Bad Choices and Bad Presumptions

There was a lot of well founded criticism of Kamala Harris plan for improving mental health care when she announced it last week. It relies on long term institutionalization as one of it’s major ideas, and neither patient advocates or mental health care providers see that as an answer to anything, except in a small percentage of cases. I’m not altogether shocked to see someone whose political career began as a prosecutor putting forward a plan which doesn’t seem to give any consideration to the good which can be done for “problem people” by making their connections to the world around them more stable, and instead believes removing them from the world they live in is better for them individually and for the community. It’s the entire function of a prosecutor to do that exact thing.

I went to go check and see how it stacked up against the other candidates. Sanders and Warren’s plans are basically “Medicare for All,” and that’s pretty much it. Buttigieg released a policy prescription which covered some pretty wide ground, including incentives to get care providers to places they are most needed, which no one else has addressed, but a lot of his plan is based on the idea that capitalism can be turned to work for the public good, and that never works anywhere near as well as it’s promised and either causes new problems or brings grifters to the spout where federal dollars are inserted into capitalist industries. Not grifters as in people feigning poverty, but grifters as in for profit colleges taking in the highest amount of federally subsidized loans, and then basically squeezing students to get every cent, with extremely low graduation rates or extremely over inflated promises of job placement, and job markets with no respect for their degree programs in the industries they promise to give students access to.

Relying on capitalism also means patients are at the mercy of the market, and its attendant fluctuations, which isn’t rational in itself. Localized monopolies are also a problem, and one we’ve seen little to no interest in dealing with, in basically every industry.

Medicare for All would certainly mean economic access to care for a lot more people who need it. Being able to afford access to care does not equal access to care though. It doesn’t address many of the other very broken parts of the way the system currently fails people in need of mental health care.

This is how we end up with so much bad policy. We get the choice between poorly conceived policy that doesn’t actually take the needs of the people it’s meant to help into consideration or there’s little to no consideration. When the poorly conceived policy doesn’t work, we get “We can fix this to be better” or “Well, we tried to fix that and look how that turned out.”

Harris and Buttigieg deserve credit for at least having specific plans. Those plans are reflective of the kinds of candidates they are as well though. They’re ambitious politicians for whom it is not in their best interest to acknowledge and address a vocal and well funded portion of the political class are served by continuing to maintain and expand the idea that the suffering of the undeserved and the other is a benefit to the deserved and their “communities.” It’s then the work of the “deserving” to profit from the suffering they help to cause and exacerbate.

Somehow, it’s still acceptable to fail to address the collective sadism in American politics and culture, but not acceptable to be a casualty of it. Individual suffering, so often caused and/or exacerbated by the collective madness that is the faith in meritocracy and exceptionalism. It’s uncivil to name this sadism for what it is, but somehow civil to repeatedly enact it.

Part of the way we got to mass incarceration was communities going to government with a laundry list of needs. Governments response was to give them more police, more jails and longer sentences, without any of the other things they had identified as needs to solve the underlying issues. In fact, this is one of the ways prisons and jails became the single largest mental health care providers in the nation. As we dumped money into policing and incarceration, we cut funding for mental health care, and many of the other things those communities were asking for. Refusing to address the sadism built into the perspective which creates that circumstance gets the result sadism aspires to, additional suffering.

This is an untenable situation. Mental health care is one are where it is exemplified, but it’s not the only one, by far.