats to you (if they round them up they will just kill them). But there has already been numerous cases of cities sending homeless people to other areas. This is where the hungry cat/homeless analogy breaks down.
That's the same thing. The same number of people exist with mental health issues regardless of whether they're receiving treatment. With stray animals you can round them up, castrate them and throw them back. With people you look after them. Either way the same number exists with or without treatment.
Only if you look at it at a global level. If you can't break the problem down to local levels and solve it locally, you won't have a chance at solving it.
I'm not sure how this all plays out in policy, but outside of the criticism of the gun community and it relates to deaths by firearms - we have half the suicide rate in the United States as Japan - which has almost no access to firearms by its general population.
It's worth noting in relevance, because the politics in Healthcare reflect the policy of public opinion as well as legislation around other tangent issues our country is trying to reconcile what it wants to do (if anything) about it.
> we have half the suicide rate in the United States as Japan
What definition for suicide does the US use?
What definition for suicide does Japan use?
EDIT: and you don't have anything like half the rate. Comparing across countries is hard, but Japan has a rate of about 17 per 100,000 while the US has a rate of about 14 per 100,000.
While this might shooting from the hip...If health care insurance came bundled with life insurance, perhaps the providers would have an incentive that would be good for everyone?
Again, this is simply a "what if", please don't go all HN on me. tia
Having seems the guts of a lot of different insurance technology stacks, it's possible to see how the nature of the commercial business biases the behavior of the systems. In the simplest cases, health care providers have systems that take enough time to just get going that someone who becomes very sick and after a small amount of expensive intervention dies doesn't become a cost, because that system operates as if they had recovered....leading to the sad mantra at one 'Death is proof of recovery' . Same case here effectively. If it isn't treated it can kill, if it isn't treated then costs don't accrue, if it isn't treated then other potential costs don't materialize. I have never met anyone in the technology side of insurance evil enough to do that, but have met plenty horrified by the fact that it is what their systems keep evolving to do. The goal of profit is inversely related to the goal of care, plain and simple.
I guess why have it at all then? If their goal is profit and profit means to skip care, which is the main reason of healthcare, why even go about trying to pretend then? Skip right to the fact, take my money and leave me to die. I know this isn't a real answer and isn't how it truly works but the system just seems to defy the whole idea behind healthcare.
The core problem of mental health and insurance is:
1) resource utilization
2) long term cost-effective value
A therapist can induce infinite demand on a patient, by just doing follow-up sessions ad-infinitum. In argentina for example, people go to the same therapist for decades!!
This means that the insurance model doesn't work well, because you can't do actuarial analysis on how much therapy someone might need and how to distribute that in the population.
The second part is that as a patient, if the insurance covers your cost, you might as well go to the most expensive therapist you can find, and consume the infinitely. Also, you know more than the insurance company if you plan on using or needing this care, thus you have a very strong adverse-selection situation going on with any plan that is generous on mental health.
Economically speaking, mental health should not be part of an insurance scheme. It should be cash pay. To help people that could not afford mental health and they need it, you would do better to provide state-run service, that is low-cost high-effective-value and cover the lower side of the population.
It's its own case because of the subjectivity of the diagnosis and the effectiveness and length of treatment. I'm sure that a bunch of other healthcare services have the same issue, like acupuncture or physical therapy.
Also, mental health is not particularly expensive to treat itself: why put the insurance company in the middle. Pay the provider directly..
So what if they need it ? I will see a physiologist all my life as I need it, because of a premature autoimmune disease. The described system is broken.
Insurance on chronic disease is absolutely doable and it has to be done before diagnosis.
I wonder if the market offers a low cost health insurance from the moment a person is born dedicated to chronic diseases. I know life-insurance does ,and rather cheaply.
> A therapist can induce infinite demand on a patient, by just doing follow-up sessions ad-infinitum. In argentina for example, people go to the same therapist for decades!!
You know people who take insulin are on it for the rest of their lives, but that doesn't make it the fault of their doctors.
Therapy actually works. "Hundreds of studies have found that psychotherapy is an effective way to help people make positive changes in their lives," Nordal says. "Compared with medication, psychotherapy has fewer side effects and lower instances of relapse when discontinued." [1]
> The second part is that as a patient, if the insurance covers your cost, you might as well go to the most expensive therapist you can find, and consume the infinitely. Also, you know more than the insurance company if you plan on using or needing this care, thus you have a very strong adverse-selection situation going on with any plan that is generous on mental health.
This is a very strange American perspective on health care. If it was suddenly available to everyone, there's a perception that we'd all be like kids in the candy store getting 1 of everything at the doctors office. That's just not how it works. Nobody in Canada goes to their GP and asks for the immunotherapy and a few casts. People go to doctors because they're sick, and they need treatment and would rather be literally anywhere else.
It's not as though we're socializing the electronics section at Best Buy.
> Economically speaking, mental health should not be part of an insurance scheme. It should be cash pay. To help people that could not afford mental health and they need it, you would do better to provide state-run service, that is low-cost high-effective-value and cover the lower side of the population.
> You know people who take insulin are on it for the rest of their lives, but that doesn't make it the fault of their doctors.
The bet on diabetes has to happen before it is diagnosed to make actuarial analysis. If you want to guarantee that all diabetes patients get access to insulin, what you want is charity, not insurance.
Insurance is risk pooling.
> This is a very strange American perspective on health care. If it was suddenly available to everyone, there's a perception that we'd all be like kids in the candy store getting 1 of everything at the doctors office
The science has already shown that is true. Over and underutilization of healthcare are studied effects, ones insurance companies pay very close attention to because if they don't, they will go bust. That is also why countries with free healthcare also have copays.
> People go to doctors because they're sick, and they need treatment and would rather be literally anywhere else.
I think you are have an outsider's view on how healthcare provision works. No doctor i met would ever agree with this statement.
> The bet on diabetes has to happen before it is diagnosed to make actuarial analysis. If you want to guarantee that all diabetes patients get access to insulin, what you want is charity, not insurance. Insurance is risk pooling.
Yep! That's why health insurance is a misnomer. There's no guarantee my house will catch fire, so I insure against it. There is a 100% chance each and every human will catch a terminal illness. That makes it at best a structured payout program. The amount of the payout can be reduced through preventative care, and yes, maintenance drugs like insulin. That's the best case for why it should be socialized.
It's not insurance, and it's not charity, it's a service in the public interest. And of course people should have access to the medication they need to live, we're not savages.
> The science has already shown that is true. Over and underutilization of healthcare are studied effects, ones insurance companies pay very close attention to because if they don't, they will go bust. That is also why countries with free healthcare also have copays.
Insurance companies get paid in advance, and their goal is not to provide the best care but to return the largest amount possible to their shareholders. Co-pays keep people out of hospital, especially lower-income folks, which allows insurance companies to make more money. Same with high deductibles. Their goal is not care, it's profit.
The UK and Canada (the systems I know best) don't really have co-payments, certainly not like in the US. The vast majority of services are co-payment free [1] (UK: "Out-of-pocket payments for general practice are limited to some services, such as examinations for employment or insurance purposes and the provision of certificates for travel or insurance", in Ontario going to the hospital you only pay for parking or 'upgrades' like private rooms - [2], [3] is the entire fee schedule). Same with Australia [4] who in 2015 rebelled over an AU$7 co-pay. You get sick, you go to the doctor, they take care of it.
Think about it, if you could access any procedure right now, what would you get done? Nothing, because it's not fun, it's not rewarding. If it's medically necessary, you'll get it done one way or the other, if it's not, literally why are you at the hospital? Yes, use goes up a bit. IMO, that can be offset by creating clinics and guiding people to them for minor ailments as in the UK.
> I think you are have an outsider's view on how healthcare provision works. No doctor i met would ever agree with this statement.
Respectfully disagree. Both my parents are doctors, and I grew up in numerous medical systems all over the world. I've benefitted hugely from socialized medical systems and not having one right now is downright terrifying even though I'm well 'insured'.
My dad refused to work in the US because he felt the healthcare system here was inhumane. He wanted to provide people care based on their needs not what they could afford. It took me until I lived here to understand he was exactly right. There's a lot of this apologist: "there must be some reason the American system is better" -- sorry, it's just not better.
> That makes it at best a structured payout program.
This is what prepay's are, and HMO's. You have 2 opinions on HMO: they love it because pricing is transparent, they dislike it because they ration service. An example of that with Kaiser: they put severe barriers on their own mental health services.
An industry gossip for you: one of the biggest consumer of mental health services at Kaiser is Kaiser doctors.
> Insurance companies get paid in advance, and their goal is not to provide the best care but to return the largest amount possible to their shareholders...
