Amidst much chagrin, chest-thumping, and gnashing of teeth, this post highlights the problems of expanding public healthcare.  Sometimes ya gotta do what ya gotta do.  After all, the truth is the truth is the truth, lied Zano.  Government funded healthcare is complicated to the point of absurdity.  In fact, Managed Care has created whole swaths of self-important middle men and middle agencies that both spend and make oobs and gobs and loads of tax payer’s money while desperately trying to justify their own existence.  This is not uncommon in super capitalism land, which is another reason why this house of cards called the U.S. economy has less sustainability than a freshly baked Krispy Kreme in Crank Manor.

Today’s post focuses on behavioral healthcare, because when I’m not bitch-slapping nuns during wild crack binges, I’m out here in the field (fighting for my meals).  OK, that’s an exaggeration, I rarely use crack.  The fact is, some of these “big brother” agencies were created by Hillarycare.  They function as liaisons between the state and the actual behavioral health providers on the ground.  So, the state comes up with dumb, unrealistic—I really don’t have a clue about healthcare—mandates, and these middle agencies complicate the matter, add forms, shake, stir, and pass-on the love to those folks supposedly treating Uncle Louie for his tendency to wear aluminum foil on his head to block out the government transmitted microwaves (GTMs).

Many of these agencies are even for profit, which translates thusly: they get all the state money to distribute to the behavioral healthcare networks that they oversee, and, if they don’t spend it on the schizophrenic crack addicts in our streets, they get to keep it! It’s unconscionable…like appointing Dick Cheney Prison Reform Czar. 

These swaths of middle men siphon off tons of money from those most in need—the money allocated to actually treat people.  They create monitors to watch the mental health and the substance abuse providers on the ground, which, in and of itself isn’t a bad thing, but in this peer-reviewed society gone wild (PRSGW), the pendulum has not only swung too far, but it has lodged itself into the side of Manute Bol’s head.

When you translate 500 “best practices” into 500 monitors, people in the trenches, the ones actually providing services can no longer function.  We stop having time to actually treat people and embark on a daily juggling act that even Squidward would find challenging. Let’s try this example: say some bean-counting, pencil-pusher decided that it’s best practice to see all 235 people on your caseload each week.  So some case manager somewhere will then run around to all 235 people and say, “Please sign this form to show that I was here.”  They will then—whether the person is drooling, tripping, or has a gun to their head—jump back into the agency van and speed away toward client 167.  But, hey, it will look great on that report for that bean counter.   My agency is not doing this, by the way (yet), but you get the idea.

This is happening all over the country.  The field is collapsing.  Put your stock in aluminum foil, folks, because the Uncle Louies of the world are going to need it.  The best example happened as my agency just announced the next round of massive budget cuts.  On the same day my agency raised our health insurance (a lot), slashed our PTO, and discussed lay offs, I heard a radio commercial during my drive home: Have you considered doing next to nothing while mental health care providers are being laid off in droves?  Join our middle men, bean-counting band of bad-karma case-manager cops.  Why actually do shit for a living, when you can move to a cushy, nearly pointless position in the heart of an entire colony of middle-management, like-minded Stepford Czars.

Now, I’m not saying all these folks are baby killers.  I have friends in several of these agencies, so I don’t say this lightly.  There are some impressive individual efforts, but overall this is a failed experiment (like American capitalism today).  But, overall, wrong career choices do have negative karmic consequences (just ask the Ghetto Shaman).

So the money these middle men receive for sanctioning mental health providers goes to hiring more of “them.”  So over time we end up with more monitors, monitoring less people that actually do stuff.

Someone at work joked recently “Therapy? We don’t have time for therapy.”

But you can bet we met all of our monitors for that month.  Rah!  If we can avoid treating anyone, we’ll do just fine.  These people must sleep at night by saying things like, we’re holding them accountable.  Of course no one’s holding them accountable. Hey, let’s have another layer of bureaucrats oversee them!  Yeah, that’s it, and eventually our healthcare system will resemble one of those Escher paintings from hell.  Oh, that’s right, it already does.  Fact: these folks shouldn’t be sleeping at night (not without Jacko levels of downers).   They are diverting money from places where it is sorely needed (aka, my checking account).

Our current healthcare reform debate is embarrassing.  To have important debates overrun with bullshit is depressing. This is important stuff, peeps; I’m talking to you Foxeteers. Just the facts, thanks, and leave the middle school rhetoric out of it.  The second healthcare wrinkle is legalese. Someone sues anyone anywhere in the U.S. and reams of paperwork are created in every nook-and-cranny of our system to assure this never happens again.  Oh, it won’t, because I don’t have time to see anyone on my caseload, let alone sleep with them. Lawyers, as usual, are at the heart of the problem.  This is where Tort reform is a must.  If a driver for my agency decides to have consensual nooky with a client in the back of the agency van (we call it the Mystery Machine, by the way, because of the mysterious things we find in it), of course, that staff person should be fired. The victim should not, however, be able to close the agency by successfully suing for millions of dollars in “damages.” Although, it is kind of fun watching a dissociative person drive a Dodge Viper through a county fair.

So each lawsuit designed to “help protect” the consumer, actually puts an increasingly debilitating strain on the entire system.  As a therapist, if I have to fill out one more form for the lawyers or the Stepford Czars, I’m gonna start mailing my clients a form that says, “Tell me about your mother…” with an enclosed bill.  Speaking of which, this IS a bill.  Subscribe to the Daily Discord, now, or it’s your turn to clean out the Mystery Machine.