As the death toll climbs, unemployment soars, and the economy grinds to a halt, an epidemic is surging beneath the surface of the coronavirus pandemic: social distancing and uncertainty are stoking America’s already rampant mental health crisis. In a nationally representative poll by the Kaiser Family Foundation, nearly half of people in the United States — 45 percent — say the situation has affected their mental health. Rates are slightly higher among women and people of color. More than half of respondents are worried about getting sick because they can’t afford to miss work.
In April, a top emergency room surgeon at New York-Presbyterian Allen Hospital died by suicide, presumably due to the emotional strain of fighting COVID-19. Comprehensive data about US health care workers has yet to become available, but research from China has revealed high rates of depression, anxiety, insomnia, and distress, particularly for nurses, women, and those on the front line.
None of this is surprising. Social isolation and loneliness are linked to numerous mental health problems and even heart disease. Experiencing uncertainty, such as long-term unemployment, increases the likelihood of chronic anxiety and depression. Over half of physicians and a third of nurses were experiencing symptoms of burnout before the crisis.
The response to this worsening crisis hasn’t been surprising, either. From Fox News to the New York Times opinion page, news outlets are awash in tips for starting a meditation practice, eating more healthy food, finding meaning, feeding your soul, and other forms of so-called self-care. Celebrities have launched charity funds to collect donations for mental health organizations. None of these are inherently bad things to do. But, given the scale of the crisis, they’re bound to come up short. They’re a nicer way of saying what the Republican Party isn’t afraid to say outright: take care of yourself.
If coronavirus has revealed anything, it’s that we must take care of each other. On top of self-care practices, we need a publicly funded Medicare for All health care system.
Yes, frontline workers need more personal protective equipment (PPE). Hospitals need more ventilators. The public needs more PPE and testing. But, as soon as possible, our health care system must guarantee quality care to everyone, regardless of income or employment status. And, as the mental health crisis worsens, it’s becoming irrefutable that such a system must include talk therapy, substance abuse treatment, and other mental health services.
Even before the pandemic, our expensive, byzantine, patchwork private health insurance system was failing to heal the emotional wounds that come with living in a capitalist society. Suicide rates are at the highest level since World War II. Drug overdoses are soaring. Rates of depression have been rising for years, particularly among teens and young adults.
Not only is mental health care stigmatized in the United States, but it’s also poorly covered by health insurance companies, which impose restrictive standards of necessity. A therapy session is five times as likely to be out-of-network — thus more expensive — than an appointment for primary care. According to the health insurance industry’s own data, the out-of-pocket cost of mental health hospitalization has been growing nearly thirteen times faster than all inpatient care.
“The result is quality mental health care out of reach of all but a wealthy, fortunate few,” writes Aaron Freedman in a vulnerable telling of his sometimes debilitating anxiety for USA Today. “When my insomnia and anxiety got so bad I considered harming myself, my psychiatrist referred me to a cognitive behavioral therapist who has made worlds of difference for me. But he also charges $385 per 45-minute session.”
How would a single-payer system help? Just like it would in physical health care. Anyone would be able to see a counselor, psychologist, or psychiatrist without having to pay a premium, co-pay, or deductible. A public insurance system would remove the profit motive, allowing care to be provided based on need rather than corporate profitability. As Tim Higginbotham, an organizer with the Democratic Socialists of America’s Medicare for All campaign, puts it, doctors and nurses — and therapists, I’d add — would be in charge of making decisions about patient care, not private companies.
Right now, many insurers allow only a certain number of mental health sessions annually and even force gag orders on mental health professionals to keep them from recommending other services that fall outside their coverage plan. This results in many people who need help falling through the cracks. It’s estimated that nearly six in ten people with mental illness get no treatment or medication.
In other words, people are suffering and even dying from untreated mental health issues, all so that health insurance executives can afford more yachts and vacation homes. As writer and clinical social work student Colette Shade writes, “Our health insurance system is the only one on the planet in which providing people access to life-saving care is incidental to turning a profit.”
Like many capitalist delusions, the neglect of mental health is connected to capitalism’s devaluing of social reproduction, so-called women’s work. As socialist feminists such as Nancy Fraser have pointed out, capitalism outsources the creation and maintenance of social bonds to the private domestic sphere. The rise of capitalism caused social reproduction to be “sentimentalized and naturalized, performed for the sake of ‘love’ and ‘virtue,’ as opposed to money,” Fraser says. Medicare for All would help reduce the burden on all of us, particularly women, of providing such care on top of working to pay the bills.
How to get Medicare for All passed through Congress is an open question. Those executives have much sway over Republicans and many Democrats, including House Speaker Nancy Pelosi. But public health insurance continues to gain in popularity. A late April poll found that 69 percent of registered voters now support Medicare for All, including 88 percent of Democrats — a remarkable figure given that presumptive Democratic presidential nominee Joe Biden is proposing only a public option.
Despite being wildly popular, winning Medicare for All will require a slow and steady fight on multiple fronts. We must loudly support pro-single-payer progressives in Congress and those working with the Biden campaign. We must organize and mobilize by joining advocacy organizations, pressuring industry groups like the American Medical Association (AMA), and convincing family and friends. We must sharpen our arguments for the working-class case for a single-payer system. And we must speak to the pain and suffering many people are feeling during this crisis. The only way to treat the widespread anxiety, depression, and other mental health problems so many of us are feeling so acutely right now is through public health insurance.