At the same time, insurance has an interest in controlling how much the insurance is used, something governments can fail at pretty hard. Remember Medicare insurance already costs 1k per person per month. That's the socialized system america has now, and it won't be more efficient by being bigger.
> Think about it, if you could access any procedure right now, what would you get done? Nothing, because it's not fun, it's not rewarding.
This is just not the reality. It's a well studied effect, denying it is depriving the science behind policy analysis from any legitimacy.
> Respectfully disagree. Both my parents are doctors, and I grew up in numerous medical systems all over the world. I've benefitted hugely from socialized medical systems and not having one right now is downright terrifying even though I'm well 'insured'.
They told you that patients never go to the doctor for superfluous reasons? I won't believe it. I am in the industry and I can see every case imaginable.
We have had this argument before. The U.S. socializing healthcare will not bring out-of-us healthcare results. It will get something else, because what makes healthcare suck is not private vs public, it's the regulatory framework.
> This is just not the reality. It's a well studied effect, denying it is depriving the science behind policy analysis from any legitimacy.
You are correct. People do go more often, and to counter it programs exist in the UK which drive people with less severe issues to local centers where they can get looked at without taxing the hospital system to the same extent. [1] It's not that big an issue. All that and they still deliver better health outcomes for a much lower price.
FWIW the NHS actually offers free mental health services with no co-pays too [2]. It looks like it's managed via GP which is a good middle ground IMO between co-pays and unlimited fee-free access. Canada does not as a rule, though it's an active conversation [3] and has been for years -- and it enjoys a (razor thin) majority of support with 51% in favor. Psychiatry is covered today, therapy is not.
> They told you that patients never go to the doctor for superfluous reasons? I won't believe it. I am in the industry and I can see every case imaginable.
No, they told me the US healthcare system is inhumane. I may have misread your post if I wasn't replying to the right section :)
> We have had this argument before. The U.S. socializing healthcare will not bring out-of-us healthcare results. It will get something else, because what makes healthcare suck is not private vs public, it's the regulatory framework.
The US is already at the bottom of the OECD, do you have reason to believe it'll get worse? We've got a lot of models that show it'll be better and really nothing to point to that shows it'll get worse. Socialized systems are cheaper and control costs better, even here.
State run will be cheap and I'll tell you right now that cheap mental hospitals are not high value.
They are prison lite™.
It probably makes sense financially though.
I don't want to pay any premiums to help out people with asthma, multiple sclerosis, diabetes, birth defects, and so on if we are going to do this though.
I would be fine with that setup. Its pretty ridicolous to me to keep all the crazy homeless people crapping on the streets of san francisco: very low standards of care will yield fantastic results for them, and not be extended to users that can pay better care somewhere else.
This duality is most common in countries with socialized healthcare: allows for the affluent to spend more, and for everyone to have a base level. (An UBI for healthcare!)
The arguments you're making could really be applied to healthcare in general. Others have pointed out the comparisons to insulin, etc. I think you've basically made an argument for single-payer government healthcare.
However, it's really not true that the typical mental healthcare user is a chronic user. The modal number of visits per outpatient therapy client/patient is 1. Many people feel better after one visit, or decide they don't need it, or it's not worth it (some of it is probably related to availability too, to be fair--they'd like to come more but can't afford it or can't get into the therapist's schedule). You can extrapolate outward from that. Many people come for a few sessions, and then stop without any explanation because they're feeling better but don't want to have an awkward conversation about stopping.
The current zeitgeist with therapy is to taper off or terminate as soon as possible, and reinitiate as needed, at least in the US. My sense is the pendulum has swung too far in the shorter end of the spectrum, and a lot of people would benefit from more sessions, but even when they can afford it, are being cut off as soon as possible by therapists who are afraid of being seen as stringing people along. In some ways this is a good thing, but therapy length should really be dictated by need (short or long).
> The arguments you're making could really be applied to healthcare in general.
For many areas sure. Most importantly to primary care. I believe primary care should not be part of an insurance model. It's been brought to this for some good reasons and some bad reasons.
Single-payer cannot fix over-utilization. The iron triangle of healthcare: cost, quality, access. If access is unlimited, cost will go up. (Over-utilization a term commonly understood for the use of resources for very low marginal returns).
> The modal number of visits per outpatient therapy client/patient is 1
Even more sensical to make it cash pay! I would agree that cash pay in the current system probably leads to underutilization. Which is why a low(access x quality) x low(price) solution from the state would be great to help the bottom ranks and the rest can pay for it themselves.
> The current zeitgeist with therapy is to taper off or terminate as soon as possible, and reinitiate as needed, at least in the US
This brings another argument on utilization: if you look at it across cultures, it's going to be radically different. It's not something reasonable to insure against.
Long term, freeing therapy from insurance works in the favor of therapists: as a political body I would ask tax exemptions that match what insurance companies get and be on your own. (I would recommend the same strategy to primary care doctors, and they are already doing it with the DPC model).
I have a lot of criticism for the Scandinavian economic model, with 50% of the working population employed in the public sector and a >50% tax burden on average. This will be visible if someone happens to read my HN comments once in a while.
But I have to say that this purely market economic view of life-saving healthcare, concluding "there is no economically viable way to ensure that everyone has access to life-saving aid, because participation has to be voluntary and that means insurance will be prohibitably expensive" is deeply cruel. Honest question, is it broadly representative for Americans to take this view without considering the human consequences to someone who is unlucky with genetics, family or circumstances? Or is the question just ignored until a problem hits?
It's really very simple to solve this in a humane way. Government pays for all healthcare that's necessary to survive and thrive to a humanely minimum standard of care, either providing the services themselves or employing private-sector partners to do so. This is paid through taxation of everyone, spreading the cost on the entire population. Private insurance or paying for elective procedures is still an option for those who have the means and wish to do so.
There will be some upheaval because the insurance sector and treatment centers will be in a dramatically worse negotiation position, but it's worth it for the public good.
> Honest question, is it broadly representative for Americans
I don't think so, but what is unique about americans and the healthcare market is very unique sensitivity to quality and access: the idea that you could to a second rate doctor goes very contrary to american culture, but is common currency in socialized health systems, where you are numb to quality as everything has the same price.
The US has a private offering called HMO which basically covers everything, and it's had mixed results: even Michael Moore made a documentary where people said "HMO's are evil". Why? Because the idea that you have to be put on a waiting list or might be denied care you want on utilization is unthinkable for americans.
That is one cultural aspect, but there are many more that make America Health system unique.
> Government pays for all healthcare that's necessary to survive and thrive to a humanely minimum standard of care...
It's a solution. Maybe because of the above, no democrat has put it forward: it would be unpopular to tell people they will get free sub-standard, sub-access care.
This solution already exists: the VA is basically that. A very low quality service but highly effective.
I don't have much sympathy for H. insurance, but if the state wanted to abolish them, they should buy them, not outlaw them. This is so out of how America operates that I don't think it could go through the senate.
Personally, i think insurance is the last thing to look at in the space..
That's the business though. Kill, maim, and let people suffer to make more money. That's the core of every single health insurance company with every single patient for every single problem. To claim otherwise is lunacy. So why don't we have nationalized, single-payer health care? People are still claiming that they don't think the government can do a good job despite the existence of Medicare and Medicaid. People are worried about government "death squads" when private insurance "death squads" have been killing people for decades. Frankly it's fucking ridiculous at this time. Can one even call the US a "developed" country anymore with this kind of healthcare? Certainly not in my mind.
Of course they are. They're incentivized to make money, not pay it out. I'm completely baffled that people would rather this system than a universal healthcare system simply because they don't want a poor person to have insurance because they're "not pulling their weight". And that's the reason. "Hard working, red blooded Amerikans don't need anything taken away from them by them poor folk that don't wanna work!". ugh.
Yeah, this system needs to be refactored for sure. But the counter argument to universal healthcare isn't as basic as you outline. It really comes down to how do we pay for it. Healthcare costs are ridiculous, and so is our deficit. The counter argument is more in that realm, and you painting it as "they don't want a poor person to have insurance" is not helping the discussion.
I've lost three friends over the years to psychotic episodes or schizophrenic breakdowns so I've seen several examples of what happens to people and it all comes down to financial means. The friend born to a wealthy family had a safety net to fall back on. Same for the friend born to a very religious family.
As for the friend from a poor family, it was horrible to watch what everyone involved had to go through. He was a happily married man in his mid 20's. Decided to go off his meds and not tell anyone. It didn't help that he had never told us about his mental illness, but that was his choice. He snapped, left his wife and vanished for a while. When he was brought home his parents could not keep him in their house as he was prone to threaten violence. He even threatened me once during this period. Since they had no insurance they could not house him at a facility. The only thing they could do was pay for him to live in a motel, one within their abilities which meant the cheapest motel they could find, one known for drug users. My friend had previously had a problem with drugs, had to go to court mandated Narcotics Anonymous, even had a mentor to help him. Despite having cleaned up for over 10 years, here he was in a motel full of drug dealers and users while in the midst of a psychotic breakdown.
