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The Real Costs of Not Having Universal Health Care

Have you read the news lately? There was a mother who killed her child and then herself in Sugar Land, TX. Another woman in San Antonio, TX decapitated her newborn son and ate his body parts. Both had a serious and untreated mental illness. The Sugarland, TX woman had bipolar disorder and the San Antonio, TX woman has schizophrenia and postpartum psychosis. (http://www.google.com/hostednews/ap/article/ALeqM5j65NeeVH5ihfMyvu7qiBZWQBV-kgD99OBR5O0) Both fell through the cracks in our for-profit health system.

I hate to pick on Texas, because this is a national problem. According to the Bazelton Mental Health Law Center, in 2006, the US Department of Justice found that 43% of jail inmates and 32% of prison inmates had symptoms of mental illness. Only about 23% of them had been treated in the year before their arrest. Recidivism rates were high: 64% of released inmates with mental illnesses were rearrested and 48% were hospitalized after 18 months. It is estimated as many as 80% of those on death row have a serious and chronic untreated mental illness. Many people with mental illnesses unwittingly wind up as victims or perpetrators of crimes. They often do not receive the quality health care they deserve that may make the difference between leading a productive life and landing in a cell. All too often, our for-profit health care system often dispenses care in accordance with a person’s ability to pay rather than in the best interests of that person’s health.

Otty Sanchez the San Antonio, TX woman was released 9 days earlier from a hospital that deemed her not a threat to herself or others. I have to seriously wonder whether the type of insurance she had was taken into consideration in her release, which frequently happens in psychiatric emergency rooms across the country. Many with chronic and severe illnesses like schizophrenia are customarily medicated and sent out the door, a phenomenon recognized as the revolving door syndrome for hospital. The conversations between the doctor and patient are centered around medications, rather than deeper life issues, which may reveal the patient's more intimate psychological state of mind. Certain insurance plans allows a certain number of inpatient hospital stays. Though I can't comment on the particulars of her case, it's not unusual for some hospital administrations to limit inpatient hospitalizations and paper process the uninsured out as soon as possible because of budget constraints on charity care. I don’t know what kind of insurance plan Ms. Sanchez had; nevertheless, Ms. Sanchez has full health care coverage now -- probably for life -- because she’s sitting in a San Antonio jail for killing and eating her 4-week old son. By law, inmates are entitled to completely free health care coverage using taxpayer dollars, but innocent people are not. It's ironic because quality psychological care just a week before could have prevented her from committing such a senseless and heinous crime. You might say that our system needs to be treated for its insanity all its own.

Republicans argue that the cost of an universal health care system is too costly and that the rich will have to bear more than their share. But we as a society already bear the costs of untreated mental illnesses in the form of dead bodies, tragically wasted lives,  and millions of dollars into our very ineffective criminal justice system – ineffective because it does not mete out justice for those are suffering from a mental illness. Many convicts with mental illnesses are victims of their own symptoms; many people with chronic and serious mental illnesses become indigent as a result of not receiving care. As they become increasingly more needy of health care, they are less likely to be in a state of mind to be employable and to afford health insurance. I am convinced whatever costs we have to bear to implement a universal health care plan, we will save in the number of inmates we will not have to house. It costs something like $40-80,000/year to house inmates – to give 3 meals/day, recess, medical care, free college education and a roof over their head. I don't know the exact costs of prosecuting a crime are, but I imagine that, too, must cost a fortune in taxpayer dollars because a single court case generates work for judges, attorneys, police departments and clerks, not to mention the mountains of administrative paperwork -- all because someone didn't get that inpatient hospitalization that they should have. Do the math. Figuring that nearly a quarter of our prison and jail population probably would not end up there if they had access to quality mental health care, medical expenses which would likely cost a lot less than $40,000/year, it would be more cost effective to implement an universal health care system, a system that serves based on need rather than the ability to pay, than to prosecute people who commit crimes as a result of suffering from a treatable medical condition.

Some figures I’ve read say that it costs taxpayers $80,000 to house a convicted felon in a maximum security prison. That’s more than what the average American earns. But if a person with mental illness does not commit a crime and suffers alone and in silence, nobody cares and they cannot have access to healthcare. Why can’t we use that money to intervene BEFORE they end up committing crimes and engaging in violent acts? Mind you, the majority of people with mental illness are not violent, but due to the decompensation that happens when the person does not have treatment, by treatment I mean people who care and see that person gets their needs met, he or she experiences a downward spiral that often debilitates that person’s ability to manage daily life. That’s what a universal health care system would, theoretically do – provide quality treatment in the best interests of a person’s health regardless of their ability to pay and meaningful preventive early intervention – way before the illness becomes a disability and way before the person loses their job, their family, their financial security and their last thread of hope.

