hobitbob wrote:From my position in EMS over the last two decades, I have become panifully aware of the difficultiues the working poor have in obtaining medical care, often relying on Emergency Departments for primary care issues,and allowing minor illesses to fester until they are major medical complaints.
Yep - happens, entire families (and thus, I deduct, entire population groups) live like that. When Anastasia came here she had to get used to us actually having a regular GP, that you went to with regular complaints, all covered by a reasonably-priced "people's" insurance.
What is so maddening about that is not just the degree to which people end up lacking proper medical care - and even when you end up at Emergency (or especially there), care would be extremely basic and troublesome to obtain, too, heard some horror stories (or they seem like horror stories from a European perspective) - but also - its contraproductive even from a heartless financial perspective, too.
Why is there no popular, affordable government-sponsored insurance scheme? Because it would be too expensive. But what is this? People clogging up the Emergency system with complaints that dont belong there, and ending up there, besides, with ailments that could have been so much more cheaply cured at an earlier stage? Is that not too expensive? As a strategy to limit the government's budget cutting (or refusing to implement) insurance coverage for the poor is not just hard-hearted, its grossly ineffective / counterproductive at that!
cicerone imposter wrote:BTW, when Reagan was governer of California, he threw all of the mentally ill patients out on the streets.
That happened here too ... its heartbreaking. Plus - same point as above - again, turned out to be contraproductive like hell, too, when it comes to cutting government expenditure.
Back when, the policy here was to confine the mentally ill in remote, leafy complexes away from the city. That had its disadvantages. Patients would have the security of lifelong care, but had also basically been given up on.
New policy from the 80s onwards was to integrate the mentally ill more, strive for some kind of re-entry into regular society again. No more confined, remote institutions, thus. A laudable enough goal, but it was accompanied by stringent budget cuts, rationalised by references to how less care would eventually be needed with the new policies. Devastating consequences.
Those who weren't all too seriously mentally ill were encouraged to live on their own again and rely on walk-in care. Sometimes against their will - friend told me about a woman who'd lived in one institution for over fourty years - ever since her teenage years - and now suddenly had to do it "on her own", despite her acute fear, and her attachment to what for all her adult life had been her home and her friends. Some of them made it, and now have an all the better life. Others didnt, and regressed into the system, at best, dropped out onto the streets, at worst. And that sometimes in combination. One of the most exasperating features of the current system, that policemen and doctors seem to complain about in equal measure, is that the extreme shortage of institutional mental health care places means that you have to regress pretty far to qualify for one of them.
Thus, a man walks the streets yelling out loud and cursing everyone, hours on end - the police pick him up, take him to the station, contact the mental health people - who have to say, sorry, this is not a serious enough case, we have a shortage, only if he'd actually threaten to harm someone, perhaps ... and so, the police, also lacking space, puts the man back onto the street. Until a week or a month later, when he's regressed so much more that he came to attacking someone with a knife.
Then he qualifies for admission into an institution. Where he is patched up, adds to the success target rates, and ultimately recovers enough to be "returned" to society - where, in x percent of cases, he regresses again, and the whole cycle starts anew. Sad, but also extremely inefficient, if you consider the money and time he has cost, by that time, and that then needs to be (re)invested in him again.
More sadder still - those who constituted extremely hard cases largely fell out of the new system, too. The new task for the system, after all, was to make people better. And considering the budget cuts, mental health institutions had to start working with strict targets on that. Not meeting these targets would risk the funding. So what happens with people who
cant be cured, ever? Not talking the extremely retarded, but the extremely disturbed? The system, once concluding that, seen from its new rationale, it "cant help" these people, turned them out onto the street in great numbers. Thazzit. Where they then start walking the streets howling and stealing and harassing people. And suffering. And dying, eventually. And costing the police, emergency hospitals, victims, etc, a lot of money, in the meantime, so that - again - overall, even as a budget cut move the whole transformation turns out contraproductive. But who sees the "overall" ... ?
What do I base all this on? I'm no expert, after all. But a good friend of mine worked in mental health care institutions for years (for a pittance), and she told me a lot. Sad. You also read a lot about it - everyone, from the "tough" police to the "soft" mental health people complaining about those maddening cycles. The result is here downtown. When I came to Utrecht 13 years ago, there were hardly homeless people. Within five years, their number boomed - and then boomed on for another five years. Now theres an estimated fivehundred or something - and this is a small town. I live downtown in a small sidestreet, and while the junkies gather at the station, the crazies walk all over - almost every night one or two will pass by down here while I'm typing - cursing, yelling, whatever. So many. Its a bloody scandal.
