Not Just Guns – It’s Mental Health Too

Gun enthusiasts have been quick to come down hard on the nation’s failure to provide adequate mental health care to those who need it most.  They are absolutely right.  We are lousy at it, and not just for those who need it most.  Mental illness needs to be addressed on a much broader scale than that. 
Years ago we closed down most of our state run mental hospitals, our insane asylums, because they were inhuman.  Many were.  We said that the mentally ill could be treated at the community level more effectively, at less cost and with more dignity.  That was true, but we never did it.  Moreover, mental illness has retained it’s patina of something sufficiently embarrassing to the rest of us that it must be kept in the closet, under the rug, locked in the basement, anywhere but admitted in decent society.
The past few decades have provided us with some extraordinary medicines that do amazing things to relieve the symptoms of mental illness, but prescribing them has fallen mostly to primary care givers who are not well trained in their use.  What choice do they have?  In our community we have only one psychiatrist in private practice.  The Yellow Pages list a slug of therapists of varying qualification.  At least, for the most part, they do no harm, and maybe some good.  So it’s the primary care physician who doles out the pills, and for goodness sake don’t ever suggest that mom or dad’s little helper has anything to do with mental illness.
As for those with serious mental illness, I have to give credit to the ones who have learned to cope with their psychoses most of the time.  Street drugs and alcohol help dull the pain, even if they make the psychosis worse.  It’s a deadly trap.  Homelessness is not that bad if you’ve got it figured out.  Holding a job is impossible, but one can learn to ignore the “pick yourself up and get a job you lazy bum” jibes from more decent people.  
We have two ways of helping them.  If they are crazy enough when they come into the ER, our Crisis Response Team can usually, but not always, find a bed for them in a city over a hundred miles away.  It’ll be a short stay, just long enough to detox and work on a new regimen of meds.  Acting out more often becomes a crime, and it’s off to jail, our number one mental health warehouse in the county. 
I don’t know what’s going on in your community.  In ours we are finally beginning to address our needs.  Both hospitals and several other agencies have a task force working on identifying our most pressing mental health issues.  The United Way has it’s own task force, and will dedicate as much as a third of it’s funding next year to a targeted mental health project.  The county will soon be receiving a small percentage of certain sales tax revenue dedicated to mental health.  All are working together to coordinate for significant impact on projects yet to be identified, but with intent to begin funding them by the spring of 2013.
In the meantime, one of our hospitals is about to offer the third in a continuing series of symposia aimed at helping physicians, nurses, hospital staff, pastors and other care givers improve the skills needed to attend to the emotional well being of others and themselves.  Another group has conducted two community wide workshops on the impact of Adverse Childhood Experiences (ACES) on emotional health and behavior.  The long standing work of other organizations that have for years helped dysfunctional families and abused spouses are getting more widely recognized.  It’s a start.  Not a very big one, but a start just the same. 

A Response to David Rose

David Rose, professor of economics at the University of Missouri, writing in today’s Christian Science Monitor, wants to chuck the entire health care system as we know it or have proposed it to be. He would replace it with a simple system in which every citizen would receive a health care voucher which would be used to buy what? He doesn’t say. It’s what I call a cute idea. It’s cute because it is both attractive and naïve.

I agree that the current non-system is needlessly complex and inefficient, and that the bills currently before congress offer only marginal improvement. But his proposal is a little like the various tax simplification schemes that come up now and then. The legislative process, by its very nature, is incapable of producing a simple product. That’s not because legislators are incompetent. It’s because public and private interest groups will always lobby to tweak a simple idea to provide for some special advantage of value to them. It’s crazy to rail against the “special interests” because you and I are part of those interests in one way or another by virtue of our age, sex, occupation, location, or particular interests. That’s life in a democracy. If you want simplicity move to a dictatorship.

Rose’s objection to the current legislation is based on his understanding of the fallacy of composition in which an advantageous change in one part of a system does not equate to an equal advantageous change in the whole system. He gives two examples, one good and one bad. The good one has to do with baseball team batting averages. If one team improves its overall average it will likely win more games, but if every team does likewise there is no advantage and any change in winning will have to be due to something else. The bad one has to do with a pencil manufacturer, and it is this example he uses with regard to the health care debate. He writes:

Suppose, for example, that a pencilmaker sells one pencil per month to 10 separate buyers. Each pencil costs $1 to make and overhead is $10. The pencilmaker needs at least $20 in revenue per month to stay in business, so the average price per pencil must be at least $2.

