From my now defunct website, 2004, but still valid:
You are a psychiatrist, and you have fifteen minutes to hear this story, solve the problem, write prescriptions, and a do a progress note.
You meet for the first time a country-bred boy or girl raised to believe the American work ethic: Work hard, and you will succeed.
Mike goes to work for a mill or factory, drives a truck, does welding, wiring, carpentry, or plumbing for a large company or contractor. He loves what he does, but pressure to perform, conflicting demands, long work hours, low pay, and personality politics lead to stress, dissatisfaction, anger, and a constant sense of being exploited on the job. This makes him impatient with details in situations where one slip-up can cause an irreversible, work-related injury. He gets hurt on the job.
Pre-paid "benefits" and workmen's compensation kick in, complicating the problem with confusion, delay, hoops, and other obstacles designed by the insurance company or the government to keep as much of the pre-paid money as possible. Meanwhile, our injured worker must try to get some benefit from the "benefits" that tied him to a demanding and unfulfilling job, and prevented him from leaving.
Now, to extract some return on his investment, he must appear as sick as possible; otherwise, health care for him is not a "medical necessity."
Obviously, he can't work. If he tries to work at all, third party payers might claim treatment isn’t "medically necessary" after all. So between doctor's appointments, tests, procedures, surgeries, and medications that are prescribed because that’s what insurance will pay for, he lounges on the couch and watches TV.
He eats, drinks, and smokes more. His joints get stiffer as his gut gets bigger, and pretty soon he is wheezing on his way to the refrigerator.
Now, he really has something to complain about. He's on pills for hypertension, cholesterol, diabetes, and pain, and he's depressed. He goes on pills for depression, too, but they don't help, so he binges on alcohol, gets into a fight or a wreck and gets hurt again. Meanwhile, his debts pile up, his wife is threatening to leave, and his children are in trouble at school. He escapes into alcohol, crack, or television and becomes more accident-prone.
He applies for Social Security Disability, which he has earned through back-breaking labor. To qualify for disability, he must convince his doctors and other treatment "providers" that he is not fit to work. Bills continue to mount, as bureaucracy drags its feet. He can’t mow his mama's grass for fear government spies will see him doing something useful and deny his claim.
He watches more TV, gets more depressed, and the downward spiral continues.
Unrelenting debt and overhead tie him to a merry-go-round of desperate measures to meet obligations. He hasn't the time, concentration, or resources to reconfigure his career when his personal world is in chaos. He watches more TV, eats, drinks, and smokes. He convinces himself and hears from everyone around him that he is worthless, hopeless, or just plain pitiful. A loser.
He can’t afford payments on the truck he bought when he was working, and he can’t afford the gas. The truck is repossessed, handicapping him further, because he no longer has transportation to any work he might get.
The threat of homelessness becomes real, because shelter is expensive. He stays with relatives, friends, or lives out of a car or camper. As frustration mounts and self-esteem plummets, he alienates everyone close to him with outbursts of temper, violence, theft, or other anti-social activity.
Under this scenario, our workman has little chance of climbing out of his rut. If he doesn't end up in jail or kill himself first, he becomes dependent on the state and gets his monthly check, provided he doesn't work very hard.
Thus he is assured a roof over his head and a few amenities, but he has signed away his right to pursue gainful employment. Once again, he is duped, because he thinks he has won.
But he hasn’t because Medicare and Medicaid are ensnarled in bureaucratic tangles, and the government is bankrupt. They compensate by raising the bar on disability qualifications, so our hopeless victim no longer meets criteria for his check. He must get even sicker to qualify for government assistance.
Your fifteen minutes are up. What is your solution?