Comment by rented_mule | Hacker News Reader

Comment by rented_mule | Hacker News Reader

I often hear treatment promoted, but it's interesting that I rarely hear a topic right next to this come up in such discussions: a for-profit healthcare system that not-only leaves these people behind, but helps to put many of them there in the first place. I can't find anything in this thread about health insurance, universal access to healthcare, etc.

I have excellent health insurance by US standards (the most expensive plan offered by a big tech company in SF). I've been battling mental illness for the last two years (more like two decades, but getting treatment for two years after it became untenable), resulting in months of medical leave from work on the advice of multiple doctors. Even with "excellent" insurance, I'm approaching $50K out of pocket over the last two years. It was more than that before my insurance company decided to cover my illness and reimbursed some of what I had previously paid (after 18 months of me, my doctor, and HR fighting them). What if I wasn't lucky enough to have "excellent" health insurance and sufficient savings from years of high paying jobs? If I wasn't so lucky and ended up homeless, what chance would I have of recovering from my condition? I've avoided alcohol and drugs my entire life because I know I'm prone to addictive behavior - I'm guessing one cold night on the street would be all it would take for the first drink. It's scary to think about where it would go from there.

Healthcare for homeless people tends to be emergency rooms and under-resourced free clinics. Given my experience being treated for mental illness, I can't conceive of making any progress in free clinics or ERs. So why wouldn't I be a permanent resident of the streets?

I see talk here of homelessness being less of an issue in Europe and China... in my opinion, access to healthcare is a key difference. Treatment for homeless people is great, but how sane is a system that pushes people off a health/financial cliff before they can get such treatment? Financially feasible access to treatment long before we get there is crucial.

My experience of mental healthcare in the UK and China is not what what you imply. Your description of mental care for homeless in USA is close to what is available for the majority of the working class in the UK.

I worked in mental health in the UK. In my area an initial mental health consult has a 6 month wait. You are unlikely to receive ongoing care in the first 2 years after the initial consult, but most will never be offered ongoing care. Lack of treatment pushes people out of the job market and into destructive behaviour. The fact that it is free at the point of care matters little when poor health is itself financially destructive.

I also cared for a relative's health in China. If you want a basic level of hygiene you will pay for everything. If you want clean sheets and avoid bed sores you may need to pay extra. Bring a good blanket, the hospital may not have a heating system.

It sounds like mental health care is in a bad state in many places. There is an illusion that the US system means we don't have the difficult waits you describe in the UK... that's not my experience as someone seeking care.

Part of why it took me so long to get treatment (I mentioned that I've been dealing with this for decades) is that 20 years ago I could only afford to get treatment that I knew my insurance company would cover (cover == 80%). I was on two waiting lists... the insurance company's own list and one at Stanford Medical Center. I tried to get on more lists, but I couldn't find any that weren't "full". I checked regularly on the two lists, each time being told I don't have to check as they'll reach out when I'm at the top. I gave up checking after three years and they never reached out. I never got as far as a consult. It's expensive for me now because I didn't go the insurance company's route - I just went straight to a doctor and submitted insurance claims after.

I almost couldn't reach out for treatment this time. I knew I was nearing a point of no return. It felt like reaching out for treatment meant facing potential rejection on my last chance and the added stress made me almost non-functional. That's part of why I describe myself as lucky. I was able to amass the savings needed for treatment before my illness incapacitated me so much that I could neither work nor seek help.

While it's a bad situation that it can take years to get ongoing treatment in a system like the UK's, I still would have had treatment many years earlier. Things need to improve all over if we actually want to make progress on homelessness. We need approaches to get people off the street. But we also need to have better systems in place that reduce the number of people ending up on the street in the first place. I don't believe that remediation without prevention will do much to reverse current trends.

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