Medicare for All

First among these is Medicare for All. Medicare for All is good for everybody, but there are some specific reasons why it is the most important policy to improve mental health outcomes in the United States.

First, Bernie’s Medicare for All program will provide full coverage for mental health and substance abuse treatment. Many people wrongly believe that the Affordable Care Act provided universal coverage for mental health care due to its requirement for “mental health parity.” This policy was an expansion of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which required group insurance plans to have the same cost structure and benefit limitations for mental health services that they applied to other types of health care.

The Affordable Care Act took this law and expanded it to include individual insurance plans as well as group insurance plans. The Affordable Care Act also eliminated “preexisting conditions” and lifetime limits on care, including for mental health.

However, these policy changes are hardly helpful to people who cannot afford their co-pays or deductibles — let alone their premiums. It does nothing to actually lower the cost of health care. It simply says that mental health care cannot cost more than other types of health care, which is already unaffordable to most Americans. Many of those with insurance can’t afford their co-pays and deductibles. And, as of 2017, 28 million Americans had no health insurance at all. This is up from 27.3 million the previous year.

Most of these people are working-age Americans, like twenty-nine-year-old Daniel Desnoyers. In 2019, Desnoyers committed suicide after he lost his insurance and access to his psychiatric medication because he was $20 short on the monthly premium.

Meanwhile, many Americans who have “good” health insurance think they are safe from financial ruin. But there are plenty of ways for insurance companies to screw their customers, including on mental health.

My current insurer, UnitedHealth Group, lost a federal lawsuit in California in 2019 after they were found to have discriminated against patients with mental health and substance abuse disorders to increase profits. Other insurance companies will cover only some types of mental health services — and patients often don’t find out until it is too late.

For example, Nicole Vlaming received a bill of nearly $20,000 after she checked herself into a psychiatric emergency room for suicidal ideations. Her employer-sponsored insurance covered no inpatient mental health treatment.

“I do have a supplemental insurance plan that will hopefully cover $6,000, leaving me on the hook for over $12,000,” Vlaming wrote in a Facebook post. Our health insurance system is the only one on the planet in which providing people access to life-saving care is incidental to turning a profit.

The Social Determinants of Mental Health

Simply implementing Medicare for All would drastically improve mental health outcomes in the United States. But access to health care does not fully address the root causes of this country’s mental health epidemics. Mental health outcomes are deeply influenced by economic and political policy choices. These choices are what public health scholars call “social determinants of health.”

An example of this is asthma, which is more common in black and Latino populations than in white populations in the United States. The reason for this is not that there is a genetic link between, say, melanin and asthma. Rather, highways, factories, waste treatment plants, and other sources of pollution tend to be placed in black and Latino neighborhoods, causing the people who live there to get sick. This is a political choice — and it doesn’t have to be this way.

Similarly, people are anxious, depressed, and addicted to substances because their lives are stressful, painful, and precarious, and their lives are stressful, painful, and precarious because of policy choices our government has made. Humans have to meet physiological needs like clean air, clean water, food, shelter, clothing, and reproduction before we can meet non-material ones like building self-esteem and achieving self-actualization. Right now, 32.7 million Americans are food insecure, more than 550,000 Americans are homeless, and one in eight Americans lives below the poverty line. It’s impossible to self-actualize when you don’t know if you’ll be eating dinner.

Bernie is the candidate with the best solutions for these problems. Bernie supports the Green New Deal, which is the best program to ensure that all Americans have clean air and water — especially poor people and people of color. Bernie supports the right to housing, which includes instituting national rent control, expanding public housing, and making it more difficult for landlords to evict tenants.

Bernie wants to empower workers to bring democracy to the workplace and raise their living standards. More than simply raising the minimum wage (which, by the way, has been shown to lower the suicide rate), Bernie wants to institute laws that guarantee the right to unionize workplaces and allow for sectoral bargaining, which would greatly strengthen workers’ power in the United States. And Bernie has been fighting for these causes for his entire career, even when political elites made him a pariah.

