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Pragmatism and the Healthcare Debate

Opinions abound about healthcare in the United States. But while people with competing ideologies retreat into their corners, people in poverty with mental illness suffer needlessly.

The debate rages over whether or not healthcare is a human right, and we’ve ended up with a patchwork of private providers and public assistance. It seems no one is happy.

For those of us with coverage from an employer it’s still difficult. My family faced open enrollment this month and it took hours, and a spreadsheet, to choose between options. I gave up, poured a bourbon, and sat staring out the window at an early snow, while my wife struggled on until we could make a choice. But we’re still unsure what it’s all going to cost.

Those on coverage through the ACA face each year with wildly different costs and coverage, and the possibility always looms that in the future nothing will be available. Those on Medicaid carefully negotiate income and possibilities that may make them ineligible, and those on Medicare live with the fear that political whims or large budget deficits may change their coverage or what gaps they have to fill.

But it’s much more difficult for those who can’t afford coverage that would take care of the cost of chronic illness, or those who can’t afford coverage at all. Those with lives battered by mental illness often fall into one of three categories: First, if they are working, it’s often in the gig economy where income is unpredictable and benefits are rarely offered. Others are trapped on disability, often with health insurance, but afraid to move into work for fear of losing coverage. Then there are those so sick, so trapped in poverty, often unable to seek or even understand the help that is seldom available. For those people we, as a society, should be making the most effort. But they have no voice or constituency and are left alone to suffer when medical help, if only it were made available, could so readily help them overcome the terror of their illness. Treatment works, but so many have no access to treatment. In our polarized debates over rights and payment, I fear we have left practical reality, and potential solutions, behind.

But questions of rights — and payment — must be settled. While some entrepreneur will surely solve the problem for those who can afford to pay, for those who can’t there may be nothing. Some solutions, like the Medicaid expansion, appear to be working in some states. Some nonprofits have found local ways to help those lost in a complicated and failing system. But a large workable solution to health inequities seems elusive. I sure don’t have the answer, but I fear we may sacrifice proven results on the altar of ideology.

People in poverty with mental illness are suffering unnecessarily. They look to us to stop stonewalling and come together to reach out and offer the help that simple justice demands. We must help them. In the words of Goethe: “Do your duty. What is the duty? The necessity of the day.”

Pragmatism and the Healthcare Debate

George Hofmann

George Hofmann is a mindfulness meditation instructor teaching people with mental illness how to manage stress. He also has bipolar disorder 1. He writes about these topics at

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APA Reference
Hofmann, G. (2018). Pragmatism and the Healthcare Debate. Psych Central. Retrieved on December 5, 2020, from
Scientifically Reviewed
Last updated: 2 Dec 2018 (Originally: 2 Dec 2018)
Last reviewed: By a member of our scientific advisory board on 2 Dec 2018
Published on Psych All rights reserved.