The Healthcare System Link in the San Bernardino Shootings

The Healthcare System Link in the San Bernardino Shootings

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Screen Shot 2015-12-02 at 4.08.30 PMAnother day, another mass shooting. At this point the news reports say nearly 30 down, 14 or more dead, multiple perps, at a banquet for the San Bernardino, California, Department of Public Health.

And instantly the argument is all about the guns. I understand that, and I’m not even saying that it’s not about the guns.

And instantly we want to say these folks are crazy and of course that’s true. It doesn’t matter if they frame their reasons around Allah or “no more baby parts” or Obama’s impending takeover of the U.S. using ISIS fascist armies disguised as Syrian refugees pouring over the border from Mexico, doesn’t matter. Anyone who turns a gun on other human beings in a school, a clinic, a public street is we can safely say, nuts, if “nuts” has any real meaning any more.

But there are crazy people in every culture, and we have always had crazy people in ours. The percentage of people who are crazy does not scale across societies and across time with the number of people walking into theaters, malls, and bus stations with guns blazing.

Even the number of guns per capita, or the caliber and size of magazines people can buy, or the rules around buying them do not scale directly with mass violence. There is something else going on here.

If you are serious, if we are serious, about the health of Americans and the healthcare of the United States, we have to ask some deeper questions. The debates about guns and mental cases are important, but they mask the rest of the story — and that “rest of the story” is a lot harder to grasp and a lot harder to find answers for.

What is the context in which these crazy people are heading off the deep end festooned with guns?

A society in which almost daily somebody somewhere starts killing mass numbers of random civilians is a society that is visibly falling apart.

This society is one in which the middle class has been hollowed out over the last three decades, especially since 2009; a society in which income inequality has been widening for 30 years.

It’s a society in which the police have killed over 1,000 people so far this year — and the champion jurisdiction for per capitadeath by cop? Not San Bernardino, but right next door: Kern County, California. Rural California has been a seething cauldron of income inequality, poverty, and violence by the authorities since the “Grapes of Wrath” days of the 1930s.

This is a society in which the most popular single cable network makes its living by frightening Americans and working to get them to hate and fear one another; a society in which the most popular Presidential candidate in one party gains in the polls by mocking and slurring women, Mexican Americans, Muslim Americans, disabled Americans, African Americans, anybody who is, by his definition, a “loser.”

We are driving ourselves apart, we are being driven apart.

Healthcare has not been spared from this division and dysfunction. The concept of the “patient centered medical home” is not new. You remember what Robert Frost said about home? “Home is the place where, when you have to go there, they have to take you in.” That’s what medicine, what healthcare, has traditionally been: When you need it, it’s there for you. Those doctors, those nurses, may be able to cure what’s ailing you, or may only be able to ease the pain — but they will be there to care for you, to do what they can, to take you in.

Now healthcare has become a minefield of hidden costs and strange bureaucratic requirements. The web of human, face-to-face trust that has always been the undergirding of medicine has been broken and replaced by narrow networks, medical interference by insurance companies, doctors and medical teams driven to distraction serving the system before ekingout some time and attention to give to the actual suffering patient in front of them.

Trust been broken by a mostly code-driven fee-for-service system of vastly too expensive care that automatically, by its very nature, must make the patient into its adversary.

Along the way, the shattering of this web of trust has increased the role of healthcare in widening the income gaps, driving more and more of the middle class into bankruptcy, and more and more of the poor into utter despair. Even now, even with Obamacare, medical bills are the number one cause of bankruptcies. It’s one of the most important drivers of keeping the poor poor, widening the cracks in society, and making people on the edge feel even more isolated, unheard, uncared for.

There is not much of a home left in the heart of America.

We can do better. Better, stronger, more accessible healthcare, healthcare that did not make itself our adversary at every step, that did not batter us down and cast us out because we didn’t make the cut — is not the answer to all of society’s ills. But it would sure help. It would gather in the people who most need help, and reduce the number of people who feel utterly alone, desperate, unheard, unnoticed, and under siege.

This, my friends, is absolutely a game worth playing: Can we work this? Can we heal healthcare? Can we make healthcare a healing force in our brutally battered and fractured society.

I say we can.

Joe Flower is a healthcare futurist and author. He is a contributing editor with THCB.

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14 Comments on "The Healthcare System Link in the San Bernardino Shootings"


Member
Allan
Dec 3, 2015

“The percentage of people who are crazy does not scale across societies and across time with the number of people walking into theaters, malls, and bus stations with guns blazing.”

I don’t know that any culture has more or less crazies, however, along with our genetics and our environment there is another factor that makes us who we are and creates disparities in income and in actions. That is the culture from where we come and that can make us very different.

“This is a society in which the most popular single cable network makes its living by frightening Americans and working to get them to hate and fear one another;”

Firstly what you say is BS, but that isn’t very important since BS is what is peddled now a days. Secondly based upon what you say it is you that is creating hate and fear of one anther because it is you who is demonizing anyone that watches a particular cable network.

