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Bryan Frahm

Signature Assignment

10/18/2019

HLTH 202
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Mental health is an important issue because in 2018, an estimated 47.6 million adults

aged 18 or older were affected by a mental illness in the past year. Furthermore, an estimated

11.4 million adults in the nation had a serious mental illness in the past year, corresponding to

4.6 percent of all U.S. adults. (Substance Abuse and Mental Health Services Administration,

[SAMHSA], 2019) Substance use can also be treated as a mental illness and in 2018, an

estimated 164.8 million people aged 12 or older in the United States used tobacco, alcohol or

illicit drugs within the last month. (SAMHSA, 2019) When it comes to adolescents aged 13-17

years old, researchers estimated the prevalence of mental illness to be 40.3%. (Bagalman &

Cornell, 2018) About 1 in 7 adolescents aged 12 to 17 had a past year major depressive episode,

or 3.5 million adolescents. (SAMHSA, 2019) This prevalence in mental illness is the major

reason I believe there needs to be an overhaul with how we look at mental illness overall.

More recently there has been a massive push for this in not only public opinion but in

policy changes as well. Even then recent evidence suggests the prevalence of depression is

increasing and despite policies designed to improve access to mental health care, disparities in

depression have persisted or worsened (Todd & Teitler, 2018) Policies designed to give better

access to health care to help treat mental illnesses aren’t making a difference for many people.

Among the 47.6 million adults who were affected by mental illness, only 20.6 million received

mental health services in the past year. Out of the 3.5 million adolescents only 1.4 million

received treatment over the past year. (SAMHSA, 2019) This results in less than half of people

in need of treatment for mental health are actually getting the services that they need.

This disparity between being diagnosed with mental help and getting treatment for it

could be caused by a multitude of reasons, such as lack of education, lack of money, or even

because of the social stigma associated with mental health. For this reason, an overhaul of how
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we treat mental health may not be as easy as one would hope. Changing a culture that may look

down on men with depression as less of a man, or seeing people of a lower socioeconomically

class as lazy can’t be fixed with one or two health care policy’s.

One way that lawmakers have tried to help people get treatment is the Affordable Care

Act. After it was implemented in January of 2014, uninsurance rates among adults fell

substantially, from 20.1 percent in the fourth quarter of 2013 to 15.1 percent by the fourth

quarter of 2014 and 12.6 percent by the fourth quarter of 2015. (Duggan, Goday, & Jackson,

2019) This increase in coverage could be a result of two controversial policies of the Affordable

Care Act. The first, the Individual Mandate, is a requirement that people must have health

insurance or pay a penalty. The idea behind this is that the penalty will be a way to get people to

get health insurance if they can afford it on their own but don’t have it, thus increasing coverage

rates. This is controversial because a lot of people feel that they should be able to choose for

themselves how they want to deal with their own health and that having a fine for deciding to not

have health insurance is unconstitutional. (Avsar, 2015)

The other policy, The Pre-Existing Conditions clause, also looks to increase health

insurance coverage. More importantly this increases coverage for people who have already had a

health issue in the past. These people may have been denied coverage before the passing of the

Affordable Care Act. This is controversial because some people feel as though they are

subsidizing other people’s medical treatments. Without this policy people with pre-existing

conditions may have to pay more for coverage or be denied any coverage at all.

There are many different viewpoints when you look at these issues ethically. To me the

three most important are Utilitarianism, Egoism, and Natural Law. Utilitarianism is probably the

best viewpoint when it comes to looking at the Affordable Care Act and expanding mental health
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care. It states that we act morally right when our actions produce the greatest possible outcome

for all involved. Allowing greater access to healthcare for all was one of the main goals of the

Affordable Care Act. Using this ethical viewpoint this would be morally right. Greater access to

mental health facilities would also stand to be beneficial for not only people who have mental

health issues but also the population as a whole.

The next important viewpoint is Egoism. This one states that we should only consider the

consequences for ourselves. This is important because for some people, it directly contradicts the

Affordable Care Act. While the policies discussed earlier were directly designed to increase

insurance coverage across the country, many people felt as though they were directly subsidizing

other people’s health and money issues. They were worried their rates would increase because

they now had to essentially pay for someone else’s insurance who got it for a reduced price. So

to them expanding health care coverage was an immoral thing to do. There are some exceptions

where this viewpoint could see it as morally right, such as if you were one of the people who

wasn’t able to afford coverage before, or if you stood to profit off of the increase in coverage.

The last important viewpoint is Natural Law. It states that humans should live according

to the naturally occurring laws found in nature. This one is interesting because it doesn’t have a

clear morally right or wrong with these issues. Some will argue that increasing coverage of

health care would be morally wrong because it disrupts the natural law of survival of the fittest.

Others will argue that its morally right because its human nature to look after and care for other

humans.

When it comes to The Individual Mandate and the Pre-existing Conditions clause I fully

support what they are trying to do. As someone who grew up in a poor family and is considered

to live in poverty I understand the fear of getting sick or hurt and not having insurance. In an
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ideal world this problem wouldn’t exist. Families shouldn’t have to go bankrupt just because a

loved one was diagnosed with cancer and they chose to fight it. Getting treatment shouldn’t be a

financial decision.

