HealthLawProf Blog

Editor: Katharine Van Tassel
Akron Univ. School of Law

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Monday, June 5, 2006

Access to Mental Health Care

This post on Daily Kos by an attorney who could not obtain the necessary medical care for his bipolar disorder is an eye-opening reminder of how our health care system needs to be reformed.  The fact that he had to leave the country to receive the necessary care is disheartening to say the least.  Here is a brief excerpt:

When I started working as a lawyer, I hoped my access to healthcare would improve, but it didn't.  It actually got worse.  My employer's insurance did not cover psychiatric care, so I went to state-sponsored clinic.  We met twice a week and since I couldn't afford the medication he prescribed, he sometimes provided manufacturer's samples.  But just when my therapy was succeeding and I had spent months without wanting to kill myself, and had even passed the bar exam, the psychiatrist said I seemed healthy and didn't need his help anymore.  . . . .

I was hired by a reputable national organization and quickly promoted and moved to a new state, where I had intense new responsibilities and no established psychiatric care.  I quickly became overwhelmed, so I discreetly inquired as to our company's health insurance benefits.  And that's when my health insurance nightmare began again in earnest. 

The employer had an HMO with severely limited number of providers who were listed in no particular order in a large telephone book.  They literally just handed me this phone book when I told them I needed psychiatric care.

When I independently contacted the professionals to whom I was referred by friends and specialists, the answer was always the same:  "I don't deal with HMOs; they're too much trouble and they pay too slowly." Psychiatrists charged $100.00 per hour, so I knew couldn't afford the two visits per week I needed to work successfully.

Ironically, while at work, I supervised a budget of over $12,000,000, with hundreds of clients and a dozen employees, yet after work hours I was medically destitute.  I took calls from the New York Times and appeared on cable news by day, while at night I went to Home Depot for a rope to hang myself. 

Still, I couldn't pay for good psychiatric help and my employer's HMO refused to pay.  When they finally referred me to a psychiatric management agency, I believed I would be meeting with a psychiatrist who could evaluate my immediate need for medication.  I was suicidal. 

But after two meetings, I became suspicious of this "doctor" and insisted on knowing the therapist's credentials. Only then did I discover that he was not a medical doctor at all and could not prescribe medication at all.  He was just a gatekeeper for the medical establishment, trying to dissuade me from getting treatment in order to save money for the HMO.  He had no intention of referring me to a psychiatrist.  . . .

Soon, I lost my job and spent the rest of my savings on $100.00 per visit psychiatric visits and medication.  My student loans fell into default.  When my money ran out and the therapy visits stopped, I alternated between hiding in my house and driving on the expressway at 105 miles per hour in the breakdown lane.  (I well remember my velocity because it was the maximum my new Honda would do while traveling downhill.)   . . . .

With all other avenues seeming closed to me, I decided to move - to France.  I reasoned that if my mind could do nothing else successfully, at least I could learn another language, for all the good that might do.  I applied for a passport and began to study French. . . .

To live in France, I would need a visa status.  So, although I had never taken a course in French and I spoke no French at all, I applied for a student visa and enrolled in a French doctoral program for international law.  What better way to immerse myself in French culture?  Plus, enrolling in a doctoral program helped me to explain leaving my latest lawyer position after only two months on the job.   

Surprisingly, the move made an immensely positive difference in terms of my access to medical care.  Even as a foreign student, for just two hundred dollars I was able to enroll for a year in the French national health care system.  How very ironic it was to receive medical treatment overseas for free that I could not obtain in the US even as working attorney.

Although I had been denied Medicaid in the United States after I lost my job, I had a French Carte Vital within a month.  This universal health card assured that doctors, hospitals and pharmacies nationwide would provide me the help I needed.  (Except, ironically, the American Hospital in Paris, which doesn't accept government reimbursements.) 

In France, I was finally diagnosed as manic depressive, bipolar.  In France, medical diseases that are particularly severe are covered for all necessary treatments at all hospitals and with no co-payments. Since manic depression is defined by the government as a "particularly serious disorder", all of my associated costs were covered 100%.  In France.

My psychiatrist treated me twice weekly without ever asking me for payment.  We tried a number of medications without the fear that the one I most needed might be beyond my financial means.   I tried lithium for the first time, but it didn't work for me.  Still, I felt much less desperate knowing that I would always be financially able to see my psychiatrist and take the medications he prescribed. 

The most difficult part of fleeing to France was foregoing the practice of law.  I wanted so desperately to live the middle-class ethos of consistent work and respectability.  Yet I finally accepted that pretending to be sane was more work that I was able to do.  Although I had managed to render service to my clients and make a professional mark, yet the emotional burden was more than I could continue to carry.

Because of effective and consistent treatment or for whatever reason, I never had a car accident in France and never received a speeding ticket.  But, as the war in Iraq drove up the US deficit and drove down the value of the dollar, I found I couldn't afford to live in France anymore.  I couldn't work and I sometimes had no food to eat beyond a croissant and a glass of orange juice.  I found myself living in poverty, unable to pay even my most pressing bills.  The desperation and anger came back and I didn't know what to do.

I came back to the United States and tried to apply for Medicaid, but after submitting ten times as much paperwork as had been required for success in France, I was rejected in the US as having too much income, even though I was living at the poverty line.

Today, I've made what peace with all of this that I can make.  I live in one of those third world countries where the dollar goes further. Although there is no national health care here, the very same medications that cost $200.00 per month in the United States are available here for just $30.00 dollars per month, which is seven times less.  . . .

The entire article is worth a read.  [bm]

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