It's All In Your Head

As you may have noticed, we at the Snark are interested in authoritarian behavior and the methods people use to justify that behavior. Sometimes the lengths that people will go to in the service of satisfying their emotional needs are funny, sometimes they are frightening. Sometimes they are just repugnant.

Apparently, the administration has issued rules requiring parity for mental health treatment with other illnesses. They'll take effect July 1st. If you want to know why health insurance costs keep marching upward seemingly uncontrolled, this is why: mandating new benefits is always popular, and the government doesn't have to pay for them.

Why do our costs keep rising? Megan McArdle believes it is because we use more health care than other nations because we're richer. She is wrong, of course; McArdle does not pay attention to facts when she can ask her guts for advice and information instead. Let's see what Ezra Klein had to say about the same subject: (not that we trust Klein, but at least he uses verifiable facts)

There is a simple explanation for why American health care costs so much more than health care in any other country: because we pay so much more for each unit of care. As Halvorson explained, and academics and consultancies have repeatedly confirmed, if you leave everything else the same -- the volume of procedures, the days we spend in the hospital, the number of surgeries we need -- but plug in the prices Canadians pay, our health-care spending falls by about 50 percent.

In other countries, governments set the rates that will be paid for different treatments and drugs, even when private insurers are doing the actual purchasing. In our country, the government doesn't set those rates for private insurers, which is why the prices paid by Medicare, as you'll see on some of these graphs, are much lower than those paid by private insurers. You'll also notice that the bit showing American prices is separated into blue and yellow: That shows the spread between the average price (the top of the blue) and the 90th percentile (the top of the yellow). Other countries don't have nearly that much variation, again because their pricing is standard.

The health-care reform debate has done a good job avoiding the subject of prices. The argument over the Medicare-attached public plan was, in a way that most people didn't understand, an argument about prices, but it quickly became an argument about a public option without a pricing dimension, and never really looked back. The administration has been very interested in the finding that some states are better at providing cost-effective care than other states, but not in the finding that some countries are better at purchasing care than other countries. "A health-care debate in this country that isn't aware of the price differential is not an informed debate," says Halvorson. By that measure, we have not had a very informed debate.

Where Megan McArdle operates, we will always have uninformed debates, because she sees no need whatsoever to become informed when she can just toss off a fact-free post and go shopping. She was not taught to think by her parents; she was taught to accept their prejudices and assumptions without question. She was taught that she is superior by virtue of birth (which is humble) and breeding (which is non-existent), and therefore she is more intelligent that those who actually felt the necessity to develop and train their minds. She was not taught to think at her exclusive elite universities and prep schools--or if she was, she was mentally absent on those occasions. She was not taught to write persuasively at Reason or The Atlantic, as her editors were only interested in the dispensation of right-wing talking points in the service of global corporations. She can't think, can't write, and can't feel, yet she feels perfectly free to tell the rest of the world her medical and political opinions.

I am very sympathetic to the plight of the mentally ill. Unfortunately, most of the people who will tap the benefits are not severely ill people who need intensive care; they're people who are unhappy. Unhappiness is not a condition for which psychotherapy, or antidepressants, have been shown to be very effective. (Severe clinical depression, yes. But contrary to the belief of people who felt awfully down the time their boyfriend left them, these two conditions are not the same thing.) Since the moderately unhappy and dissatisfied are much more prevalent than those with serious disorders, that's most of what we'll be paying for: someone to listen to complaints. That's what Senators are supposed to be for.

No proof. No facts. No argument. Just a declaration that unhappy housewives and love-lorn men will bilk the insurance companies and taxpayers so they can feel better about themselves. That most people who say they are mentally ill are, in fact, just dissatisfied. She has the arrogance, the unmitigated gall, to say that real people with real problems, medical problems and emotional problems that affect the mind and body, are just complainers. You thought schizophrenia was a problem? Dumbass. Oh, sure, maybe a few people have a problem but most don't, so don't care for any of them. Depression? Doesn't exist. Severe clinical depression, maybe that exists, for a few people, but unless you're 100% incapacitated, you're just a big old faker. Bipolar disease? Anxiety? Post traumatic stress syndrome from growing up in poverty, in horrendous abuse, in war? Silly housewives, you just need to buck up and quit whining.

