The battle over how best to handle healthcare in America is divided between two sides: government run and free market. There is some squabbling over the exact methods, but the left wants a single payer system and the right wants some form of free market healthcare. Whether one argues on economic or ethical grounds, both sides have some potential merit and some drawbacks. The right certainly has a better grasp on the economic arguments for laissez-faire healthcare while the left tends to pull at peoples heartstrings more successfully.
However, there is one area where those in favor of a free market system are lacking an effective response–mental health.
When it comes to mental health care in America, the arguments for a free market start to break down. The typical argument is that, if a person becomes insured at a young age, they can get coverage for cheap instead of being bankrupted by expensive healthcare costs. When we are dealing with people who are severely mentally ill, rational thinking and advantageous behaviors are not always an option. There are diseases, such as schizophrenia, dissociative identity disorder, or bipolar disorder, in which a person is not always capable of making decisions in their best interest.
This creates a problem for civil libertarians and conservatives who are against involuntary commitment and social spending on mental health. Some argue that a person should be helped by their family or community, but what if they don’t seek help? Often times they don’t even know they need help. This leaves them out on the street, in jail, or worse. It is estimated that at least 25% of our homeless population has a severe mental illness and 20% of our prison population.
Whether we pay for these people’s care in shelters, in the hospital, in prisons, or at home, one way or another, we will pay.
At one time there were psychiatric hospitals, typically run by the state. They grew out of lunatic asylums and helped to usher in the new field of psychiatry. They were a place to house and treat a wide range of illnesses, and often used controversial treatments to subdue patients. It was these treatments which lead Hungarian Psychiatrist Thomas Szasz to advocate against involuntary commitment and psychiatric institutions. After the decline of institutions since the 1960s, the system has put an emphasis on treating a patient in the outpatient setting in their own community.
While this system is not without its merits, it also has significant drawbacks. By making it more difficult to involuntarily commit someone who does not want treatment, we are forced to wait until they are a risk to themselves or others. By the time treatment is started, they may already be seriously injured or imprisoned.
Herein lays the problem with free market healthcare and patients with serious mental illness. You cannot trust a patient to pay for their own healthcare if they are too sick to work a job, they cannot always be trusted to stay on their medications to keep that job, and you cannot commit them to get them on their medications until they have already caused harm.
The solution of the left is simple. They already wish to upend the current remnants of free market healthcare we currently have and make it universal. So, in their plan, these people would be covered already, making their answer much easier.
The right needs to grapple with this tricky issue and find a better pitch to the American people and explain why a free market system would benefit everyone, including those with severe mental illness. We need to find a way to not only ensure coverage is available, but those who are unable to access it on their own can still be covered for their illness.
The views expressed in this article are the opinion of the author and do not necessarily reflect those of Lone Conservative staff.