When I was a kid, seeing a psychiatrist carried a stigma. Those requiring treatment for mental illness were deemed “cuckoo” and the reference was typically made with circular hand motions around the head. In grade school, dismissing someone as “mental” was the ultimate putdown along with saying they belonged at 999 Queen Street, which we believed was the address of what was generally referred to as Toronto’s “mental hospital.”
In the 70s, Missouri Sen. Thomas Eagleton, then the Democratic vice-presidential nominee, dropped out of the 1972 race after only 18 days after it was revealed that he received multiple treatments of electroconvulsive shock therapy (ECT) to treat his depression a decade earlier. Emily Kaplan argues in her Harvard master’s thesis that it was Eagleton’s ECT treatments, not his depression, that alarmed the public but nevertheless there were debates about whether someone suffering from a psychiatric disorder could effectively serve as president.
Donald Trump’s mental fitness has repeatedly been called into question, including by a psychiatrist who never met or treated him. During Trump’s presidency, psychiatrist Bandy Xenobia Lee, then an associate clinical professor at the Yale School of Medicine and president of the World Mental Health Coalition, took to Twitter “as a public service” and began offering real time psychoanalysis of Trump’s tweets. Lee declared Trump mentally unstable and argued she had “social responsibility” to warn about Trump because “our survival as a species may be at stake.”
Lee said that anyone who supported Trump suffered from a “shared psychosis,” meaning that the more than 40 percent of Americans who supported him also suffered from mental illness. The American Psychiatric Association was silent about Lee weaponizing psychiatry for political purposes, despite the so-called Goldwater Rule, which prohibits psychiatrists from making clinical diagnoses on people they haven’t seen or treated.
Strides are finally being made to remove the stigma of mental illness, particularly among families who have lost loved ones because of the often-debilitating disease, especially depression. The family of Blake Hounshell, a beloved Politico reporter who committed suicide at age 44, was one such example.
The family’s death notice statement said Hounsell died after “a long and courageous battle with depression.”
Pennsylvania’s newly elected Senator John Fetterman also moved to remove the stigma of depression with his announcement weeks ago that depression had forced him to check into a hospital for medical treatment after winning a hard-fought election. Fetterman eloquently shared in a recent interview with CBS News how depression conquered him.
“It’s like … you just won the biggest, you know, race in — in the country. The whole thing about depression is, is that objectively, you may have won, but depression can absolutely convince you that you actually lost. And that’s exactly what happened. And that was the start of a downward spiral,” he said in the interview given two days before his release from Walter Reed National Military Medical Center. “I had stopped leaving my bed. I had stopped eating. I was dropping weight. I had stopped engaging some of the most things that I love in my life.”
The New York Times reported that Fetterman is set to return to the Senate on April 17, after a two-week holiday recess and in the interim planned to spend time in Pennsylvania with his family and constituents. His office said that Dr. David Williamson, the neuropsychiatry chief and medical director at Walter Reed, had determined that Mr. Fetterman’s depression was now in remission.
“I am so happy to be home,” Mr. Fetterman said in a statement. “I’m excited to be the father and husband I want to be, and the senator Pennsylvania deserves.”
Fetterman received bipartisan support for speaking candidly about his illness and his need for treatment. Perhaps Congress could show the same empathy and support for the more than 50 million Americans who suffer from depression but can’t get treatment because they either can’t afford it or there’s a shortage of available therapists.
America has morphed into a nation of depressives with nearly 25% of the population experiencing depression for two weeks or more a month but don’t receive medical treatment because they can’t afford it. That’s led to widespread substance abuse problems, yet 94% of Americans with addiction issues receive no treatment. Nearly five percent of Americans have given serious thought to killing themselves, and in 2021 47,646 individuals took their lives, up from 45,979 a year earlier.
The pervasive malaise explains why American life expectancy is at its lowest levels in two decades.
Fetterman is blessed. Getting elected to Congress gave him access to some of the best and affordable healthcare insurance on the market. As he recovered at Walter Reed, I imagine he received his full pay and was never required to provide proof of his illness. While he was recovering, Fetterman didn’t need to worry about losing his job.
Most Americans can only dream about getting the quality treatment that Fetterman instantly received when he needed it. A survey conducted by The Commonwealth Fund last year revealed that 43% of working-age adults were inadequately insured, meaning their insurance wasn’t sufficient to cover their medical needs.