While mental illness can disable, it does not have to be debilitating. Many people with mental illnesses lead highly productive,and in general successful lives. However, there are some with psychiatric disabilities who rely on Social Security Disability Insurance (SSDI) to live on. It is a safety net for people with disabilities and includes Medicaid coverage; however, of these, many who recover from their disability and can work choose to continue to collect SSDI because they cannot afford to lose their health insurance benefits. People with psychiatric disabilities, in particular, frequently have expensive medications and other benefits, that would not necessarily be a part of a private group insurance plan. I’m convinced that many people on SSDI who would like to work would go off Disability Insurance the minute that health care coverage becomes an universal reality. The subject of my documentary film (www.amongourkin.org) has been on disability since 1996 and is deeply ashamed of being on Social Security Disability Insurance though he feels that he should not feel ashamed because SSDI is a safety net designed to help people with disabilities. They often feel ashamed, which actually  compounds their pre-existing emotional issues of inadequacy, that they have to be dependent on the government to survive and that they cannot stand on their own two feet. People on SSDI can earn up to about $1,000/ month without losing their disability benefits, which allows them to work part-time. But because health care costs a fortune and most private group health insurance plans do not have as much coverage as Medicaid or Medicare, they sadly cannot afford get off of SSDI even when they desperately want to.

They say that Social Security will be bankrupt by the time Baby Boomers retire. Would it be bankrupt if millions of these people with disabilities who want to work could actually work without losing their health care benefits? I wonder how many of these people would make the choice to join the workforce when universal health care becomes a reality. Considering that there are 50 million people with disabilities on the U.S., and many of them on SSDI, can you imagine the millions of dollars we could save by providing universal coverage?

Basically, our system inadvertently rewards criminal behavior and people with disabilities who are not working with free health care coverage. Is it me or the system who’s crazy? I think innocent people, by law, should have access to quality health care that is about their health and caring. Prevention is always cheaper than treatment. Quality medical care should always include healing modalities that aren't about pharmaceutical drugs, but about managing stress, which helps to keep mental health issues abay. Every person deals with stress in their daily life; this is about the human condition and the vulnerability that accompanies living. Good health care gives people life coping skills and an opportunity to regain their dignity after losing their judgment and community connections due to their illness. I don’t think people should have to commit a crime or claim disability in order to see a doctor and get their medical needs met. Give people with disabilities the right to work with losing their health benefits. Work contributes to their dignity. Universal health care coverage would ultimately cut costs for many federal, state and local social service programs and eventually reduce crime by at least 25%.

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koala on Fri, 07/31/2009 - 19:06

I think mental health issues are a largely overlooked issue in this current healthcare debate and one that's going to be increasingly apparent as our wars will eventually end and our veterans that have gone through multiple-deployments will come home with severe mental trauma.

Currently, one out of every three homeless people on the street are veterans of some kind of War.  Those numbers are going to jump.

My state of California has a ridiculous history (starting with Ronald Reagan) of cutting off aid to the mental ill.  It's unconscionable and wrong to the greatest degree.  And the stories about mental illness and insurance are absolutely horrible.

Like that football player who shot and killed his coach because his insurance refused to pay for a mental health evaluation.  And for the Asian American community we have the Georgia Tech Shootings and the Binghamton Shootings where psychiatric intervention could have saved a lot of lives.

Although, I do want to point out some minor objections with some of the non-major points you make--

Social Security will not go bankrupt and the myth that comes from it are a result of the Reagan Administration heavily borrowing from the Social Security Trust Fund to help pay for his 1981 tax cuts.  If these monies were paid back and Congress lifted the $100,000 limit on Social Security Taxes, Social Security would be an solvent and reliable protection for the poor and disabled.

Also, the notion that we "reward" criminals is somewhat upsetting.  I think you would agree with me that criminal is a pretty relative term.  Right now we have a rather healthy private prison industry that has considerable lobbying power in congress, again, a product of the Reagan Administration.  Powerful forces profit when more people are in jail.  The entire point of the non-profit prison system pre-1980s was to rehabilitate law-breakers back into society.  Now it's to keep putting more people in jail.  We have more people in jail than in China!  On top of this, we have too many people in our jails who don't deserve to be in jail thanks to America's pointless War on Drugs.

Criticisms aside, enjoyed your post.  Thank you-

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