We Need Mental Health Care for All

Elizabeth Warren wants to “hold insurers accountable for providing adequate mental health benefits.” We want to eliminate private insurers and provide mental health service as a right.

Democratic presidential candidate Sen. Elizabeth Warren speaks during a Town Hall at Keene State College on September 25, 2019 in Keene, New Hampshire. Scott Eisen / Getty

Elizabeth Warren has finally released her health care plan. She calls it Medicare for All, but as Tim Higginbotham and Natalie Shure have both noted, she leaves out any number of crucial details about eliminating premiums, co-pays, and deductibles, or about providing dental, vision, hearing, and mental care.

My concern is different. The wording on Senator Warren’s website looks to me like it does answer the question of whether mental health is included — and that the answer is “no.” If this wasn’t her intention, the Warren campaign should clarify this immediately. If my reading is correct, however, this gap is a perfection illustration of why the Warren plan is inferior to that of Bernie Sanders.

Sanders vs. Warren on Mental Health

Sanders wrote a detailed damn bill that lays out the finer details of how he thinks Medicare for All should work — but you don’t need to read it to know what is says about mental health. On the second paragraph of the brief description on Sanders’s website, he talks about how we should be spending money not on insurance industry profits but on “doctors, nurses, mental health specialists, dentists, and other professionals who provide services to people and improve their lives.” He’s crystal clear on eliminating the private insurance industry from psychiatry as well as other branches of medicine.

On the other hand, the only mention of mental health on the relevant section of Warren’s website is this paragraph:

In addition to the right to physical health care, we must prioritize affordable, high-quality mental health services. Despite the widespread need for these services, many Americans are denied coverage. Elizabeth’s Behavioral Health Coverage Transparency Act would hold insurers accountable for providing adequate mental health benefits and ensure Americans receive the protections they are guaranteed by law.

If insurers are going to be “held accountable,” then — at least in this area of health care — they must continue to exist. If “mental health services” are going to be “affordable,” they aren’t going to be decommodified.

The Case for Mental Care for All

I’m a logic guy. My preferred mode of political discourse involves rigorously evaluating arguments. But in this case I can’t resist the temptation to include anecdotal personal information — if only to explain why Warren’s apparent exclusion of mental health from her “Medicare for All” plan infuriates me.

My wife and I are both philosophy professors. I’m keenly aware that, compared to the overwhelming majority of jobs under capitalism, this is a pretty sweet gig. I get paid to lean against chalkboards and chat with students about ideas.

However, like approximately 75 percent of people teaching at colleges in the universities in the United States, neither of us has a tenure-track job. For the last few years, we worked as adjuncts at Rutgers. We recently moved to Atlanta, where we both got full-time but nontenure-stream positions at George State University’s Perimeter College. Before that, I spent a couple years teaching at Yonsei University in South Korea while Jennifer worked on her dissertation.

One of the things that’s meant in practice is a lot of bouncing around between insurance plans. This is especially stressful because Jennifer has long-term prescriptions for anti-depressants. Inevitably, the doctor who prescribed her regular refills on the old plan isn’t “in-plan” for the new one. Getting a new refill means first finding a new in-plan psychiatrist, then scheduling a first appointment, waiting for it, scheduling a second appointment at which an actual prescription can be written, and waiting for that, all the while counting out her remaining pills.

Millions experience the same hardship, yet the apparent implication on Senator Warren’s website is that she doesn’t think that “All” includes those whose medical issues have to do with brain chemistry.

The case for nationalizing mental health insurance is the same as the case for nationalizing any kind of health insurance. The degree of separation that exists between these kinds of care is a relic of the archaic Cartesian belief that mental activity resided in a nonphysical soul. In the twenty-first century, we should know better.

If Warren didn’t mean to imply that mental health would be excluded from her plan, she needs to say so loudly and clearly. Either way, the one in six Americans with prescriptions for some sort of psychiatric medication deserve to know whether she thinks they should be included in her vision of Medicare for All.