“If you’re delaying medical visits or not getting prescriptions filled because of costs, that means your overall health is not as good as it might have been,” said Sara Collins, a Commonwealth senior scholar and vice president who co-authored an analysis of the foundation’s findings. “That is an impact not only on individual lives but the productivity of employers and the overall well-being of the economy. And on the financial side, it is having a massive impact on people in terms of medical debt.”
My simple solution to get Congress to act immediately to solve America’s healthcare crisis: Legislation that would deny members paid healthcare insurance of any sort, aligning them with a huge swath of the constituents they represent, most of whom aren’t earning the $174,000 annual salaries of Congresspeople.
There are few certainties in life but denying Congresspeople their healthcare benefits would be a surefire way to make healthcare reform a bipartisan priority and achievement. In the meantime, let’s look at some more questionable behavior that’s recently been exposed in U.S. healthcare.
For the uninitiated, reading Cigna’s professed passionate commitment to ethics and principles of conduct would lead them to assume the insurance company hires only executive altar boys and girls with a demonstrated record of corporate piety and adherence. But regular readers of this blog are familiar with the Starkman Approved Principle, which holds there’s invariably an inverse relationship between the loudest virtue signalers and how they conduct themselves.
Cigna is but yet another example.
ProPublica recently reported that Cigna, one of America’s largest insurers, has developed a system that allows its doctors to instantly reject a claim on medical grounds without opening the patient file, leaving claimants on the hook for medical bills, some which could potentially bankrupt them.
A Cigna algorithm flags mismatches between diagnoses and what the company considers acceptable tests and procedures for those ailments. Company doctors then sign off on the denials in batches, according to interviews with former employees who spoke on condition of anonymity.
“We literally click and submit,” one former Cigna doctor said. “It takes all of 10 seconds to do 50 at a time.”
I’ve grown inured reading stories about healthcare wrongdoing, but ProPublica exposed just how ethically challenged Cigna’s culture really is.
ProPublica reported that some executives from the outset worried about the legality of a system that rejected claims without a physician actually reviewing them.
“We thought it might fall into a legal gray zone,” said a former Cigna official, who helped conceive the program. “We sent the idea to legal, and they sent it back saying it was OK.”
Cigna’s corporate slogan should be: “We skate as close to the legal line as possible.”
ProPublica’s Cigna story is typical of the news organization’s superior reporting, but it likely won’t have its deserved impact.
Cigna is a heartless behemoth of an insurance company, but real people are responsible for its behavior. The story would interest and outrage more people if ProPublica had humanized Cigna. As an example, I’d welcome knowing more about the sorts of physicians who choose to waste their medical training and enable Cigna’s rejection practices, effectively doing harm when they took an oath not to. I’m curious why Cigna doesn’t employ physician assistants to do the job.
Cigna CEO David Cordani received $21 million in compensation in 2022, a year in which the company reported profits of $6.7 billion, up from $5.4 billion it reported in 2021. Given that Ford Motor Co. paid CEO Jim Farley $21 million for orchestrating a $2 billion loss, Cordani’s pay isn’t as obscene as it appears.
A Shoutout for Ohio’s Dave Yost
It’s unfortunate the national media doesn’t have a beat covering state attorneys general because the gap in performance is frightening.
Take the incompetence of Michigan’s Dana Nessel, who has spent more than $55 million trying to prosecute former Gov. Rick Snyder on – are you sitting down? – misdemeanor charges. Nessel’s hand-picked lawyers keep striking out every time they show up in court.
The distance between Lansing and Columbus is a mere 255 miles, but in AG terms Ohio is another universe. The Buckeye State’s Dave Yost is a heavy hitter, particularly on healthcare.
Calling them “modern gangsters,” Yost recently filed a lawsuit accusing pharmacy benefit managers of illegally driving up drug prices for patients who rely on insulin and other key medications.
“Medications shouldn’t cost an arm and a leg, metaphorically or literally,” Yost said in a written statement. “Insulin is just a symptom of the problem; PBMs are the disease.”
Among the PBMs Yost is suing for ripping off Ohioans is Express Scripts, which – surprise, surprise –is owned by Cigna.
Yost isn’t just another saber-rattling politician. He’s already recovered more than $100 million in settlements from the PBMs.
When University of Toledo Medical Center three years ago announced plans to investigate a sale, Yost leaked to the media that he’d “scrutinize” the deal. By comparison, Michigan’s Nessel ignored warnings about the implosion of Metro Detroit’s Beaumont Health and rubber stamped its acquisition by Grand Rapids-based Spectrum Health.
Michiganders might consider outsourcing their state’s AG function to Ohio. It could save them tens of millions of wasted legal costs.