Diseases of the brain don't exist, people. It's the Magic Organ, that never malfunctions or is damaged. Because Miss Megan McArdle says so.

On a more serious note, I feel like we could have achieved the laudable goal of ensuring that serious mental illnesses are not left untreated (at least, in cases where the patient wants to get treatment), without guaranteeing cheaper psychotherapy for America's ennui-laden affluent classes. Of course, then we'd have to recognize the fact htat this stuff has to be paid for, rather than pretending that benefits can somehow be magically generated for free with just a wave of the regulatory pen.

People do enjoy mental illness so. They don't even want treatment some of the time.

For some bizarre reason, McArdle thinks she's an expert on depression, without actually knowing anything about it, and always with the motive of denying corporations any expense. It's not that she wants people to be unable to get health care. She just wants health insurance and drug companies to have as much money as possible.

From the comments:

jegmont (Replying to: David Cohen) January 29, 2010 4:49 PM
I didn't mean to imply that any one who feels sad is in danger of developing clinical depression. The point I intended to make is that when someone does have a mental illness, it often progresses, so if there isn't early treatment, things can get very, very bad. The spirit of the post seemed to be that it is so easy to distinguish between someone needing treatment and someone just feeling down.

Reply

Megan McArdle (Replying to: jegmont) January 29, 2010 5:41 PM
As far as I know, that's not really true. People don't start out feeling sad, and then progress to severe clinical depression, except perhaps in cases of severe trauma. People who become severely clinically depressed have usually been struggling with fairly severe episodes of depression that go way beyond feeling sad since at least late adolescence. It may progress from severe to psychotic. But the majority of people who say they're "depressed" are in no danger of developing severe depression, and mild depression doesn't seem to be all that responsive to treatment.

[snip]

Nimed (Replying to: Skullberg) January 29, 2010 5:19 PM
Skullberg, this is pretty basic - Megan, not Martin, made the claim that most future beneficiaries are people who are just unhappy. It's up to her to back it up, not Martin to disprove it.

Reply

Megan McArdle (Replying to: Nimed) January 29, 2010 5:43 PM
Sigh. Look at the incidence of mild depression, which shows limited response to either treatment or drugs that is actually distinguishable from a placebo effect, and moderate-to-major depression. This isn't even vaguely controversial, as far as I know: mild depression doesn't actually respond to drugs in a way that is easy to distinguish from placebo, talk therapy has very dubious benefits except for CBT, and mild depression is much, much more prevalent than the kind that ends in suicide or a locked ward.

[snip]

alkali (Replying to: DBN) January 29, 2010 5:37 PM
Medication is pretty cheap too, relative to 24/7 hospitalization of a seriously-afflicted schizophrenic

Reply

Megan McArdle (Replying to: alkali) January 29, 2010 5:50 PM
Yeah, except the number of seriously afflicted schizophrenics who are holding down jobs, and thus eligible for employer-sponsored private health insurance (or able to afford their own) is very small. http://www.schizophrenia.com/szfacts.htm With people who have schizophrenia or similar illnesses, Medicaid, Medicare, and state insurance programs are more important. People underestimate just how disabling it is--just because we can control the hallucinations, doesn't mean we can restore people to a normal life.

For that matter, the severely clinically depressed are also fairly likely to exit the private insurance market, because one definition of severe clinical depression is that you're so impaired that you have difficulty carrying out major life activities. If it's persistent, it's probably not being covered through private insurance unless you have a very supportive spouse.

The New York Times must have run an article about depression, in between articles about young Park Slope matrons and trophy banker girlfriends. Now Dr. Megan knows all about the subject, and with the full authority of The Atlantic and David G. Bradley's hundreds of millions behind her, feels free to tell the anguished and suffering that they can just go curl up in a ball and die. The fakers.