Now suppose some buyers form a cooperative and use their newfound market power to negotiate a price below $2. To continue generating $20 in revenue, the pencilmaker must now charge the remaining buyers more than $2 because overhead has to be paid by someone.

If the remaining buyers also form a cooperative they may to able to negotiate the pencil price back down to $2, but only if pencil buyers in the first cooperative experience a price increase. Once everyone is large, the advantage of being large disappears.

That, he says, is why the co-op and public option health care schemes will not work. The problem is that his example assumes that the pencil company is both efficient and honest, and that there are no other pencil companies. My take is that the current non-system is neither efficient nor honest, and that a “robust” public option, or perhaps co-ops, would go a long way toward changing that. Detractors assume that nothing the government does or sponsors can be efficient or honest, and, therefore, why go down that road. It’s the old Peggy Noonan line that government is not part of the solution, it is part of the problem. My logical and fact based response: Fiddlesticks!

I Don’t Want Government Messing With My Health Care!

“I don’t want the government messing around with my health care.” That’s the most reasonable of the rallying cries against health care reform legislation. Oddly enough, it frequently comes from those covered by Medicare, which is most curious. But yesterday I was thinking about government messing around with health care from a different point of view. In our community, as in many others, government already messes around with health care through the provision of emergency medical services.

More than half of our fire department personnel are paramedics fully trained to provide the best in on-the-scene emergency medical care. I thought about that yesterday because in our small city we had a lot of afternoon calls. Two were bee stings resulting in anaphylactic shock. A small child fell from a horse and was unconscious. Someone with a back problem could not move. Another had a heart attack. A motorcycle accident victim was badly torn up. Skilled paramedics treated each one of them at the scene. On top of that, we had number of transfers to larger hospitals in places like Seattle and Spokane. The department’s front line ambulances are go anywhere rigs fully equipped for everything up to, God forbid it, minor surgery. All the up front costs were paid for by taxpayers. Insurance will reimburse the city for a lot of it, but not all.

I suppose we could get government out of messing with our medical care and go back to the days when I was young. Then I was among the first responders with nothing more than basic first-aid, and the privately owned ambulance was just a white hearse whose driver didn’t know any more than I did.

Tea Party Invitations

What an interesting day! I seem to be on a Tea Party e-mail list and have received invitations to attend Town Hall meetings with members of congress in Grand Junction, CO and El Dorado, AR. Both invitations emphasize that HR 3200 would enable massive federal tax subsidies for abortions and demand that members of congress who have not been listening will be forced to listen now. I’ll say this for them, they have thoroughly read and learned well from Saul Alinsky (that nasty old South-side Chicago Socialist), and they just might pull off killing this legislation. It will be a shameful moment and drive America further toward becoming a former great power, but they will have won.

Town Halls and Health Care

I’ve been watching the news clips featuring the rampages at some Democratic town hall meetings. I also watched the Rachel Maddow interview with Tim Phillips, president of Americans for Prosperity, one of the leading organizers of opposition to health care reform. Two things struck me.

First, Mr. Phillips is quite proud of his organizing skills, and unabashedly asserts the evils of health care reform without the slightest embarrassment at the falsehoods used to make his argument. Claiming, without fear of contradiction, that the Democrats are out to ration health care, deny treatment, increase costs, mandate government care, put a bureaucrat between you and your doctor and so on, his self confidence is both impressive and, for some, persuasive. One is inclined to be speechless in the face of the brazenness of it all.

Second, I don’t think it took much organizing to turn out the hysterically anti health care reform zealots to try to shut down any form of democratic assembly at Democratic Town Halls. These are people who are truly scared, but of what? I suspect they are the same ones who participate in tea bag parties, believe that Obama is not an American and are certain that the federal government wants to kill the elderly. They believe that “their America” is being taken away from them. The elderly among them railing against government health care insurance are happy they are on Medicare and have no idea what a contradiction that is. Those who claim to be happy as can be with our current health care system are like persons content with oppression because they have never known freedom from it. Those who are frightened that the Constitution is under threat by the Obama administration seem to have no recognition of the damage done to it by the Bush-Cheney gang and how close we came to De facto dictatorship. There is no more deadly threat to democracy than ignorance combined with a generous proportion of fear, and these are truly frightened people, but frightened of what?