The last time I ever saw him he was having a fit in a field near a mall. I stopped to help him, he was in a fugue state thinking he was in World War 3. he smelled of urine and his clothes were a mess. I drove him to a local YMCA because I had no idea what else to do. They told me there was nothing they could do, but agreed to take him in for the day and see if they could clean him up. Knowing he was prone to violent behavior I figured that wouldn't work out.
I never saw him again. A friend of five years just evaporated. But what I saw is that if you are poor and have a mental breakdown, and your family has no means to help you, you are screwed and have no choice but to live on the street.
Hasn't suicide rates increased along with mental health coverage/therapist usage?
It seems like everyone is seeing a therapist nowadays. Why are suicide rates still increasing?
Is there any real scientific proof that therapy or mental health coverage does anything?
Why was suicide lower when nobody was using therapist? Why is it increasing now that so many people see therapist?
What's with the neverending drive to get people to take more drugs, spend more on counseling, etc? Every week there is an article about how depressed we are or how lonely we are and all the pharmaceutical or therapy that can help.
What we need to do is turn the procedures on their head--you can demand the insurance company find you an appointment with <any specialty>, they have say 30 days (to the appointment, not to respond). If they don't come up with one you can go out of network and pay no more than you would in network. Exception: If you're in a smaller place and there's only one such doc in town you're expected to go to the bigger city instead. (So you can't have one specialist setting up in an area without any such and charging an arm and a leg.) It's not the insurance company's fault if there are no providers, it is their fault if there are no in-network providers.
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[ 2.8 ms ] story [ 256 ms ] threadTo go through this system and think "well it couldn't possibly get any better than this" makes me think one's capacity for either self delusion or idiocy knows no bounds.
When the ACA was going through Congress, there were accusations of "death camps" flying around that the new healthcare system was going to round up and exterminate old people. These rumors were sometimes pushed by congressional candidates and high-level party officials.
Fast-forward to today, and you see opponents of the ACA claiming that they're trying to protect preexisting conditions coverage too, when they're absolutely not.
Our political system rewards lies and disinformation, and when a significant portion of the population believes these lies without any skepticism, then we're no longer debting rationally.
I know it's the topic under discussion, but today your statement applies to virtually everything under debate. We are in a very bad situation, that only seems to be spiralling downward, to what end is anyone's guess.
https://youtu.be/LrerNmwpzHY?t=59
The fact that it's the 21st Century, and despite all the progress of science that religion still exists, should give you pause.
Plus we have had decades of propaganda about public sector waste, that doesn't care about or ignores private sector waste.
Yep. Just look at health care and related salaries in other countries. There are many fewer people in pharmaceutical sales in the EU or in Asia. Likewise, while being a doctor is a comfortable career in EU countries, no doctor earns $400k+ per year, like some surgeons/specialists in the US do. The problems aren't unique to any specific role in the US system, they are ubiquitous.
I am generally opposed to any major health care reform that the AMA, the AHA, PhRMA, or AHIP is in favor of.
That is, the myth perpetuates the energy that permits the men running these insurance companies to make billions. All reinforced by the whimsical meth-addled pipe dream that “I could be king too, one day” of the legion of white men of lesser caste.
—Ronald Wright
Reinforced yearly, daily, and minutely by the constructs of media.
On a seriously everything including regulations have a place in civil society.
At least that's how it seems to me, and why for some people on the left, healthcare isn't the most important issue to tackle. Having humans die in agony or poverty is terrible, but having it happen to your fellow countrymen is unforgivable.
1: That's not to say there aren't exceptional people that are wealthy, just that being exceptional is not a prerequisite to being wealthy, or even becoming wealthy (but I'm sure it helps in that case).
Your life might be miserable due to poverty, but you might still view that as a preferable situation compared to another even poorer group getting the same universal benefit as you, even if that universal benefit would make both of you better off.
https://psmag.com/social-justice/taking-freedom-capitalism-d...
Lots of people don't want to pay for problems they don't have control or influence over. You don't have to be racist, just a bit myopic.
Segregation and redlining have led to people of color living in marginalized communities in "food deserts" where there are few to no fresh food options, so people that live there (who are too money-poor or time-poor to travel for groceries) have to rely on processed and shelf stable food, leading to a very poor diet and the health problems associated with it.
Just because the immediate observation isn't related to racism doesn't mean the root problem isn't racism.
I just get tired of bad faith racism interpretations.
How about small government? Maybe people are worried about turning healthcare in the U.S. into even more of a dysfunctional bureaucratic nightmare like the current VA? What about ideals like self sufficiency? Avoiding centralization of power? Wanting power over one's healthcare and the choice to go without?
No, much easier to dismiss 50% of the population as "racists" without even attempting to understand that they may have perfectly reasonable values that are contrary to your own. Ironic that your own comment is a racist stereotype.
A lot of the small government rhetoric in the present day United States is actually rooted in racism. Google Lee Atwater's n-word quote for a 1980s GOP strategist's perspective. To summarize: overt racism becomes unpopular with some of the electorate so they come up with coded language about small government and taxation to appeal to racists.
I know this might be hard to believe but some people actually believe that all of society would benefit from less government involvement in all manner of things. Calling all that racist looks like you're just trying to find an excuse to dismiss it without having to make an argument for why it won't work.
Me: A lot of the ... rhetoric
You: Calling all that racist
By pointing out this, I don't believe I called the views themselves, nor any specific adherent to the viewpoint, let alone 100% of them, racist. Just that "a lot" of the rhetoric comes from this. Which it does.
Meanwhile, did you listen to the Lee Atwater clip? Here it is: https://www.youtube.com/watch?v=AT2fsv7xt4E
This aligns pretty well with the rise of Reagan (for whom Atwater worked) and the late 20th century to present wave of "small government" politicians who somehow, shockingly, seem to rack up massive debts without a care when they are in power.
Lastly,
> you're just trying to find an excuse to dismiss it without having to make an argument for why it won't work.
Health care is the perfect such argument, actually. Look at the rest of the developed world, or even something low overhead like Medicare [which doesn't need massive advertising budgets or, say, thousands of redundant billing companies], and tell me the US private sector does a better job.
Like, take small government on a local level. You cut the city budget by a third, which part are you cutting? Do you cut the police budget? Do you cut the parks? Public transportation? Public health services? Some of those will impact communities of color more than others. So be specific and say "yes, I want to cut public transportation, recognizing that it disproportionately hits communities of color." And we can talk about that, instead of just "well small government is better".
Or what would you cut at the federal level, to have a smaller government? Housing and urban development, which again predominantly benefits communities of color? The military? The legendary farm bill?
Depending on how you rejigger the government, I'm all for a smaller one.
Cut the military down to a hundredth its size and institute medicare for all and free higher ed and you're probably still smaller than you started.
But these days, in general, there's a lot of overlap in the venn diagram of "smaller government" and "cut policies that help communities of color," and that's why people are quick to call small government republicans racist.
(That and the racism that a lot of republicans now openly display.)
So is it socially acceptable to hold any typically Republican/right leaning position without being dismissed and smeared as a racist? You don't see a problem with this unnecessarily divisive, racist, hand wavey rhetoric?
What's the point in having any kind of political discussion at all if people are just going to make the bad faith claim that any right leaning policy is a secret dog whistle?
In my personal observation, there often seems to be a lot of unaddressed anger involved in that form of extremism. I am not saying this is everybody with such a view.
But when somebody goes on a tirade that people deserve to die, go bankrupt, or be denied care to protect margins of some private sector behemoth because taxation is theft ... When the evidence suggests the public sector tends to do a pretty good job at this. Yeah, there is something a little weird going on there.
You would have more freedom in a most liberal people's idea of universal healthcare which basically amounts to "medical professional says it's necessary -- gov't pays the full amount." Does anyone, of any political leaning, really think that politicians or insurance companies -- really anyone other than the individual and their doctor -- making medical decisions is what we should strive for?
You can be insulated from the problems by somewhat by having enough privilege and money which is why it becomes a race and class issue. And it's precisely the people who are largely unaffected or benefits from these policy changes who are making them.
The people who worry about having shortages and wait-lists, or the burecratic nightmare are the people who today can pay to be at the head of the line. Everyone else already is dealing with this.
