Sounds cute. Perfect for a fictional story.
But I agree with part of what Wendy said. Instead of opening an apartment building, the hospital should open a non-profit in-patient mental health wing. Treat people with injuries as needed in the ER, then move them to the mental health ward and get them the help they really need.
As a nation, we turned our back on mental illness in the 1980s. Shut down the vast majority of treatment facilities. Those with untreated mental health issues tend to commit crimes. So jails became mental health wards. And they’re terrible at that job.
As Wendy rightly points out, medications can help many of these people. But keeping them on their meds outside of an inpatient setting is tough. And it wouldn’t shock me if some people are being medicated to keep them sedated rather than to actually treat their conditions.
Frankly, mental health is ripe for picking as an entry into socialized medicine. Insurers don’t want to pay for it, so they limit payments. Hospitals aren’t equipped for it. PCPs know it’s needed, but have few (or sometimes no) places to refer people to. No one really wants the job, yet it is desperately needed. So let’s set it up at the federal level.
Let’s run some numbers. I’m getting my tax statistics from here: https://taxfoundation.org/publications/latest-federal-income… It’s for 2019, but that will have to do.
Let’s say we wanted to add a 1% tax on the top 1% of incomes. And use that to pay for nationwide mental health services. What would that look like?
Let’s start by computing taxable income. The table at the above page doesn’t show taxable income, only AGI. But it does give total taxes paid and an average tax rate which, according to the linked definition is total tax paid divided by taxable income. So let’s reverse that. We have $612 billion in taxes paid and an average tax rate of 25.6%. That works out to $2.391 trillion in taxable income. (Just slightly less than the total AGI. Probably could have just used that instead. But naysayers would complain that is wrong, so let’s get it right.)
A 1% tax on that would raise $23.9 billion. So that’s a starting budget number. (BTW, there are about 1.48 million returns with that income, so the average income for the 1% is just over $1.6 million. Interestingly, that is remarkably similar to California’s 1% tax on income in excess of $1 million earmarked for mental health services.)
So how many people need mental health treatment? Here you go:
The key findings show that only 27 percent of the 21 million individuals in the study had a behavioral health diagnosis or received behavioral health treatment
https://stateofreform.com/featured/2020/11/study-mental-heal…
With a total population of about 335 million, that means there are around 90 million people in the US who need or are getting mental health treatment. Time for more math.
$23.9 billion raised by this tax, spent on 90 million people give a per person budget of … click, click, tap, tap, … $265 per person. That’s just a couple of 30 minute therapy sessions a year. Or a year’s supply of a modestly priced medication.
Well, that math didn’t go so well. On the other hand, the study linked above also notes:
Half of the 5.7 million individuals who received a behavioral health diagnosis received less than $68 per year in mental health treatment.
So this could still be an improvement over the status quo.
I’m also ignoring any savings by allowing insurers to drop mental health coverage from health insurance policies. (Insert standard intercst rant about those savings ending up with JCs instead of passed on to those paying for the insurance. Because, well, he’s right.)
Anyway, just trying to put some numbers to this issue.
–Peter
