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What would Mao have done with our behavioral healthcare system?

October 20, 2010
by H. Steven Moffic, MD
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Do you remember the "Cultural Revolution" that Mao unleashed in China from 1966-1976? Among other drastic changes, he encouraged young men and women, called the Red Guard, to reform, destroy, and/or kill all that seemed to have to do with high culture and scholars, including parents, relatives, and friends. In a country rich with intellectual accomplishments and scientific discoveries, teachers, artists, scientists and the like were especially targeted. "Barefoot doctors" was an innovation (that proved to be temporary) to serve rural areas instead of training more real doctors.

After spending some time recently in China, it was interesting to hear the mixed opinions on those years, which were similar to the mixed opinions on Mao. (Of course, when one talks with Chinese people in China, you cannot assume they are telling you the truth as they see it, as criticism of the government can get you in trouble). Like any good mental health therapist, you have to listen with a "third ear" and read between the lines. If they say that Mao did 70% good and 30% bad, as I often heard, maybe they really believed just the opposite.

After a period of transition following Mao's death in 1976, China reestablished the value of those targeted, and the current phase of tremendous capitalist growth emerged. The party line is that this is "socialism with Chinese characteristics", but whatever this is called, it is a unique and successful model. So now we have China with the world's second largest economy, basketball star Yao Ming, and the most famous pianist in the world, Lang Lang. Beijing is attempting to become the museum and art gallery capitol of the world. Even psychiatry, and psychoanalysis, is in a growth phase. Of course, like most things, there are side effects and drawbacks, especially severe air pollution.

Some proclaim all this startling development would have started at least 10 years earlier if not for the "Cultural Revolution." Others say that the attempt to make everyone equal (even at a lower level) was a necessary "cleansing," so that development would take off more quickly. Who can know in retrospect? It's like "Monday morning quarterbacking" after a Sunday football loss that is explained by player injuries. It is certainly hard for me to accept that such development was worth the costs of the Cultural Revolution.

Somehow, this got me thinking about our healthcare and mental healthcare reform. As we now know, whatever is emerging from President Obama's reform is coming slowly and minimally, if not surely. What is not changing much is the control and management of the insurance and managed care companies. No public option was included to compete or level the playing field. Do we really think this is going to improve mental healthcare? If the Republicans regain power, the insurance companies are likely to become even more powerful.




I guess my attempt to be a little tongue-in-cheek and paradoxical didn't come across to this reader, whoever "anonymous" is or represents, but I appreciate the comments. To be clearer to everyone, I don't really recommend anything like the "Cultural Revolution" due to the wanton destruction of lives, but history and nature has an odd way of showing that great creativity and advances can come out of destruction, intended or not.

Yes, many people do come to the U.S. for high tech treatments, but many here do go overseas for cheaper surgery of equal quality. For mental healthcare, all I know of Canada, including many visits there, indicates better care at lower costs with little wait time. Yes, there are waits for routine healthcare, but if they spent as much as us, that would diminish drastically. The USA is also not very high on all cross-national measures of quality of healthcare, and our current waste in poor quality of care certainly contributes to our debt. I also personally know that I have to go through too many obstacles, mainly by for-profit managed care companies, to try to provide competent care.

I wonder why healthcare is a business here, and only has been a right for those in prison? And why I can provide better care for inmates than those in our community mental health system?

I would certainly be in favor of pilot projects to assess any new ways of delivering healthcare or mental healthcare, but that is not in the reform package. My own prior recommendation was for a not-for-profit managed, single payer with universal coverage. And I don't personally have any problems with the post office when I need to use it.

Maybe you need to re read your first paragraphs, my goodness how could you even say that maybe "that we needed something like a cultural revolution in our healthcare reform"...Universal coverage, please-where do you think the money will come to support research? Why do you think others from all over the world come to us for our healthcare? Please have you spoken to people that have lived in Canada? I know a nurse that has just obtained US citizenship, he tells how his family cannot believe that he can go to any physican of his choice with out 1-getting approval from his primary care physician and 2- without waiting a usual 6 months for an appt.
You think the insurance companies are what is causing all the "problems"...just think of what it will be like with government run healthcare-here let me give you a thought-go to the post office and check it out, see if you like that, and translate that into going to the doctor...Oh yes, you mention China "that the attempt to make everyone equal (even at a lower level) was a necessary "cleansing"...that very statement should send shivers down anyone with a spine and a brain attached!
I for one think "blaming" a polictical party or the insurance industry as causing the "fault" of our health care delivery system is simple minded, in the fact that our culture, our society here in America was never set up for someone, insurance companies, or government to "take over" or "run" healthcare or other business, and yes Health Care is a business...
How can you avocate to wipe out something before you have a evidence based tested replacement?????
What you call "unnecessary private business sector" is the very sector that makes us USA and good bad and ugly lets work with what we have, if I may, repair the parts that need repairing, replace parts that have been proven to no longer function with parts that have been tested, (by the private sector lets hope), to improve not destroy-no bandaid for this, no placing the burden on someone else, the debt to be paid by the unborn babies of tomorrow, who will say "WHY"???

I am not well acquainted with the system in China, but I strongly support Dr. Moffic's (implicit) call for something like "universal coverage" and a single-payer system in the U.S. Health care ought to be considered a basic human rightnot a privilege contingent upon the "free market" or the whims of insurance companies. Basic human rights require sacrifice, and yestaxes! That's the price civilized countries pay for being civilized. I believe most MDs in this country would agree with these sentiments.

And while I applaud the incredible technology and innovation in medical science in the U.S.as well as the stalwart efforts of doctors, nurses, and allied health professionalsit is a dangerous myth to assume that our health care system is the "best in the world", the "envy" of other countries, etc. We have fallen far short in some of the most basic areas of health care delivery in this country, and it will indeed take a "revolution" of some sort to change things for the better. Ronald Pies MD


H. Steven Moffic

H. Steven Moffic

H. Steven Moffic, M.D. retired from the clinical practice of psychiatry and his tenured...

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