Tuesday, May 18, 2010

Your Health Care Or Your Job?

They may not have known it, but in the 2008 presidential election America's youth was deciding between health insurance and a job.

They were choosing between health insurance that many of them did not want or especially need and a place in the world of adult work.

They may not have known it then, and they may not even know it now, but in voting for Obama they were choosing a European style social democracy that is more intent on caring for people than in allowing them to compete in the marketplace.

They may not have known it then, but they should know now that the Nanny state that provides for a lifetime of tender, loving care also stifles economic growth. When Greece was bailed out of its profligate ways last week one condition was that it privatize its government-run health care system.

They could have known it then, if only they had looked at the experience of France. While everyone was in awe of the French health care system, few noticed the unhealthy side effect: chronic high unemployment-- stuck at around 10% for decades.

Perhaps our youthful Obama enthusiasts did not know that young people in France have been the primary victims of economic stagnation, to the point where there has been a veritable exodus of French youth to nations where the job and career prospects are more promising.

For today's youth, the under 25 generation, job prospects are bleak indeed. Just read Joe Queenan's sobering assessment in today's Wall Street Journal. His title says it all: "A Lament for the Class of 2010: New college graduates face a labor force that neither wants nor needs them; a plum job interning at a street fair." Link here.

As Queenan suggests, it is a lamentable condition. But it is endemic to the kinds of social democracies that are now failing in Europe, but that, nevertheless, have remained the systems that Obama wants America to emulate.

Lamentable means depressing and Queenan's observation adds more fuel to the idea that America's youth are suffering an abnormally high level of depression because they are pessimistic about their future.

Does this mean that they are all fortunate to have access to good health care? Not really.

No pills or talk therapy sessions are going to solve the problem of a jobless economic recovery. As Dr. Richard Mollica of Harvard famously said: "The best anti-depressant is a job."

If these young people had jobs or job prospects they would feel optimistic about the future, would suffer less depression, and need less treatment.

Not only does health care reform provide more health care services, but, perversely, it produces more consumers for that service.

It may be an accident, but France has led the world in the per capita consumption of psychiatric medication. I would also mention that, when I was in France in the 1970s, there was, next to the national health care system, an entirely free market in psychotherapy. It was largely a cash market; fees were highly variable; and it was providing something like talk therapy for large numbers of people.

In the midst of this crisis, and it is indeed a national crisis, Nancy Pelosi has offered some consoling thoughts. To her mind, now that young people have health insurance they do not have to take any old job just to have insurance. They can go off into the woods to develop all of their creative potential. No heath insurance; no problem... just go out and throw pots. Link here.

If these young people learned in college to be self-indulgent narcissists Pelosi's message will resonate. If they have not, and if they are really looking for a new path that is going to take them through difficult economic times, they would do better to pursue careers in the military.

To Pelosi and the democratic leadership there is not real value to competing in the marketplace, to engaging in free enterprise. Surely it is good that society has artists, but, as everyone knows, very, very few aspiring artists will ever be able to earn a living making art.

Economic stagnation is depressing. I opined yesterday about the possibility that in parts of the country that are feeling the economic decline more acutely students are more likely to be depressed and to seek out treatment for it. Link here.

After I posted my remarks, I discovered, via Dr. Helen Smith, that a recent report designates Rhode Island and Massachusetts as leaders in the consumption of mental health services. Link here.

As Dr. Helen points out, there are many possible reasons for this. People in these states may have a stronger faith in the value of talk therapy, or they may live in an environment that is causing them to have mental health problems, or they are using services that are more available at lower cost in Massachusetts and Rhode Island.

A thorough analysis will require that we weigh the relative importance of each of these factors. Of course, it is still striking that Massachusetts, whose medical reform plan was a model for Obamacare, should have so many of its citizens availing themselves of mental health services.

It's also worth noting that mental health care providers in Massachusetts, this article reports, are losing money on multi-session psychotherapy. Their solution, not unknown in other parts of the country, is to demand clear and precise details about treatment sessions, accompanied by signs of improvement. Obviously, such demands compromise the privacy of the therapeutic session, and thus inhibit communication.

Some might think that the best way to improve things is for the federal government to take over the system. And yet, when it comes to Medicare, the Houston Chronicle reports that more and more physicians in Texas are opting out of Medicare. Link here.

When government decides to take over functions normally handled by the market, most often it makes a hash of things. If somebody asks you to choose between your health care and your job, if you choose your health care you might well end up with neither. And if you choose your job you will likely end up with both.


Anonymous said...

Fantastic post, Stuart.

I think that parents have focused too much on providing material things to children, instead of providing them with wisdom.

And by wisdom I mean awareness of the moral law, and the design of the universe. What kind of person did God intend us to be, if he intended us to work to have something to share with our neighbors in need?

Anonymous said...

From Lacan to Dr. Helen in the course of a few decades. What is it like to move into your sunset years having adopted the reductive vocabulary of the reactionary? Oh, and to be an "Executive Coach." Eeek. Your anti-therapy stance is compromised by your parroting of the psychobabble buzz. Guess it is true that old dudes become curmudgeons as they age. Anti-intellectualism, and a variation of "Get off my lawn, kids." Then again, maybe you were always a hack. Time to shower.

Ralph said...

When you are young the trade offs you make are relatively benign. Trade offs do not have an impact until you have to pay for them.

Not only were many youth trading a job for health care, they may also be trading security. While France and Greece may have had indulgent health and welfare benefits, neither country has the capability of defense the US has.

I don't know what Anon added to the conversation except to make a personal attack. From his post I have no idea if he thinks many youth are depressed, if joblessness is a cause, how health care relates, etc. I assume from his post he is young (reference to old dudes becoming curmudgeons suggest he is not old yet), and an Obama supporter (anti-intellectualism) and he needs a shower.

I worked in a daycare years ago and quit because I thought it was a poor place to put children. I still do. Does that make me a "get of my lawn" curmudgeon? I actually liked the kids and thought they deserved better, and I could not provide it. No one can in an institutionalized building with a maximum child to minimum adult ratio.

Stuart Schneiderman said...

My thanks to wintery knight and Becky for their comments.

I agree that young people simply do not make the connection, because they do not see the bill coming due. Unfortunately, it is.

I'm not going to respond to Anonymous because I have a policy of not responding to mental drool.

I am not unsympathetic to Anon;if I could not do any better than that I would not use my name either.

I think that we can all take some consolation from the fact that there is still a place in the marketplace of ideas for those who are barely literate.