Member
lawyerdoctor
Dec 3, 2015

This is not about healthcare. It is not about gun control, or “certain cable TV stations,” or Trump. It was not caused by polar bears or “climate change.”

It is not even about “income inequality” – a term which, to most people who work hard and pay taxes, is the equivalent of hearing the “n word” if you are a minority. It is not about unemployment or lack of job training.

It is about a-holes who feel it is ok to kill people you disagree with.

Member
Peter
Dec 4, 2015

“It is about a-holes who feel it is ok to kill people you disagree with.”

When that becomes an epidemic it’s usually important to find a cause. Generally it’s been mental white guys. Maybe we should do more for access to mental heath treatment – and funding it through a tax on guns and bullets – their easily accessible choice for problem solving.

Member
lawyerdoctor
Dec 4, 2015

By “mental white guys” are you meaning to include Dzhokar and Tamerian Tsarnaev? Sayed Farook? his wife? Chris Harper? Nidal Hassan? Seung Hui Cho? John Malveaux? Mohammed Youssuf Abdulazeez? Elliott Roger? Aaron Alexis? John Zawahri? One L. Goh? Amy Bishop? Jiverly Voong? Suleman Talovic? Jennifer San Marco? Byran Uyesugi? Colin Ferguson? Gang Lu?

Oh, and google up Joseph “Moe” Allen. Shot 17 people in a park in New Orleans just a few days ago. Crickets in the media.

But agree with you that better mental health treatment is indicated. One huge mistake we made in the mental health arena was to assume that significantly mentally ill people are better off being homeless, exploited, and noncompliant with meds, as opposed to being in an institution where they receive care.

I work in an ER where large numbers of potentially dangerous, psychotic patients experience a literal revolving door of:

1) agitation resulting in violent episode in community
2) police respond
3) police call EMS
4) EMS bring agitated, combative psychotic patient to ED
5) ED stabilizes, admits to psych
6) psych discharges patient to “personal care home” with 2 dozen other mental health patients, to be exploited further
7) patient discontinues meds, plus or minus drugs and/or etoh
8) rinse, repeat.

Member
lawyerdoctor
Dec 4, 2015

oops, forgot:
Omar Thornton (killed 8, injured 2).
Jeff Weise (16 y/o Ojibwe killer of 9 at his school)

Member
Peter
Dec 4, 2015

“Since 1982, 46 white men were involved in a total of 44 massacres, more than four times the tally of African Americans, who account for just 11.”

Would you deny a gun to any of the above 8? And if you if you agree on mental illness treatment how would you pay for it?

Member
lawyerdoctor
Dec 10, 2015

Dont’ have any problem denying guns to crazy people.
Don’t care what color the crazy people are.
Don’t have any problem with keeping crazy people from coming into the U.S.
The issue with mental illness treatment is not that we aren’t paying for it, it’s what we are paying for that isn’t working.

Member
Peter
Dec 10, 2015

“Don’t have any problem with keeping crazy people from coming into the U.S.”

Would Muslims be considered crazy?

“The issue with mental illness treatment is not that we aren’t paying for it, it’s what we are paying for that isn’t working.”

When our jails are being used to manage the mentally ill then of course the incarceration system (we are paying for) isn’t working.

Hard to believe your education doesn’t carry to a deeper understanding of the problem instead of hip shots.

Member
lawyerdoctor
Dec 11, 2015

Would Muslims be considered crazy? yeah some of them. Hard to believe you don’t understand this.

You already stated that white males are dangerous. Is it all of them, or just the ones who belong to the NRA?

Member
Peter
Dec 11, 2015

I do understand it. My point on white males was Trump and others are getting the hate crowds all scared about all muslims when white males account for more mass shootings. In fact there are about 8000-9000 gun homicides each year (FBI) committed by your fellow Americans, you know, the ones next door, not here as a refugee. I don’t see the Islam haters taking note of that – not on their agenda. Guess it’s OK to be gunned down by a non-Muslim.

“Is it all of them, or just the ones who belong to the NRA?”

Just those radicalized by the NRA.

Member
lawyerdoctor
Dec 10, 2015

Hey Peter,

I think you got me. Cops just arrested a 46 y/o white guy who was wearing tinfoil on his head (yeah you just can’t make this stuff up!) and yes, he previously had a firearms license. Judge ordered him to give up his guns.

Are you ready for it? He’s an IRS employee from Massachusetts.

Member
Peter
Dec 10, 2015

Not sure why being an IRS agent would make any difference. They can be crazy and own guns (with the blessing of the NRA) as well as anybody.

Member
Peter
Dec 3, 2015

It’s a sick country Joe. I don’t see any solutions on the horizon unless politicians start the healing.

Member
Dec 3, 2015

Politicians thrive on division and fear. The coins of the Realm.