Arguably because of regulatory capture, market collusion, and lack of transparency. There's no way to prove that the system will necessarily be better under single payer, but at least under a loosely regulated free market system with transparency and antitrust regulation, competition can to some degree keep corruption in check. Contrast that with single payer which centralizes power under an already corrupt American bureocracy and is bound to legistion, which is painfully slow to change in comparison to corporations which respond to market forces.
That depends on if the patient is a woman.
/dead serious, unfortunately
In South Africa, public hospitals are terrible and private hospitals are generally good and operated as far as I understand in a similar fashion to the US counterparts.
This may suggest that our future should look like the US's present. But it is a complicated subject. To start off with, many of the doctors at public hospitals are good doctors, paid well and respected. However, by a combination of being a new nation, having diverse cultures, having a high Gini coefficient (or <insert here coefficient>), having terrible rural schools (and excellent middle and upper class schools), etcetera, our public health care is frankly terrible. The hospitals are not well stocked, you'll wait for hours, they'll amputate your leg unnecessarily.
In our scenario we have both the European "socialist" model, which worked well during South Africa's past. However, once the hospitals had to cater (and rightly so) for the full population, including poor and formerly disadvantaged, the system could not cope. So now we also have the American "money driven" model, but of course it is expensive and you have to have a medical fund or you are out.
I don't think it is a question of idealogy. It's a simple premise. There is the world of sick people (which you are lucky if you join only a few times a year). And there is the world of healthy people. The premise is that sick people need to be treated. However you get there is perhaps politics, but I see it simply as a resource and logistic problem that need to be approached with commitment and expertise.
This simple premise: to heal the sick, is how I see the early doctors that came to Africa [1].
Of course OPs topic is more complex, mental health, but my point is that idealogy is often lost on people (including myself) that have more obvious challenges in their midst. And mental health in South Africa is an even more pressing issue. [2]
[1] See for example: https://en.wikipedia.org/wiki/Albert_Schweitzer
[2] Not going to share a link since they all seem written according to rather Trumpian standards. But about 90 mental health patients died in SA in one incident in 2017 due to what can maybe be termed "bureaucratic incompetence".
For the vast majority of Americans, their only interactions with the federal government are through social security and through medicare--two of the most widely popular functions of government. Government has plenty of failures, but that's the nature of enterprise writ large.
This is largely true.
Notice how easily our government, "with the stroke of a pen", can fully fund state-sanctioned violence and institutions of violence.
And we the people have no problem with this; some of us even cheer it on; some encourage their sons and daughters to join up to these institutions of violence. Others shake the hands of those who already are a part of it, and say "thank you for your service" - in almost reverent fashion.
I'm not saying we don't need these people or those institutions - they do serve a needed purpose - but let's not pretend that need is anything but ultimately for terrible violence.
Yet - we and our government somehow has a problem fully funding things like healthcare, education, infrastructure, and a whole host of other programs, which again could be easily done, "with the stroke of a pen". But we'll hem and haw on that all day long...
...our teachers will never be thanked "for their service" in reverent fashion.
Unless of course they were veterans of those institutions of violence.
It's easy to say "it's too hard, and the government will futz it up," but "the free market" produces predatory companies pursuing profit.
The current healthcare environment is not a free market, government is involved heavily at every level. Which is the main reason it sucks.
How do you explain all of the successful socialized medicine in other countries, if government involvement = healthcare sucks?
Don't get me wrong, it's a young man's system. You pay in when you are young, so you can have it when you are old. This is clearly the UK model after WWII and why its so popular here as an idea as our sister-mother country.
Flawed? Maybe ... terrible? no.
I think rebranding it as 'care' was a real slick move by some marketeers and absorbed by the media. Every time i see the word repeated i feel like they won their little subliminal game. Recently i read someone using the words "climate disruption" instead of "climate change" which i rather liked.
https://news.ycombinator.com/newsguidelines.html
Edit: this account unfortunately has quite a history of posting like this—and we've warned you before—so I've banned it until we get some indication that you intend to follow the site guidelines in the future. We're happy to unban anyone who gives us reason to believe that they want to use HN as intended: for thoughtful, curious conversation, not political or ideological or national battle. If you'd like to commit to that, you're welcome to let us know at hn@ycombinator.com.
1. Have a mental health problem
2. Seek help for a mental health problem
This leads to insures being able to deny this, and it not seen as a negative, because it's denying something that's weak. And weakness in the USA is the ultimate sin. Homelessness/Joblessness also fall under this same belief system.
And frankly, compared to Facebook posts from Fox News or indeed any other news outlet, the "savagery" on HN is downright pleasant.
Maybe I should have told the people slamming my back into hooks repeatedly that and they would have stopped. Or the people who refused to hire me. Or the people who refuse associate with me. Maybe you should tell the associates I have who accidentally let slurs slip out of their mouth with me right in front of them. Just look at the slang internet shitheads use. "Retard" and "Autist," are super common.
Just because you're blind to the stigma out there doesn't mean it doesn't exist. Mental illness causes many problems and often the easiest way for somebody to deal with those problems is to not deal with the mentally ill person. Even if its not right. Stigma is practical. People in the developed world give a lot of lip service to how mental illness shouldn't be stigmatised I guess.
I'm curious if you believe the developed world doesn't have sexism or racism anymore.
I talked with my doctor about a referral, he essentially just said "find somebody in your network" and gave no direction. Of course, finding psychiatric care in my network was a no-go, so I ended up paying out of pocket.
Even with the diagnosis and subsequent medication prescription, the out of pocket price was $189 for 30 days for a generic medication! Only with a coupon app was the price lowered to ~$50.
It's no wonder the black market for drugs is so strong considering the barrier to entry, not just monetarily but logistically.
I don't see how this gets any better with single-payer/government funded funding routes. I don't want anyone to know what I discuss with my therapist much less a soulless corporation or the government. The avenues this could open up for oppression from corporations and/or the government sends a shiver down my spine.
> The insurer can also audit your records at any time they wish, which means they have full access to any details your therapist has, including information the therapist intentionally did not include in the claim submitted to the insurance company. Any and all information, including progress notes, which can include details about what occurred during the therapy session, is technically open to the claims specialist.
[0]: https://tampatherapy.com/2017/01/25/reasons-not-use-insuranc...
Tons of vets already avoid mental health services because it's a black mark on their career and can hinder their ability to bear arms in civilian life.
It is hard to actually manage to get help for mental health issues in the first place, but if the issue is so great, that you need to share with strangers on the Internet need that you suffer from similar FUD about the process, then it is possible that the issues are a bigger problem than you realize.
It's fine that you trust the (de facto) government. And I'm certainly not going to convince you otherwise right here. But don't casually brush off the opinions of those of us who don't.
The effective requirement to expose your permanent identity as a condition of receiving medical care is an ongoing travesty. It also is a large component of how the healthcare market is so fucked, in that it fosters extreme price discrimination.
Edit: btw, talking to strangers on the internet is a little like therapy. It's easier sometimes to talk about yourself when it's to someone you don't know.
Last issue is anxious of sitting in session after session trying to a)settle on a particular person b)tracking/having any sense of real progress.
*mainly it's all creative avoidance out of fear, I guess.. Good point re strangers on the internet. I hardly bring this up anywhere, especially not online - not sure what happened this am.
I faced my own issues with depression in my late teens and early twenties. Gun rights are very important to me, and I was extremely hesitant to speak to any mental health professional due to the potential future restrictions it might place on me. I did see someone, and over the course of a few years recovered to the point that I was able to get my life back on track - but even then, it was difficult to find a therapist that wouldn’t immediately demand that I dispose of all of my firearms. I ended up asking around and basically “interviewing” several providers before I chose one. I wasn’t suicidal and didn’t have anything resembling an urge to harm myself or others, for what it’s worth.
I still believe that seeking help may come back to haunt me one day. It’s something I’ve come to terms with and I believe I made the right decision, but I think my ability to introspect and make a rational decision in the face of my illness is... atypical.
I think it’s a consequence of the “do you have firearms in your home” questions during routine checkups. The current push for so-called “red flag” laws seems to validate the concern.
NB many think firearms are illegal in the UK. They are not! I was surprised to discover this when I moved out of London to the countryside 10 years ago. It's very difficult to get a firearms license in an urban location. But rifles and shotguns are commonplace in rural areas. Handguns have been banned since the Dunblane massacre, and semi automatics since Hungerford. But in rural areas few dispute that shotguns and rifles are legitimate tools.
[1] https://www.theguardian.com/society/2016/jun/22/uk-gun-licen...
[0] https://en.wikipedia.org/wiki/Firearms_policy_in_the_United_...
When you taught at college and had to deal with a deranged individual who eventually got himself expelled for stalking and attempted rape your opinion about gun rights changes.
I'd rather hang all the mentally ill people, then. That also would defend society if I am not mistaken. For you downvoters, I'm only making a point, I don't mean it.