It’s Not Your Fault

Beyond policy questions, however, there is something else at play in Bernie’s campaign. As Briahna Joy Gray and Meagan Day recently discussed on Gray’s “Hear the Bern” podcast, the official podcast of the Sanders campaign, Bernie tells struggling Americans a message they desperately need to hear: “It’s not your fault.”

The dominant ideology of the past four decades has told people that their worsening living conditions are due to their own bad choices and lack of merit. On top of that, it has promoted an individualized view of mental illness that tells people that their anxiety, depression, and substance abuse is the fault of their brain chemistry alone — not the reaction of their brain chemistry to external conditions.

People are ashamed to share that they are struggling, even among friends. Bernie has given people a platform to connect and place the blame where it belongs: on the political causes of our individual problems.

And in an attempt to rebuild unions and other institutions that are rooted in a sense of solidarity and common purpose, he is working to given them a community, which, as Day has written, can be a bulwark against despair.

The other candidates borrow Sanders’s rhetoric because it is popular. But their policies offer the same incrementalism and non-solutions that got us into this situation.

Other Candidates Don’t Cut It

Elizabeth Warren’s website says she supports Medicare for All. But in recent months, she has vacillated on this position. Besides, Warren has said she will implement her plan over three years. This is political suicide, because the president’s party usually loses seats in Congress during a midterm election, which will make it particularly impossible for any of the president’s policies to be implemented.

The nation watched as Barack Obama squandered his majorities in the House and Senate during the first two years of his presidency. His ineffective policies arguably contributed to his losses in 2010. Contrast this to FDR, who, in his first one hundred days in office, pushed through sixteen major new laws, including the Federal Emergency Relief Act, the National Industrial Recovery Act, the Tennessee Valley Authority Act, and the Glass-Steagall Banking Act.

Warren must know this, which leads me to believe that that her policy timeline is a delaying tactic put forth by someone who doesn’t actually want Medicare for All.

Joe Biden’s health care plan is even worse. He wants to “give Americans a new choice, a public health option like Medicare.” There is very little information about what this would look like, except that he wants to do it in conjunction with private health insurance — which would be a disaster, as Timothy Faust explored in his 2019 book Health Justice Now: Single Payer and What Comes Next, essentially creating a bifurcated, tiered system. This might be marginally better than the current system, but it is hardly a rallying cry.

Moreover, from a strategic standpoint, Medicare for All is more politically durable than a patchwork system that divides constituents. In the decade since the Affordable Care Act was implemented, we have watched its meager reforms get dismantled piece by piece. Meanwhile, in the UK, the National Health Service (NHS) has hung on despite decades of cuts and a current Tory government.

Pete Buttigieg, Michael Bloomberg, and Amy Klobuchar also have terrible ideas for improving US health insurance. Klobuchar wants to expand Medicare and Medicaid. This is a good thing, building upon the most successful part of Obamacare. But it’s not enough. Plus, her program would be means-tested, making it political poison.

Bloomberg and Buttigieg want to provide a new public option that will coexist with a private health insurance system. For Bloomberg, this program will have co-pays that he says are “affordable.” But there is no explanation of what that means. And besides, we should eliminate co-pays. Why not just go all the way and shoot for single payer? It would be far less confusing and far more resistant to Republican sabotage.

Our Best Bet

Beyond the immediate realm of health care, none of the other Democratic candidates offer the kinds of transformative policies Bernie does. Besides, Bernie is the only candidate whose strategy aims to redistribute power in American society. As many to Bernie’s right have pointed out, Bernie will be up against a hostile Republican Party willing to do whatever it takes to stop him. But this will be the case with any Democratic president. Bernie has the best strategy for dealing with this situation.

Americans hate their health insurance, their jobs, and their lives. In fact, almost half of Americans hate capitalism, period. Bernie, unlike the other candidates, has centered his career around this. People find catharsis in Bernie’s yelling and pointing. He makes people feel, as some therapists might say, validated.

Klobuchar, Buttigieg, Biden, and Bloomberg act like they’re keeping it real by telling Americans that we can’t have nice things. They’re wrong — we can, and Bernie is our best bet for achieving them and solving the mental health crises in the United States.