The Individual Mandate is probably the most controversial to me. I don’t like the fact that

some people have to pay a fine simply because they don’t have insurance. I know there are

plenty of exceptions to it though. I haven’t had health insurance in 2 years and have never had to

pay a fine for it because I make under a certain amount per year, but not everyone is in the same

boat as I am. With that said there isn’t a perfect way to increase coverage across the country,

unless health care becomes a right for every citizen. This is very much a Utilitarianistic view.

The greatest good for the majority would be to allow everyone equal access to health care

facilities. As it stands now, if you don’t have the money to get treatment or health care, you

would have to go into significant debt to get that treatment. Even with health care, your condition

may not be completely covered.

Being selfish simply won’t fix this problem. As cost of living continues to rise, and

wages continue to stagnate, more and more people find it difficult to get the treatment that they

need. Looking at this through egoism would leave many people without the help and care that

they need. Not everyone has the same opportunities as others, and what may be in your best

interest could contradict what is best for many people. This is an important aspect to look at

though because there are a lot of people who look at health care in this way. As long as they are

ok, the struggle of others isn’t their problem.

One of the main problems when it comes to universal health care is who pays for it.

People in The United States notoriously hate taxes and any mention of raising them. There is a

lot of information out there stating that people will pay more or people will pay less under
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universal health care, and this causes a lot of confusion for people. Some like Bernie Sanders say

the answer is to tax the super-rich and corporations so the effect for 99 percent of people will be

almost negligible. While I agree this is the best way to finance universal health care this can

cause a multitude of issues. Increased taxes could cause an increase in prices, it could cause more

corporations to leave and set up in different countries, and many more economical effects that we

simply can’t predict. With all of this in mind I still believe that the morally right thing to do

would be to take care of our fellow humans and allow everyone access to health care.
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Bibliography

Avsar, R. B. (2015). A Rawlsian Defense of the Individual Mandate: The “Collective Asset”

Approach. Review of Social Economy, 73(2), 146–153. doi:

https://doi.org/10.1080/00346764.2015.1035911

Bagalman, E., & Cornell, A. S. (2018). Prevalence of Mental Illness in the United States: Data

Sources and Estimates. Congressional Research Service. Retrieved from

https://fas.org/sgp/crs/misc/R43047.pdf

Olfson, M., Wall, M., Barry, C., Mauro, C., & Mojtabai, R. (2019). Effects of the Affordable

Care Act on Private Insurance Coverage and Treatment of Behavioral Health Conditions

in Young Adults. AJPH POLICY, 108(10), 1352–1354. doi: 10.2105/AJPH.2018.304574

Duggan, M., Goda, G. S., & Jackson, E. (2019). THE EFFECTS OF THE AFFORDABLE

CARE ACT ON HEALTH INSURANCE COVERAGE AND LABOR MARKET

OUTCOMES. National Tax Journal, 72, 261–322. doi: 10.17310/ntj.2019.2.01

Kaye, S. (2019). Disability-Related Disparities in Access to Health Care Before (2008–2010)

and After (2015–2017) the Affordable Care Act. AJPH POLICY, 109(7), 1015–1021. doi:

10.2105/AJPH.2019.305056

Substance Abuse and Mental Health Services Administration. (2019). Key substance use and

mental health indicators in the United States: Results from the 2018 National Survey on

Drug Use and Health (HHS Publication No. PEP19-5068, NSDUH Series H-54).

Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse

and Mental Health Services Administration. Retrieved from

https://www.samhsa.gov/data/
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Todd, M., & Teitler, J. (2018). Darker Days? Recent Trends in Depression Disparities Among

U.S. Adults . American Journal of Orthopsychiatry. Advance online publication.

http://dx.doi.org/10.1037/ort0000370

Reference List

Avsar, R. B. (2015). A Rawlsian Defense of the Individual Mandate: The “Collective Asset”

Approach. Review of Social Economy, 73(2), 146–153. doi:

https://doi.org/10.1080/00346764.2015.1035911

Bagalman, E., & Cornell, A. S. (2018). Prevalence of Mental Illness in the United States: Data

Sources and Estimates. Congressional Research Service. Retrieved from

https://fas.org/sgp/crs/misc/R43047.pdf

Duggan, M., Goda, G. S., & Jackson, E. (2019). THE EFFECTS OF THE AFFORDABLE

CARE ACT ON HEALTH INSURANCE COVERAGE AND LABOR MARKET

OUTCOMES. National Tax Journal, 72, 261–322. doi: 10.17310/ntj.2019.2.01

Substance Abuse and Mental Health Services Administration. (2019). Key substance use and

mental health indicators in the United States: Results from the 2018 National Survey on

Drug Use and Health (HHS Publication No. PEP19-5068, NSDUH Series H-54).

Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse

and Mental Health Services Administration. Retrieved from

https://www.samhsa.gov/data/
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Todd, M., & Teitler, J. (2018). Darker Days? Recent Trends in Depression Disparities Among

U.S. Adults . American Journal of Orthopsychiatry. Advance online publication.

http://dx.doi.org/10.1037/ort0000370