You're being led by the nose down a dark path and you don't even realize it.
Around the corner from my house one early morning (around 3am?) erupted a 4-alarm fire at a neighbor's home. Several fire trucks, etc later, the fire fighters tried to enter the structure when they were shot at by someone inside. They retreated and the police (SWAT) were called.
They entered the home with the fire fighters; the person inside attempted to fire again, and was shot and killed. The fire was put out, and while I never learned all the details in the aftermath, I learned enough to know something very terrible had happened.
The person that SWAT had shot and killed was the adult son of the family who lived at the home. The parents had kept numerous firearms in the house, and the son had only been living there for a few months before this incident occurred. Prior to that, he'd be virtually homeless, struggling with bipolarism and schizophrenic issues.
These mental health issues were known to the parents and family; they had originally kicked him out of the home years prior, but let him back in trying to get him better help or something like that. But they kept their weapons in the house; at one point, IIRC, they also bought him his own weapon for his birthday.
Apparently there was some kind of an argument, based on what immediate neighbors had heard earlier in the night, but they thought things had calmed down. Unfortunately for the family, they had only started. Sometime during the night, for reasons unknown, their son decided to take one of the family's or his own weapon, shot the mother and father, then his sister, and the family dog, then set fire to the house and waited in his bedroom.
The entire family - including the dog - dead inside a few hours.
It's not known (that I really know of) if the son's mental health issues played any role in the shooting deaths of his family, but they certainly can't be discounted. It's not certain that had there not been guns in the home, if the results would be different, but I tend to think fewer deaths would have occurred.
Note - I'm liberal in my views and political leanings, I also support gun rights as well. But I think that a discussion on how to temper these rights with keeping such weapons out of the hands of potentially dangerous people needs to be had. I don't know what a good solution would be in such cases. There are many issues intertwined, that we have let become a morass in our society, which may make the issue nearly impossible to untangle.
It's the issues and problems we have surrounding mental health, and healthcare/coverage in general, the stigmas and such.
It's issues surrounding guns, our culture of violence, the rights of individuals, etc.
It's our society's tendency to seek to place blame elsewhere, and not take responsibility for our problems (we claim "self-sufficiency!" as "being American" - but forgetting the other side of that coin is also personal responsibility).
It's our weird obsession with violence; how as a culture we've deemed it more fit for people to consume as media and knowledge - almost elevating it as something aspirational, especially when it comes to the military.
Simultaneously, we've deemed sexual knowledge and media to be something shameful - at least on the one hand; yet on the very other, such knowledge and media is blatantly used to sell products - so there's this mixed message "violence ok, sex is bad, but if you want to buy something - here's sex to sell it".
Our media, our politicians, and increasingly each of us - have fostered and promote an "us vs them" dichotomy amongst the population.
All of these things - and many more - are all tangled up. They are all problems we need to solve, but like a box of Christmas lights or a bowl of spaghetti, they are hopelessly tangled up, and one can't be sorted and fixed without causin...
And yet they still were unable to prevent this tragedy. The main thing I take away is the ultimate futility of believing that top-down control can prevent tragedies if only it is given more power!
> Our media, our politicians, and increasingly each of us - have fostered and promote an "us vs them" dichotomy amongst the population.
I'm right there with you in seeing this dynamic as ultimately one of decay. In fact I think second amendment culture functions more as a crutch that enables totalitarianism. It fosters a fallacious belief that the fight for freedom is some eventual violent confrontation rather than insidious gradual creeping.
But I maintain the burden of reform is on the government - its institutions, politicians, and the media - as it is the government which is the overwhelming aggressor. An individual that eg fantasizes about defending their family from an overzealous cop isn't actually harming anyone. And tax protesters eventually get the rats on their face.
But once bureaucrats become accustomed to entrenched authority, they succumb to fallacious thinking that they are in charge, rather than servant facilitators. Even little things like all these various "user fees" need to be fully repudiated, as they are ultimately symptoms of government agencies leveraging their power-held-in-trust to generate more revenue for themselves - ultimately that same basic "go ahead and stop us" adversarial dynamic.
> while a smaller minority "fights" among each other for control, both with agendas they believe will fix everything, when the fact is, they won't fix anything - and likely will make it worse. Or at least, that's what they say about the other side.
I'm here with you as well, but I think the statement fully applies to the gun "issue" as well.
The main profiteers of mass shootings are "news" channels, and yet they continue to blamelessly fan the flames. One specific type of weapon being a little harder to get isn't going to reduce the appeal of getting on the prime time scoreboard. But it's a simplistic divisive bikeshed narrative, right up there with how other people pee, so it get focused on.
I'd call the ultimate topic that of societal mental health, from being continually bombarded by bad news. We're getting much safer, yet "so many bad things are happening". It's true we're more connected, but that is only one part of it. Most people aren't actively seeking out tragedies to bathe in the emotion of, but rather are having tragedies pushed at them because the induced panic drives their continued attention.
I don't have an answer to this, besides hoping it's merely a phase that we'll pass out of as people get numb to and check out of mass media (including mass social media). But I'll note that an assumption that a perspective is only worthwhile if it implies a straightforward answer is essentially just another way of looking at our current problems.
FTFY
If anything I would expect it to get worse, since the government has an incentive to use this in far more areas than an insurance company.
Mental health is getting worse because the economy is getting worse, simply.
By liberalism here, I mean the original (and only sensible) meaning of a system of individual freedom in social, religious, and economic spheres, equality before the law, and democratic representation, not the New Left's utter misappropriation of the term to represent tribal resentment and mob justice.
Mental health services in the "good old days" were shrouded in a thick fog of Freudian bullshit and couldn't do much for really troubled patients besides keep them warehoused and docile. Before that, they didn't really exist at all.
The feeling of a collective mental breakdown has been in the public consciousness since at least WWII. The loss of meaning and religious faith after such large-scale horror and the response in postmodern aesthetics and philosophy, the isolation beneath the surface-level perfection of the new suburbs, the invention of mass market consumerism, the constant threat of nuclear annihilation, struggle and upheaval around gender/sexuality/race, the Kennedy assassination, the Vietnam War and Nixon-era loss of faith in institutions, stagflation, you name it.
https://twitter.com/AllOnMedicare/status/1124042436345569286
Moneyed interests are pulling the levers:
https://twitter.com/mattb/status/1015270406754713600
This is damning.
IMO, it's criminal what these insurers are doing.
Also, there was a post here, I believe, about a successful therapist (in Australia, I believe) that was quitting because of the BS he was putting up with from the insurers. It was a youtube video where he laid out all the reasons. It was just heartbreaking to watch.
And sometimes you can find a good one and watch them, over the span of 5-10 years, turn from good to bad. Then you're back and in the market looking for a new person to divulge your innermost thoughts and intimate experiences to only to realize they're all actually shit now.
/endrant
A friend that has been certified mentally ill stopped taking his meds and was fantasizing about killing himself, a family member and shooting up religious organizations. His doctor, family, employer and friends all called the police, talked to lawyers, mental health professionals, etc.
The end result was that he was facing sleeping in a car that was about to repossessed, and eating in homeless shelters. At that point he decided to accept free housing in exchange for seeking help.
His family’s only other recourse would have been to pay tens of thousands of dollars in legal fees to petition the court to force the police to uphold the law. This would have had a medium to low chance of succeeding.
Of course, during the months this dragged on, he missed an insurance payment or two (he had also been fired, divorced and evicted), so it lapsed.
There is a 12 (6?) month wait to get government disability insurance to kick in for this sort of thing, and the clock starts after the mentally ill person goes in for scary interviews with the government to establish they’re actually crazy.
The law used to handle this sort of thing properly in California, but Regan repealed the lions share of it as governor, and loopholes that accidentally allowed people like my friend to get health care have been progressively closed since them.
Nurses at the intake office of the appropriate mental health facility in Santa Cruz told me that most of the homeless people in the Boardwalk area there are in exactly the same situation as my friend was in, except they’ve been trapped in it for years.
I'm not sure I see a better solution to this that doesn't come with its own set of risks and downsides (involuntary commitment or counseling of someone against their will is not something to be taken lightly in any event, even if their reality diverges from your own).
Describing psychotic delusions as 'reality diverges' is something or other, I have to say.
Of course we need to respect the rights of individuals, but it shouldn't be the case that family and friends are the first, second, third, fourth and so on interventions, there can be professional resources available.
- healthcare not linked to employment
- a housing-first homeless policy
- a compassionate aid policy that presumes that people who are asking for help need help, and starts providing help as soon as it is asked for rather than after a year or more.
Those don't seem like they have any major risks other than monetary.
Threat of homelessness is basically the only remaining lever the law allows in these situations.
