Let’s talk about healthcare, please.

I support the Affordable Care Act because I believe it will help our Gross Domestic Profit go up, and because I believe in social justice.  Let’s talk about it.

I spent a year working as the site supervisor for a homeless shelter, and then a year and a half as a “float” between several residential mental health facilities, so I’ve seen my share of people who have no choice but to rely on the state.  Any time an issue about state benefits come up, my mind immediately flashes back to my experiences there and I judge everything I hear not of how it affects me personally, but how it would change the situation for the people I have served.

Please, give me a few moments of your time.

Working with the homeless, I saw a side of the mental health industry that was chilling.  A large proportion of the guests at the homeless shelter had mental health problems.  Bipolar syndrome was a constant theme.  Why?  Because it, like schizophrenia, tends to manifest in adulthood rather than childhood.  The first symptoms don’t show up until someone is in their mid-twenties or later.  If you’re in college, in an office job, or in another supportive environment where you have a lot of hands-on supervision when the symptoms start to show, you have a good chance of being referred to help before it derails your life.  If, on the other hand, you are flipping burgers or nailing window panes on a factory floor, it’s far more likely that the first “incident” that lands you in front of someone who could help you isn’t going to be mild, it’ll be extreme.  More often than not the outbursts that can characterize mania (or the paranoia of schizophrenia) are misinterpreted as aggression or something more extreme.  There are books, and volumes, and scads, and rants, and epics of information on why it is that poor people with mental health problems seem to inevitably end up in jail or residential treatment for the rest of their lives.  But the truth is the answer is very straightforward:  right now, that’s just what the system is.  If you are poor, the only way you can stay medicated is if you are in jail or residential therapy indefinitely.  That means if you’re in your mid twenties and married with children when you first have an aggressive manic episode on a factory floor, not only is that the only route available to you, but it is the only route available to your family.

Ask yourself if that is just, or even necessary.  Is that the society you want to live in?

Addiction operates in much the same way.  White collar addicts can get chain prescriptions for pain killers, and there are many supports there to act as a barrier between the addict and extreme consequences.  For the poor, reality is again far more harsh.  Unless there is insurance coverage for treatment expenses, chances are treatment will happen when the addict is caught in an illegal action and sent to jail, or their children are taken away and rehab is proscribed by the state as a requirement for reunion.

Is that justice?  Is it necessary?  As the self-ascribed “greatest society”, is that how we should live?

Despite any issues that there may be with the Affordable Care Act, there are a few things it does which are absolutely necessary if there is to be any sense of social justice in the United States.  It makes it so that the poor can have preventative and maintenance mental health care, meaning that problems like bipolar disorder and schizophrenia can be treated before they become debilitating, and poor people with those illnesses can remain productive members of society and their families are not torn apart.  It also means that people with addictions can be helped before their addiction becomes so severe it becomes a legal matter instead of a personal one.  Even if you have absolutely no interest in those issues as a social justice matter, think about the expense.  How expensive is it to maintain treatment for bipolar disorder and schizophrenia through the jail system and residential programs as opposed to having insurance cover medications?  How expensive is it to treat addiction as a legal matter- court fees, jail costs, state paying for rehab- as opposed to treating it through insurance as a private matter?

The Affordable Care Act isn’t about coddling the poor, it is about saving money, saving lives, and keeping people economically stable and productive instead of burdening society with unnecessary expense and unnecessarily broken people.

If you don’t believe me, go to your nearest residential mental health treatment facility and talk to the people there about how they ended up in that situation.  Hear them talk about how schizophrenia made them homeless and years of going without medication or health care on the streets broke their bodies and caused so many complications they could no longer care for themselves or became suicidal, and the state remanded them to residential care.  Here them talk about how they ended up in jail because they punched their boss but now they know aggression is a symptom of their illness.  ”I can’t live without the lorazepam, without it I am violent, but I can’t buy it unless I’m here, so the state says I’m a threat to others.”  Hear their stories, and realize that if we defund the Affordable Care Act, there are only two options open to the very poor who have abnormal mental conditions:  jail, or residential care.  Neither of those options are freedom.

Then ask yourself if that is the society you want to live in.  If you want my generation, and the generation of my children, to send a significant segment of their population to be jailed by the state either literally or with high doses of medication administered several times a day, because their brains are wired differently and we can’t be bothered the expense of keeping them productive.

Think about it.

And when you get that statement in the mail saying your copay is going up to provide full coverage, realize this:  every time a copay goes up, a bipolar factory worker gets to stay on his medication.  Indirectly, your money isn’t going to brigands or scum or people who can’t be bothered to get better jobs; actually, it is going to keep people working and improve the Gross Domestic Profit.

Everybody wins.