Tuesday, April 26, 2011

Fuck The Doomed

There’s this guy. Call him Jim. He has a condition. Take your pick: high blood pressure, diabetes, manic depression. All three can be managed by regular daily doses of prescription medication.
The guy functions normally with these pills, holds down a job, pays his bills, loves his family, sends his kids off to school with a little kiss every morning.
Now what? The economy comes along and takes a dump. He loses his job, loses his insurance, and now what? He can’t afford the medication.
Now what? He’s eventually going to have an event and end up in the emergency room.
It’s costing a ton of money and nobody’s paying it! He can’t get reinsured because he has a pre-existing condition. It’s a long involved process before he qualifies for Medicaid, if the bureaucratic thuggery of getting it is something he actually decides to endure.
What about that program called Medically Needy for someone like Jim?
Wrong answer. That program, that had been managing costs for 177,000 Floridians, went out the window in the heyday of “let’s kill it all” in 2011.
So who’s paying for this guy? We all are and costs are going up, exponentially eventually, as we all get fired if the economy doesn’t turn around.
The exercise isn’t an academic one. This isn’t something you look at on a spread sheet and go ‘wow, that’s interesting.’ This tragedy is being played out across the state, and the country as you read these words. Just ask a nurse.
As of April of 2011, the GOP plan in Florida, for this scenario was essentially “fuck the doomed.” (FTD).
Do you know what? FTD is actually a more expensive plan, definitely over the short run, than not-FTD.
People pointed this out repeatedly in protests all across the state, and do you know what the GOP governor and the GOP legislature said? Fuck them anyway! (FTA).
Both the house and the senate were looking at different ways to say it, as of April 26, 2011.
The idea behind fighting reform to healthcare, which is what Rick Scott is all about, is this: that guy named Jim is going die sooner. And then perhaps, if we are just as heartless as our governor (pretend here)we hope maybe the costs will start going down as more and more people die, in this inhumane fashion.
Fuck the doomed.
Pretend this is moral, in some perverse version of Wal-Mart Jesus, and pretend it will work this way. Pretend we allow a whole lot of people to flop around like fish on a dock for a while, and step over the bodies, and glut our emergency rooms, while this cruel die-off occurs. So that we can all move on with our lives.
Now let’s move down the layer cake to the less fortunate; the Medicaid recipient. Yes, if you are on kidney dialysis and your funding gets cut, you will die, very soon. And the two birds and one stone? Well, you’re going to die before you’re eligible for Medicare!
This would be the appropriate moment for the tea party reader to cheer. Go ahead, we’ll wait.
There. Feel better?
Now, what about the mentally ill? What about the version of Jim that has manic depression or a touch of schizophrenia?
Oh, by the way? How about those immediate rising health care costs to the hospitals with all these sick and dying people, coming in for their last flop at the emergency room? Who’s paying for that?
No? No answer? Hmmmm. Well, one again, we all are.
Oh, are we just standing around watching as people are lying down in the streets to die? How’s that for quality of life for all of us? Even if we don’t care about the human suffering of others, because Wal-Mart Jesus says it’s okay to turn away, what about us? Is there a downside? Oh, I don’t know, disease?
Food for thought.
Now back to the mentally ill. The ailment is in the brain which is starved for healing medication, and the brain begins to propel the otherwise healthy body into bizarre behaviors; sometimes these are criminal, sometimes violent.
Suddenly there are all these people walking around, doing inappropriate things. And they are everywhere.
Does it amaze you sometimes the physical strength of the mentally ill, the capacity to endure the elements, wind, rain, sun? Hell these folks can take just about anything that nature has to dish out. (Takes one to know one, as they say.)
So what do we do with them? They don’t need dialysis, they need cigarettes, beer, three hots and a cot. And failing the former two, they’ll do just about anything to find the latter.
Here’s a quote from the Orlando Sentinel

The Senate's budget proposal also makes deep cuts in mental health services that could set Florida's care back several decades, say advocates for the mentally ill.

Since we started the de-institutionalization efforts in the '50s and '60s, we have never seen anything like this," said Bob Sharpe, head of the Florida Council for Community Mental Health.

The Senate budget eliminates adult mental health and substance-abuse funding except that for crisis stabilization units, other crisis-related services and detox services.

Communities throughout Florida would lose funding for medication, psychiatric care, outpatient treatment, residential treatment, case management, prevention services, day treatment, housing and employment assistance.

In the same article this source estimated 140,000 mentally ill Floridians would lose their care and 5,000 staffers who help them would lose their jobs.
So what do we do with the sufferers, or as they are viewed in RILAB terms, “defective employees”? In this case the answer is very simple: we incarcerate them. You want to have a society, and not anarchy and chaos, you can do one of two things with the mentally ill, you can care for them, or you can jail them.
But you can’t not pay for them in one way or another, if you want to have order. You can’t cut their medications off, close their hospitals and not pay for their treatment while they’re in jail.
What, you want the jails to become defacto lunatic asylums?
They’re ill, remember? They can’t help it. They can’t just “stop doing that”. They may look normal, THEY’RE NOT! Oh, and by the way, Wal-Mart Jesus isn’t going to come in on a shaft of light and fix them. In 150 years of treating mental illness, the medical profession has yet to find one case of a floating Jesus saving the deranged in this fashion. Highly cost ineffective to lock someone up and just pray for them. Really doesn’t work.
If you don’t want chaos inside the jail: if you really don’t want to go fully Medieval on anyone who ever sets foot inside a jail for whatever infraction, accused or otherwise, you will have to have special wings for the mentally ill, and you will have to medicate them.
So part of the jail becomes an asylum?
And what’s great about this is, it’s more expensive to do it this way, not less, when it comes to the mentally ill.
Every $1 not spent on the mentally ill outside the prison becomes a fortune spent on them, inside the prison.
Here again from the same Orlando Sentinel article:

The Florida Council for Community Mental Health notes that the average cost of treating a mentally ill person on an outpatient basis is $1,551, while the cost of housing a mentally ill person in a state mental hospital is $112,000 a year.

And if you are a governor, or a legislator salivating at the prospect of cutting some deals, and getting some hand grease on the back end of a game called “privatize corrections” that just might suit you fine and dandy.
Now do you see where this is going?

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