Reply #42: it's a huge set of issues- I'll give you one re: mental health [View All]

When the Republicans broke their agreement to fund mental health care as part of the now defunct Oregon Health Plan 2 (which was a Section 1115 Medicaid expansion), several things became apparent.

The first and most poignant was a rash of suicides by people who could no longer afford their medications or counseling. As the months passed, many, many clinics were forced to drastically reduce staff. Some communities, especially in rural Oregon, lost all their mental health services as a result of the cuts.

So, all of the people who were once employed at these clinics no longer had jobs- at a time of historically high unemployment, when it makes the most sense economically to have them employed even if that employment is subsidized by state and federal money (the multiplier effect and all that Keynesian stuff...;-) ).

However, there were more effects. Many if not most of the people formerly on the plan developed behavioral problems or became dysfunctional, and so many lost their private jobs (meaning that they no longer contributed to state and federal tax bases). Some went on disability, further draining funds those funds. Others ended up in the criminal justice system- a very expensive entry on the balance sheets- particularly if as a result their families had to rely on state social services for any length of time. Not to mention any effects that might be felt by crime victims.

Even if they stayed out of trouble, former patients now required more care from family members and friends- and that results in productivity losses for businesses. Moreover, if and when a crisis occurred, patients ended up in emergency rooms and pysch wards- THE most expensive places for them to be. That results in a couple of effects.

First, since hospitals are no longer receiving some types of reimbursements, they have to write these off as charity cases. Second, it clogs emergency rooms and increases waiting times (again- draining productivity from multiple businesses, not just hospitals or even the families of the mentally ill). Third, it increases the cost of care for everyone else (increasing premiums, copays and deductibles for businesses and individuals alike).

Finally, when the debts are passed on to families that cannot afford them (which is most families) and aggressive debt collection agencies get into the picture (which happens way too often) families must decide whether to pay other creditors- or pony up for the most expensive, inefficient care they could have received. They cut back on purchases in the local community (decreasing the multiplier effect). Or they may declare bankruptcy.

So you see, when you do all the math, it makes a lot more sense to fund country mental health clinics up front. Otherwise, as Oregon has learned the hard way, you pay A LOT more a little ways down the line.