Atlas Shrugged: The Mocking

Friday, January 29, 2010

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.


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.


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.


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.


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


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. 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.


Clever Pseudonym said...

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.

Yes, with severe trauma, you start out a little sad and you get progressively worse as the shock wears off. Even to someone who knows nothing about mental illness, that doesn't make any sense. What a clueless dolt. She doesn't have the slightest clue what she's talking about.

And again with the "as far as I know" stuff. Remember when journalists once felt compelled to actually know stuff before writing about it?

Kathy said...

I doubt the NY Times is the source, I think McArdle got all her information about mental illness from Cosmopolitan and Law&Order shows. I expect she always scores high on the Cosmo Quiz's, too.

Nathan Bamford said...

What a horrid, vapid monster she is. Her shtick is the "reasonable" libertarian, but she's just as mean spirited and vicious as Glenn Reynolds on his worst day. I've always wondered why in God's name so many ostensibly left wing bloggers link to her. She's an awful, awful person who brings nothing to the debate except her fact free prejudices. Yuck. I feel dirty just reading the excerpts.

Batocchio said...

This one pisses me off more than most of her bullshit - probably because I know a few people who've dealt with serious depression or other mental illness. It takes an arrogant carelessness to be this damn clueless about the subject, because she couldn't spew this crap honestly if she had done even the most cursory research. Her attitude toward easily preventable human suffering is what makes her monstrous.

I think I'll stick with the people who have a fucking clue - and a soul - thank you very much, Ms. Megan.

aimai said...

I think the part that is typically Megan is that she makes everything up--not just her facts and her figures and her ideas but the very topic of conversation. It is trivially obvious that most mental health counseling is not going to go to depressed bored housewives. That was simply never in question. The reason people are going bankrupt and are desperate to get mental health coverage through their plans isn't because they are lonely and need someone to talk to. Its because their children are suicidal, or prone to psychotic rages, or having bipolar breaks. The worst part of Megan is the way she just makes up the very topic of conversation, then argues against the straw man assertion no one has made using fake stats. IF you went through her essays with a red pen and eliminated everything that had no basis in reality, that was purely there as some kind of defensive screen against thought, there'd be nothing left but her fucking byline.


Susan of Texas said...

She exists only to give intellectual cover to the exploitation of the poor. She drowns out the feeble voice of conservative conscience, which these conservatives call the voice of God, with her utterly wrong opinions.

If she weren't a woman she'd be writing for the New York Times by now.

You've read the Victorian children's book that taught morality, and how charity, honor and self-respect were both the core principles and the constant struggle for us all. In Alcott's books, charity was sacred, literally and figuratively. It killed Beth but that belief was never questioned. How low we have become.

Well, some of us.

jp said...

It's been said, but yah, this post of Miss Meghan's takes the fockin' biscuit.

bulbul said...

Depression? Doesn't exist. ... Bipolar disease? Anxiety? Post traumatic stress syndrome...?
... you just need to buck up and quit whining.

In my limited, yet in a way very rich, experience with psychology and psychotherapy (fortunately only on the helping side), I have encountered a lot of people with this particular view of mental illness. As it turned out, all of them had been damaged or were outright ill themselves, yet for some reason they would or could not accept help. And so they tried to rationalize their way out of it by insisting that their own pain or disease is really nothing and even if it were, they are strong and capable enough to overcome it themselves. Consequently, all those who do recognize that they might need professional help are nothing but a bunch of pussies and if they can't buck up, tough luck. After all, why should they be helped, if I can't?
Maybe Ms. McArdle isn't evil and cruel, maybe she just needs help.

as a Law and Order buff, I can assure you that had a single episode of LandO (especially SVU) that deals with mental illness, depression of PTSD (again, especially SVU) is much more factually accurate, let alone compassionate and understanding, in treating mental illness than Our Lady of Fuck You, I Got Mine.

MrsTarquinBiscuitbarrel said...

How on earth does this person justifying posting such halfwitted fuck-you stuff with introductory clauses like, "As far as I know..."? Nobody has introduced Meghan to Teh Google yet?

bulbul said, "I have encountered a lot of people with this particular view of mental illness. As it turned out, all of them had been damaged or were outright ill themselves, yet for some reason they would or could not accept help. And so they tried to rationalize their way out of it by insisting that their own pain or disease is really nothing and even if it were, they are strong and capable enough to overcome it themselves. Consequently, all those who do recognize that they might need professional help are nothing but a bunch of pussies and if they can't buck up, tough luck. After all, why should they be helped, if I can't?"

Spot on, bulbul. Bravo. This line of "thinking" goes, "Keep your pecker up, even if you don't have a pecker. Or you're a pussy." It's about as far from a helpful POV on mental disorders as one can get.

Kathy said...

bulbul: I didn't mean to dis L&O entirely, just their attitude towards schizophrenia. They really muddy the waters on an awful condition/disease.

aimai said...

I think what really kills me about Megan is she's just such a classic suck up. She's nothing but remora of the shark of capitalism, or maybe I mean its tapeworm.

She lives only to feed on the scraps that fall from its jaws, it barely knows she exists, and yet she preens herself on her wisdom, connections, merit, hard work, etc...etc...etc... And yet, even more disgustingly, she's so tenously attached to her source of income that she can and will fall, all the way down the drain, and find herself living in the sewer and *still* not grasp that perhaps her master's interests and her own were not identical.

I can't decide whether I think that if Megan had to "walk away" from her own mortgage, if she had one, she'd find and excuse for it and make it come out as the moral decision, or if she wouldn't and would still slavishly prostrate herself at the altar of Big Bank. And I can't decide which is worse: if her second order rationalizations of authority are totally and transparently self interested or if they are opaque, even to her.


Susan of Texas said...

She keeps trying to justify her point of view but only when she's criticized, so maybe she has managed to decieve herself.