The other two points are spot on.
The one place I know of where a housing-first policy has been implemented, Salt Lake City (or maybe all of Utah?), doesn't just give homeless people a set of keys. They do assign everyone a social worker at the same time. The goal is to minimize the risk of what happened to your friend; that isn't good for anyone, including the person spiraling.
It's key, though, to start with a home (and a social worker). The wealthiest country in the world can do that for its people -- and it shouldn't be on private citizens, though that was generous of you.
My ex was schizo-affective (had traits of both schizophrenia and bipolar disorder). He was on disability. His doctors did not want him living by himself. Some things were simply too stressful and he couldn't do all of it. He'd only cook instant food. He wasn't good at budgeting money. And so on. For a while after we split up, he had a social worker coming to his house for wellness checks. My friend worked a similar job for another hospital: SHe'd visit mentally ill patients and help them, sometimes shopping and whatnot.
There was no recovery for him, only meds. That's it. Only meds.
I cannot fathom how stressful it would be to have your housing and your safe space be dependent on taking your meds, especially when your meds need adjustment... and paranoia strikes up again. Every stressor simply complicates things.
In my friend’s case, he had actually set up permissions for the doctor, his family, and I to initiate such a thing, but after his episode started, he fired his doctor and was quiet for a month, which nullified the paperwork he had done to create a safety net for himself.
The law has a list of things that have to happen before the psychiatric hold if there is not such an arrangement.
Basically, the mental illness has to affect some number of life areas. I think this is the list, I might be remembering wrong:
- work - finances - shelter - self care (eating, etc) - family life / marriage.
It used to be that one thing on the list was sufficient. I think the current law is that a total of three are necessary, but not sufficient.
Risk of immediate self harm or harming others is a different path, but the person basically has to say “yes, I do plan to kill myself, or that fellow over there, officer” on camera for that to count.
Anyway, my friend ticked all six of these boxes, and that wasn’t sufficient. If the person is borderline coherent, don’t think anything really is.
(Nothing in this message should be considered medical or legal advice. Go talk to a doctor and a lawyer if you might need to know any of this stuff, especially if everyone is healthy at the moment.)
(Edit: upvoted sokoloff because this is exactly what everyone with any power to provide care says.)
We have a history of using this policy in multiple countries, and in each one the system was abused to torment and commit minorities, people (including children) who were deemed an inconvenience, and political enemies.
I say this as someone with a family member who went through a very similar experience as your friend. I know just how scary and frustrating it is, and the immense burden of care and worrying it puts on people who care about someone going through mental breakdown like that.
I wish there was a solution to this problem, but I don't know what it would look like.
Rosenhan's paper itself ("On Being Sane In Insane Places") also makes for fascinating reading and is very readable even for laypeople.
Even more interesting is those that are clearly insane who are never institutionalized. For example, not too long ago there was a man who authorized the vaporizing using nuclear bombs of two Japanese cities consisting of almost entirely civilian targets. If that's not pure insanity what is? Along with all his advisors. Yet rather than acknowledge that this man was clearly a deranged madman, the preponderance of the public celebrates him as a hero and call his critics mad. Leaving no possible conclusion other than that most of the public is mad.
What treatment is possible for madness? None that has been demonstrated. Is mental health treatment a myth? Yes. Is insanity caused by chemical imbalances in the brain? Perhaps, though there is no evidence whatsoever supporting this claim. Are those that continue to promote this hypothesis as fact insane as well? No doubt some of them are.
In so many ways, America needs to start understanding that solutions to these problems have been explored and, just possibly, greater progress achieved in other countries... progress can be gleaned by studying outcomes from those countries.
It's easy to dismiss suggestions as having "its own set of risks and downsides", but in critical areas, America is significantly underperforming other first world countries and we need to get past the Not Invented Here syndrome.
It's Indoctrinated That Anything Socialized Is For Weak Moochers And Cannot Succeed Because It's Not Capitalism syndrome.
You then provide free legal advice, and access to mental health act tribunals where people can challenge their detention.
You have independent regulators who provide some oversight, the rpess can report on it all, and of course the courts provide a final backstop.
There are problems with this, but it's pretty good.
We have short detentions for assessment. We have longer detentions for treatment. We have police powers to take someone from a public place to a place of safety for assessment. There's another police power where the police can take someone from their home to a place of safety for assessment, but only if they have a valid warrant.
Most cities & states just try to fix the symptoms of homelessness (& crime), and not the actual root of the problem. There needs to be a federal mental health program to handle this, and maybe states & cities will stop playing 'hot potato', shipping them back and forth to be someone else's problem
Reagan was elected governor over FIFTY YEARS AGO.
Why not blame Julius Caesar, or George Washington, instead?
I had to ask family for help and one by one after a time they began to resent me and abandon me. I was denied SSDI. I was denied nearly everything I applied for and buried in bureacracy. I lived abroad for a time and had a much better quality of life and access to healthcare, but I couldn't legitimize permanently (still a fantasy at times) and had to come back to the USA. I now live, and who knows for how long they will allow it, with resentful family, isolated in rural Murica with no transport or access without much more expense and effort. No insurance. Limited income based medical care. Living on 600 dollars a month from a partial pension I was fortunate to have. Hearing every day how it simply has to be my fault and treated as if I am a loser who chose and continues to choose this. I am the same person I was when I was a public servant and seen as doing good in the world, but now that I have lost my autonomy I am lower class and shamed.
There was a time when my root issues would have been addressable and I could have had a decent life, but there was no help and things got worse. There was a time I though if I could just find someone to give me the "right" job that would work around my issues I could have a survivable life, and finally a kind and caring soul did that after years of nothing, but those two buckets I mentioned above poured in and things got worse and I wasn't able to do it. Now I have no idea what if anything can save me. How is one supposed to survive since "suicide is never the answer" when you have a miserable, painful life and no realistic way to dig yourself out? I cannot magically become a citizen of a nation with social support and healthcare. I don't have the bootstraps to pull on and rebuild. I cannot endure decades more of this yet anytime I discuss it I hear "seek help" or other shallow pearls of wisdom. Hotlines and calling the police seems the default response if someone brings up the topic. Everyone feels good like they did something and pats themselves on the back. The patient might get sent to hospital and that results in tens of thousands in medical debt and a worse problem. So it goes. No real solutions happening.
In cases like mine, which are a majority of suicidal people in my experience professionally and personally, it's rooted, situational stuff (often from multiple angles) and not some primary mental illness that Prozac and CBT mitigates. It's not simply about insurance (or the lackthereof) and what it will and will not pay for. I have been to a lot of doctors in my day and not a single one has improved my quality of life, most in fact the opposite. It's about there being no willingness to solve root causes and the eventual response being victim blaming and turning a blind eye when the bandaids don't work. Until society addresses the fact that many people end up in bad situations through no fault of their own (and honestly even those to blame somehow are still human beings who deserve help and not some abstract calculations on a moral or financial ledger) and provides a safety net and path to rebuild as much life as possible (something friends have accomplished in nations with such support), you will find more and more people ch...
Godspeed.
I'm sorry, friend, but it's strikingly obvious that you're not. I hope you can be, again, someday.
Your root cause - is it loops of mental and physical pain? If so, have you by chance experimented with psychedelics for "rewiring neural pathways"?
Sorry if this has been asked of you before - just not worth missing potentially benefitting someone.
You seem highly intelligent, so I'm assuming you have explored this avenue thoroughly. But just in case not, have you investigated the immigration terms of all countries that have socialized healthcare? I was thinking there could be a chance that one would be able to give you permanent residency. Honestly, it seems as if there should be a policical asylum (no pun intended) quota for this kind of thing.
I read a local newspaper story of an American who was able to immigrated to Norway some years ago, motivated by the fact that his American insurance didn't cover a very important back operation or something like that.
If you are capable of holding a Norwegian 80% job of 40*0.8 hours per week with the 4 or 5 weeks standard holiday (probably with some local-doctor sanctioned sick leave in there), a working visa would qualify you for medical aid here immediately, and give you permanent residency after 3 years, if I read the regulations correctly. Should probably be double-checked by a local lawyer.
https://www.udi.no/en/want-to-apply/work-immigration/skilled...
Please feel free to reply if you'd like to investigate this further. I'll give you my contact information. (My profile is normaly pseudonymous due to political comments and other stuff, so the info is not in my profile).
There's no one to catch you if you fall.
It could happen to you, or your loved ones next.
Try to have some empathy, and fucking VOTE
We could vote to build more housing. Oh wait, SB50 just got rejected by the appropriations committee - which is full of non-elected government officials.
I know, we could completely re-elect all of our local government officials to shake everything up, oh wait that's the promise of our last N mayors who haven't done anything.