Are they afraid of a “black” man in the White House? I’m not sure it can be reduced to something that simple, and yet I believe it does strike at the truth. A huge population shift that brings people of color and non-European ethnic heritage into positions of power and influence is threatening to those who never questioned their own exclusive right to power and influence. Or, having little of either, never questioned their superiority over those others who are not like them.

As one of my very conservative friends said the other day, “Everything I’ve feared about this president has come to pass; it’s even worse than I thought.” What is it that he feared? A recovery plan that prevented a depression and is slowly leading us out of the worst recession in history? Renewed respect for America in the community of nations? More support for troops in harms way and assistance to returning veterans? An effort to reduce costs and increase options for health care? Tax reductions for the middle classes? No, to the contrary, all of these things are seen as nothing more than cleverly designed camouflage for the real agenda of turning us into a socialist state ruled by people who are not like us.

I feel sorry for these people. I know that the fear they have is genuine and raises their anxiety levels of astronomical heights. On the other hand, if their fear is allowed to dictate public policy we will all be the losers.

A Few Thoughts on Congress

I just can’t figure out my member of congress (WA 5), a conservative Republican by the name of Cathy McMorris Rodgers who is attractive, charming and a whiz at constituent services. The first two attributes are always helpful to any politician, although they have little substantive value. The third is the key to staying in office. When she first ran for office she made it clear that she was a Christian candidate who would represent Christian values within the context of a conventional conservative mindset. Now in her third term and rising in the leadership ranks, she has become something of a hard line right-winger, and her position on the issues of the day bear little resemblance to anything Jesus did or taught. Moreover, she opposed every economic recovery proposal, is a leader in stopping any kind of legitimate health care reform, and has appeared on television encouraging the ‘birthers’ and the ‘deathers.’ She has left the conservative main-stream shifted to the fringe.

What the district needs is a Democratic Party able to put forth a candidate strong enough to make a decent race of it, but that has not happened and is not likely to happen. Without credible electoral opposition, the natural tendency of elected representatives who have an inclination to be extremely liberal or extremely conservative is to drift farther and farther toward the fringe, and that is not healthy for our democracy.

Health Care Hopes?

I’ve been in a conversation about health care over at Allan B. Bevere’s place. That, combined with driving today for a couple of hundred miles listening to a bit of this and that talk radio, has been an enlightening experience. There is genuine fear out there that America is spending itself into bankruptcy, and the most serious threat is anything the president has proposed about health care reform. There seems to be no recognition that our health care costs are the highest in the developed world at 17% of GDP, as opposed to a range of 8% to 11% for other nations. For that we get the least comprehensive coverage, an excessive waste factor due to high insurance company overhead, endless delays and bickering over what is and is not covered, and plenty of room for fraud.

Critics trot out an entire menagerie of horror stories about delays in treatment and surgery, sloppy medicine and bureaucratic bungling in nations with socialized health care, and all of them are true. Which is why we are not interested in having those kinds of systems. What they fail to mention is the over abundance of stories just like that and worse that populate our own health care system.

There is an absolute conviction that any federal government program is, by definition, wasteful, inefficient, bloated with bureaucracy, and detrimental to individual freedom. Is that true? As it turns out, at least according to several government and industry sources, private insurance company overhead in 2004 as a percent of all health insurance payments was about 14%. That’s compared to around 2%-5% for Medicare (You can look this stuff up for yourself on the web; it’s all easy to find.) I’m sure there is a lot of fudge factor in these numbers, and one has to be careful that apples and oranges are separated, but it’s hard to believe that a thorough audit could eliminate a nine-point spread.

Right now congress is debating how to craft a health care reform bill and pay for it, and it’s going to be rough. Paying for it is a budgetary issue that cannot take into account whether the nation as a whole can lower its total health care costs as a percent of GDP. It can be concerned only with the effect on the federal budget. Moreover, congress is loathe to do anything to curb insurance company excesses, and will probably end up with some addition to our current Rube Goldberg contraption providing second rate coverage for many of the uninsured without changing anything else. Conservatives will gloat that they stopped socialized medicine, but they will have done so at an enormous cost to human suffering and waste. If that’s the case I hope the president vetoes it and tells them to start over.