A Seat at the Table for the Mentally Ill

I lost the ability to sleep naturally, to the best of my reckoning, about eight years ago. To keep away insomnia, I take a very strong sedative that doubles as an antidepressant. Last night I didn't get much rest because I'm currently withdrawing from another medication, a tranquilizer known to most Americans as Valium. One can't come off of Valium or any of what are categorized as benzodiazepines cold turkey, and yet I've had to because I couldn't get in touch with my doctor.

Obamacare, by my direct observation, has been very effective in some areas and minimally effective in others. Psychiatrists in this city charge $700 out of pocket for a first-time appointment and around $200 for follow-up visits. Because I cannot pay enormous bills like these, even with Obamacare coverage, I have to go to the worst, least funded clinic in the District. Doctors will counter that health insurance companies don't reimburse them adequately enough to allow them to make much money. If that is the case, then our next set of reforms should ensure that a psychologist can make as much as a heart surgeon.

My psychiatrist is sharp and well-trained, but when the money and staffing isn't there, one has to improvise and prioritize. It shouldn't take me ten days of persistent inquiry to get medication refills. In a much more affluent setting, a nurse on call would handle this request within 1-2 days. Or, in some cases, a psychiatrist himself or herself would, in about the same amount of time. For every single area of specialization besides mental health, my insurance covers most of the charges I accrue.

These are the things money can buy. Dreams are wonderful things, but concrete plans are even more wonderful. Last night I heard President Obama talk about making sure to include those with mental illness in this grand coalition of our nation's population. I'm glad that I was finally noted in a Presidential address. Mentioning mental illness of any form in so public a forum would have caused deep shame and discomfort to everyone in my grandparent's generation. That's how far we've come and, don't get me wrong, I'm grateful. Yet, I kept hoping the President would offer specifics of where the money would come from and who would pay for it.

Health care in this country is still about access to coverage and the money to ensure it. The system needs to be fixed when a psychologist in private practice will charge upwards of $150-$200 per session often without taking any insurance because Medicare and other insurance plans only pay $60. As it stands now, my psychiatrist charges $150 for each session, but I'm sure his actual take-home pay is much less. Modern medicine should be a holistic experience, where a doctor takes the time to get to know his or her patients. Instead, patients are often rushed in and out for the sake of profit.

Again, I know that throwing money at a problem is no solution. But fully funding clinics for every American would provide, at minimum, jobs for nurses, doctors, physician's assistants, and secretaries. It's short-sighted in the extreme to overlook a pressing need such as this one. Though, as I noted above, we have come quite a ways in general mental health awareness, but a tremendous amount of stigma and misinformation still exists with mental illness. Far too many people are not being treated because they are being denied access to coverage. They can't pay the cost or take off work easily to be properly treated.

The American health care system is still based on profit. I don't expect a single-payer system to ever be passed into law. What I do know is that it will take time for Obamacare reforms, as enacted, to show evidence of their stated goals. Rural Maryland needs psychiatrists and psychologists as much as Washington, DC. The difference is that more profit can be collected from affluent urban dwellers than rural residents. Capitalism and our continued reliance on it continues to trip us up. Casting blame on one group or another isn't fair. We are shackled together by a system that will always reward privilege and increased income first.