I'm disgruntled, if any of these points are incorrect please let me know - it's very frustrating and I feel helpless as a voter (in SF).
A year later, she said she’s still studying the proposal.
She’s happy about voting for those expanded pentagon budgets though!
Technically legal? Sure, they're the legislature, they can do whatever they want. Incredibly disappointing as a voter.
[0]: https://www.politico.com/story/2019/02/11/utah-medicaid-expa...
Except for staying in office if the voters vote them out.
The problem with mental health care is that such providers either don't exist or are very rare, meaning there is little to no effective care to be had for any amount of money. Simply throwing more money at this problem will not do anything to solve it.
On the other hand, if an individual provider can rely on getting a fee for service without crazy overheads of private insurance approvals/unapprovals, then they can make a business commitment to supplying that service. This costs far less overall when you don't have to price risk and extra work into the service rendered.
As I responded to your sibling commenter, I don't think my original point was clear. I'm asserting that those existing provider services suck and are ineffective, and that what is needed is a paradigm shift in how mental health care is formulated and delivered, not a spread of those existing services.
The funding societally is so poor now that the common end path is people ending up in prison. And, as the article indicates, it's not like the private insurance companies are picking up the expenditure.
My solution is to introduce salary caps. So that NGO's cannot compensate any employee more than some modest amount. Bonus if the state or local gov could give people tax breaks (fed would never go for this) for working on an NGO. So, say a lawyer or accountant could take a few months off their high-stress, white-collar job and work for an NGO for part of the year, make enough for rent, reduce their tax bill, reduce their stress levels for a while, and help the community, then go back to "real" work.
Sounds like what ever metric is used to determine these are good people to elect is broken and needs to be adjusted.
It is a sort of prisoner's dilemma, and while you can say you will choose to do what you think is the right thing regardless of cost, you will find that most people will only follow that so far (though they will not likely admit it to avoid the social damage admitting such will do).
In the cat analogy, not offering services is just pretending the cats don't exist thus solving the problem once and for all. The cats are still there and so are all the negative consequences associated with a large population of feral cats. This is sorta head-in-the-sand thinking, right? The problem needs to be solved nation-wide.
In the cat analogy, you are correct because other cities won't go about shipping their stray cats to you (if they round them up they will just kill them). But there has already been numerous cases of cities sending homeless people to other areas. This is where the hungry cat/homeless analogy breaks down.
It's worth noting in relevance, because the politics in Healthcare reflect the policy of public opinion as well as legislation around other tangent issues our country is trying to reconcile what it wants to do (if anything) about it.
What definition for suicide does the US use?
What definition for suicide does Japan use?
EDIT: and you don't have anything like half the rate. Comparing across countries is hard, but Japan has a rate of about 17 per 100,000 while the US has a rate of about 14 per 100,000.
Again, this is simply a "what if", please don't go all HN on me. tia
Edit: missed a word.
To be fair, most healthcare doesn't. Primary care being part of insurance is ridicolous.
It’s the cheapest to provide and saves a lot of “downstream” costs
It is also bad for the pcp to be so transactional with insurance: it should be a relationship, which is proven to give better medical outcomes..
1) resource utilization 2) long term cost-effective value
A therapist can induce infinite demand on a patient, by just doing follow-up sessions ad-infinitum. In argentina for example, people go to the same therapist for decades!!
This means that the insurance model doesn't work well, because you can't do actuarial analysis on how much therapy someone might need and how to distribute that in the population.
The second part is that as a patient, if the insurance covers your cost, you might as well go to the most expensive therapist you can find, and consume the infinitely. Also, you know more than the insurance company if you plan on using or needing this care, thus you have a very strong adverse-selection situation going on with any plan that is generous on mental health.
Economically speaking, mental health should not be part of an insurance scheme. It should be cash pay. To help people that could not afford mental health and they need it, you would do better to provide state-run service, that is low-cost high-effective-value and cover the lower side of the population.
People can have mental health needs that can be improved or resolved in a finite time frame. They might have a difficult life event for example.
People can also have non-mental issues that are chronic and require lifelong attention—diabetes for example.
Also, mental health is not particularly expensive to treat itself: why put the insurance company in the middle. Pay the provider directly..
I wonder if the market offers a low cost health insurance from the moment a person is born dedicated to chronic diseases. I know life-insurance does ,and rather cheaply.
You know people who take insulin are on it for the rest of their lives, but that doesn't make it the fault of their doctors.
Therapy actually works. "Hundreds of studies have found that psychotherapy is an effective way to help people make positive changes in their lives," Nordal says. "Compared with medication, psychotherapy has fewer side effects and lower instances of relapse when discontinued." [1]
> The second part is that as a patient, if the insurance covers your cost, you might as well go to the most expensive therapist you can find, and consume the infinitely. Also, you know more than the insurance company if you plan on using or needing this care, thus you have a very strong adverse-selection situation going on with any plan that is generous on mental health.
This is a very strange American perspective on health care. If it was suddenly available to everyone, there's a perception that we'd all be like kids in the candy store getting 1 of everything at the doctors office. That's just not how it works. Nobody in Canada goes to their GP and asks for the immunotherapy and a few casts. People go to doctors because they're sick, and they need treatment and would rather be literally anywhere else.
It's not as though we're socializing the electronics section at Best Buy.
> Economically speaking, mental health should not be part of an insurance scheme. It should be cash pay. To help people that could not afford mental health and they need it, you would do better to provide state-run service, that is low-cost high-effective-value and cover the lower side of the population.
Sold, but it should cover everyone.
[1] https://www.apa.org/monitor/2013/02/therapist
The bet on diabetes has to happen before it is diagnosed to make actuarial analysis. If you want to guarantee that all diabetes patients get access to insulin, what you want is charity, not insurance.
Insurance is risk pooling.
> This is a very strange American perspective on health care. If it was suddenly available to everyone, there's a perception that we'd all be like kids in the candy store getting 1 of everything at the doctors office
The science has already shown that is true. Over and underutilization of healthcare are studied effects, ones insurance companies pay very close attention to because if they don't, they will go bust. That is also why countries with free healthcare also have copays.
> People go to doctors because they're sick, and they need treatment and would rather be literally anywhere else.
I think you are have an outsider's view on how healthcare provision works. No doctor i met would ever agree with this statement.
Yep! That's why health insurance is a misnomer. There's no guarantee my house will catch fire, so I insure against it. There is a 100% chance each and every human will catch a terminal illness. That makes it at best a structured payout program. The amount of the payout can be reduced through preventative care, and yes, maintenance drugs like insulin. That's the best case for why it should be socialized.
It's not insurance, and it's not charity, it's a service in the public interest. And of course people should have access to the medication they need to live, we're not savages.
> The science has already shown that is true. Over and underutilization of healthcare are studied effects, ones insurance companies pay very close attention to because if they don't, they will go bust. That is also why countries with free healthcare also have copays.
Insurance companies get paid in advance, and their goal is not to provide the best care but to return the largest amount possible to their shareholders. Co-pays keep people out of hospital, especially lower-income folks, which allows insurance companies to make more money. Same with high deductibles. Their goal is not care, it's profit.
The UK and Canada (the systems I know best) don't really have co-payments, certainly not like in the US. The vast majority of services are co-payment free [1] (UK: "Out-of-pocket payments for general practice are limited to some services, such as examinations for employment or insurance purposes and the provision of certificates for travel or insurance", in Ontario going to the hospital you only pay for parking or 'upgrades' like private rooms - [2], [3] is the entire fee schedule). Same with Australia [4] who in 2015 rebelled over an AU$7 co-pay. You get sick, you go to the doctor, they take care of it.
Think about it, if you could access any procedure right now, what would you get done? Nothing, because it's not fun, it's not rewarding. If it's medically necessary, you'll get it done one way or the other, if it's not, literally why are you at the hospital? Yes, use goes up a bit. IMO, that can be offset by creating clinics and guiding people to them for minor ailments as in the UK.
> I think you are have an outsider's view on how healthcare provision works. No doctor i met would ever agree with this statement.
Respectfully disagree. Both my parents are doctors, and I grew up in numerous medical systems all over the world. I've benefitted hugely from socialized medical systems and not having one right now is downright terrifying even though I'm well 'insured'.
My dad refused to work in the US because he felt the healthcare system here was inhumane. He wanted to provide people care based on their needs not what they could afford. It took me until I lived here to understand he was exactly right. There's a lot of this apologist: "there must be some reason the American system is better" -- sorry, it's just not better.
[1] https://international.commonwealthfund.org/countries/england...
[2] https://www.qch.on.ca/hospitalcharges
[3] https://www.qch.on.ca/uploads/Finance/Hospital%20fees%20Webs...
