Fayette County News

Fayette County


One way to reduce gun violence: Mental health funding via single payer

Jack Bernard, a retired SVP with a large national healthcare firm, has worked extensively with hospitals across the nation regarding cost containment and insurance. He was also the first Director of Health Planning for Georgia.
Jack Bernard is a retired SVP with a national firm. He is also the former Chair of the Jasper County Commission and Republican Party.

The NRA cites one of the main reasons for multi-victim gun violence as mental illness. The fact that our national mental health system is a mess, as is proven by the number of homeless mentally ill on the streets of our major cities, is one of the few areas of agreement between conservatives and progressives…although each side has a much different take as to the issues and solutions.
With the latest mass shooting, we hear a lot from both sides about possible actions we can take. They agree on the need for better mental health services, although actual appropriations are another matter as I can tell you from experience.
The early part of my career was spent in public service. I was an organizer with the poverty program, OEO, back in the 1960s. I was a true Kennedy idealist, fighting the good fight.
I admired Jimmy Carter, our Governor and another idealist, and I eventually went to work for the Deputy Director of the welfare department for state of Georgia. In the early 1970s, I began funding deinstitutionalization programs as part of a federally funded state block grant program, Title XX.
One key aim of Title XX was to fund local programs aimed at getting and keeping people out of mental institutions. For example, we funded mental health halfway houses.
Back then, we thought that we should get more people out of deplorable mental institutions, a laudable goal. State mental hospitals were in many cases (not all) warehousing pits with substandard care, and our reasoning was to move inpatients into clearly more humane and appropriate outpatient settings.
Later, as the DHR (Physical Health, Mental Health, Rehab, Welfare) Commissioner’s Office of Planning and Budget staffer handling Mental Health, I continued to promote deinstitutionalization. I was very young, still in my 20s, when I was promoted to be Director of Health Planning for the State of Georgia. My employees incorporated deinstitutionalization into the State Health Plan.
When Reagan was elected, a shock to me, I changed directions, going into private enterprise, making a lot of money, and becoming a cynic. A cynic is an idealist who has been faced with reality, in this case, the reality of the self-centered “me” generation. And, a cynic is what I am too often now days, especially when I look at the mess we are in regarding mental health in this state.
A key causal factor underlying the deterioration of our public mental health delivery system nationally was deinstitutionalization, specifically the lack of funding for alternatives to institutional care, otherwise known as community care. This unfortunate situation was avoidable but for our current decentralized, politicized national healthcare system. But, let me address what happened here in Georgia.
While in the Commissioner’s Office and later on as Director of Health Planning, my assumption was always that the Georgia Legislature would do its part: adequately fund community care as detailed in written documents that they received. They did not. Instead, slashing the budgets of the mental hospitals became just one more way of reallocating money to other more politically important programs, or saving money and cutting taxes so legislators could be reelected.
For the partisans out there, please note that this disaster happened with Democrats as Governors and both Houses in the hands of Democrats. Not that the GOP, consisting originally of former Dixiecrats, has been any better since the relatively recent “coup” placing them in sole power.
To this day when I see a homeless person, and there are many of them including a large number of PTSD vets, I think about the failures of the Georgia State Legislature under both parties. Lack of funding has caused tremendous, unnecessary, and immoral suffering. And, the same problem exists in most states nationwide.
It is never too late to correct the real underlying problem: our fragmented, decentralized national healthcare system. How? The answer is simple technically but not politically: single payer healthcare (think expanded Medicare) with centralized budgeting. Currently, not only is our national healthcare system by far the most expensive, it is one of the worst of the developed nations of the world (per Commonwealth Fund, 7-17).
Bloomberg issued a report a few years ago saying we are 50 out of 55 nations in health system effectiveness. Relative spending as a share of gross domestic product, life expectancy, and health-care spending per capita are key factors in the Bloomberg index. Our system of private health insurance has become outmoded and is eating up more and more of our GNP every year.
Please don’t not believe those blowhard politicians saying, without quoting any sources, that the USA has the best healthcare in the world. All objective studies, including the World Health Organization, have shown the opposite. Look at those homeless people on our streets if you still have any doubts.
If the costs of our current system of physical and mental health were comparable to that of other nations, and rational budgeting were done centrally, there would be sufficient funds for community mental health services and then some. That can only be done via single payer.