[4] h...
This is what prepay's are, and HMO's. You have 2 opinions on HMO: they love it because pricing is transparent, they dislike it because they ration service. An example of that with Kaiser: they put severe barriers on their own mental health services. An industry gossip for you: one of the biggest consumer of mental health services at Kaiser is Kaiser doctors.
> Insurance companies get paid in advance, and their goal is not to provide the best care but to return the largest amount possible to their shareholders...
At the same time, insurance has an interest in controlling how much the insurance is used, something governments can fail at pretty hard. Remember Medicare insurance already costs 1k per person per month. That's the socialized system america has now, and it won't be more efficient by being bigger.
> Think about it, if you could access any procedure right now, what would you get done? Nothing, because it's not fun, it's not rewarding.
This is just not the reality. It's a well studied effect, denying it is depriving the science behind policy analysis from any legitimacy.
> Respectfully disagree. Both my parents are doctors, and I grew up in numerous medical systems all over the world. I've benefitted hugely from socialized medical systems and not having one right now is downright terrifying even though I'm well 'insured'.
They told you that patients never go to the doctor for superfluous reasons? I won't believe it. I am in the industry and I can see every case imaginable.
We have had this argument before. The U.S. socializing healthcare will not bring out-of-us healthcare results. It will get something else, because what makes healthcare suck is not private vs public, it's the regulatory framework.
You are correct. People do go more often, and to counter it programs exist in the UK which drive people with less severe issues to local centers where they can get looked at without taxing the hospital system to the same extent. [1] It's not that big an issue. All that and they still deliver better health outcomes for a much lower price.
FWIW the NHS actually offers free mental health services with no co-pays too [2]. It looks like it's managed via GP which is a good middle ground IMO between co-pays and unlimited fee-free access. Canada does not as a rule, though it's an active conversation [3] and has been for years -- and it enjoys a (razor thin) majority of support with 51% in favor. Psychiatry is covered today, therapy is not.
> They told you that patients never go to the doctor for superfluous reasons? I won't believe it. I am in the industry and I can see every case imaginable.
No, they told me the US healthcare system is inhumane. I may have misread your post if I wasn't replying to the right section :)
> We have had this argument before. The U.S. socializing healthcare will not bring out-of-us healthcare results. It will get something else, because what makes healthcare suck is not private vs public, it's the regulatory framework.
The US is already at the bottom of the OECD, do you have reason to believe it'll get worse? We've got a lot of models that show it'll be better and really nothing to point to that shows it'll get worse. Socialized systems are cheaper and control costs better, even here.
[1] https://www.newdevonccg.nhs.uk/file/?rid=109734
[2] https://www.nhs.uk/using-the-nhs/nhs-services/mental-health-...
[3] https://globalnews.ca/news/5276022/canadians-mental-health-s...
It probably makes sense financially though.
I don't want to pay any premiums to help out people with asthma, multiple sclerosis, diabetes, birth defects, and so on if we are going to do this though.
This duality is most common in countries with socialized healthcare: allows for the affluent to spend more, and for everyone to have a base level. (An UBI for healthcare!)
The arguments you're making could really be applied to healthcare in general. Others have pointed out the comparisons to insulin, etc. I think you've basically made an argument for single-payer government healthcare.
However, it's really not true that the typical mental healthcare user is a chronic user. The modal number of visits per outpatient therapy client/patient is 1. Many people feel better after one visit, or decide they don't need it, or it's not worth it (some of it is probably related to availability too, to be fair--they'd like to come more but can't afford it or can't get into the therapist's schedule). You can extrapolate outward from that. Many people come for a few sessions, and then stop without any explanation because they're feeling better but don't want to have an awkward conversation about stopping.
The current zeitgeist with therapy is to taper off or terminate as soon as possible, and reinitiate as needed, at least in the US. My sense is the pendulum has swung too far in the shorter end of the spectrum, and a lot of people would benefit from more sessions, but even when they can afford it, are being cut off as soon as possible by therapists who are afraid of being seen as stringing people along. In some ways this is a good thing, but therapy length should really be dictated by need (short or long).
For many areas sure. Most importantly to primary care. I believe primary care should not be part of an insurance model. It's been brought to this for some good reasons and some bad reasons.
Single-payer cannot fix over-utilization. The iron triangle of healthcare: cost, quality, access. If access is unlimited, cost will go up. (Over-utilization a term commonly understood for the use of resources for very low marginal returns).
> The modal number of visits per outpatient therapy client/patient is 1
Even more sensical to make it cash pay! I would agree that cash pay in the current system probably leads to underutilization. Which is why a low(access x quality) x low(price) solution from the state would be great to help the bottom ranks and the rest can pay for it themselves.
> The current zeitgeist with therapy is to taper off or terminate as soon as possible, and reinitiate as needed, at least in the US
This brings another argument on utilization: if you look at it across cultures, it's going to be radically different. It's not something reasonable to insure against.
Long term, freeing therapy from insurance works in the favor of therapists: as a political body I would ask tax exemptions that match what insurance companies get and be on your own. (I would recommend the same strategy to primary care doctors, and they are already doing it with the DPC model).
But I have to say that this purely market economic view of life-saving healthcare, concluding "there is no economically viable way to ensure that everyone has access to life-saving aid, because participation has to be voluntary and that means insurance will be prohibitably expensive" is deeply cruel. Honest question, is it broadly representative for Americans to take this view without considering the human consequences to someone who is unlucky with genetics, family or circumstances? Or is the question just ignored until a problem hits?
It's really very simple to solve this in a humane way. Government pays for all healthcare that's necessary to survive and thrive to a humanely minimum standard of care, either providing the services themselves or employing private-sector partners to do so. This is paid through taxation of everyone, spreading the cost on the entire population. Private insurance or paying for elective procedures is still an option for those who have the means and wish to do so.
There will be some upheaval because the insurance sector and treatment centers will be in a dramatically worse negotiation position, but it's worth it for the public good.
I don't think so, but what is unique about americans and the healthcare market is very unique sensitivity to quality and access: the idea that you could to a second rate doctor goes very contrary to american culture, but is common currency in socialized health systems, where you are numb to quality as everything has the same price. The US has a private offering called HMO which basically covers everything, and it's had mixed results: even Michael Moore made a documentary where people said "HMO's are evil". Why? Because the idea that you have to be put on a waiting list or might be denied care you want on utilization is unthinkable for americans.
That is one cultural aspect, but there are many more that make America Health system unique.
> Government pays for all healthcare that's necessary to survive and thrive to a humanely minimum standard of care...
It's a solution. Maybe because of the above, no democrat has put it forward: it would be unpopular to tell people they will get free sub-standard, sub-access care. This solution already exists: the VA is basically that. A very low quality service but highly effective.
I don't have much sympathy for H. insurance, but if the state wanted to abolish them, they should buy them, not outlaw them. This is so out of how America operates that I don't think it could go through the senate.
Personally, i think insurance is the last thing to look at in the space..
Then I sure wish people didn't say that if they don't mean it.
As for the friend from a poor family, it was horrible to watch what everyone involved had to go through. He was a happily married man in his mid 20's. Decided to go off his meds and not tell anyone. It didn't help that he had never told us about his mental illness, but that was his choice. He snapped, left his wife and vanished for a while. When he was brought home his parents could not keep him in their house as he was prone to threaten violence. He even threatened me once during this period. Since they had no insurance they could not house him at a facility. The only thing they could do was pay for him to live in a motel, one within their abilities which meant the cheapest motel they could find, one known for drug users. My friend had previously had a problem with drugs, had to go to court mandated Narcotics Anonymous, even had a mentor to help him. Despite having cleaned up for over 10 years, here he was in a motel full of drug dealers and users while in the midst of a psychotic breakdown.
The last time I ever saw him he was having a fit in a field near a mall. I stopped to help him, he was in a fugue state thinking he was in World War 3. he smelled of urine and his clothes were a mess. I drove him to a local YMCA because I had no idea what else to do. They told me there was nothing they could do, but agreed to take him in for the day and see if they could clean him up. Knowing he was prone to violent behavior I figured that wouldn't work out.
I never saw him again. A friend of five years just evaporated. But what I saw is that if you are poor and have a mental breakdown, and your family has no means to help you, you are screwed and have no choice but to live on the street.
It seems like everyone is seeing a therapist nowadays. Why are suicide rates still increasing?
Is there any real scientific proof that therapy or mental health coverage does anything?
Why was suicide lower when nobody was using therapist? Why is it increasing now that so many people see therapist?
What's with the neverending drive to get people to take more drugs, spend more on counseling, etc? Every week there is an article about how depressed we are or how lonely we are and all the pharmaceutical or therapy that can help.