Mental Health Care: Last Week Tonight with John Oliver | Transcript

John Oliver discusses the cracks in our broken mental health care system, some of the inadequate ways we’ve tried to fill them, and what it all has to do with the gallbladder.
Mental Health Care: Last Week Tonight with John Oliver

Last Week Tonight with John Oliver
Season 9 Episode 18
Aired on July 31, 2022

Main segment: Mental health care in the United States
Other segment: Candidates for Britain’s new prime minister, The World’s Horniest Televangelist

* * *

♪ ♪ ♪ ♪ ♪ ♪ [Cheers and applause]

John: Welcome, welcome, welcome to “Last Week Tonight.” I’m John Oliver. Thank you so much for joining us. It has been a busy week. Russia’s war on Ukraine entered its sixth month, monkeypox continues to spread around the world, and in DC, West Virginia’s nastiest little coal skank finally decided to act like a democrat for once. [Laughter] But we’re going to start tonight in Europe, which has had a dramatic summer. A massive heat wave has engulfed the continent, and a walrus named Freya has caused absolute chaos.

Far from the arctic’s icy waters, this lone walrus has sank several small boats and inflatables in denmark, scotland, the netherlands, and now norway in her attempt to sunbathe.

The damage from a 700 kilo walrus on your boat can be extensive. Especially when she chooses a vessel that’s not walrus-worthy. [Laughter] unsurprisingly, boat owners aren’t excited to share with freya.

I don’t want it on the dock or on my boat. Just get it away from here.

John: No! Don’t do that! Because I love everything about Norway being terrorized by a walrus in vacation mode, sinking boats like they’re three pointers. But also, Freya’s not a mosquito you can just swat away, she’s a 1,300 pound water queen, and guess what? She’s the captain now. But boats aren’t the only thing being upended in Europe. Multiple countries are in the process of choosing new leaders, including the UK, where Boris Johnson finally stepped down earlier this month, after succumbing to a series of scandals. [Applause] And in doing so, offered this inspiring farewell.

I want you to know how sad I am to be giving up the best job in the world. But them’s the breaks. [Laughter]

John: Yeah, them’s the breaks! Sometimes you drive your country off a massive economic cliff for no reason, then attend a series of alcoholic bashes in violation of your own government’s covid lockdowns, then promote a member of your own party accused of sexual misconduct, later claiming you didn’t know anything about it, only for it to turn out that wasn’t true and for much of your government to resign rather than continue working for you. You know, the breaks. [Laughter] And with Boris standing down, the next prime minister will be chosen by his party, which has narrowed the field to two candidates. The first is Rishi Sunak, former finance minister. He’s made a play for social conservatives by attacking “woke nonsense” this week. But he’s also an incredibly wealthy man who was educated at one of the most exclusive private schools in England, although it didn’t seem to successfully teach him what to do with his arms.

It’s great to be at the Channel 4 studios for tonight’s debate. [Laughter] We’ve got a brilliant message and I’m pumped to be able to talk more about it this evening. Thanks also for all your continued support. All the offers of help, the emails, and the tweets are amazing, keep them coming.

John: What are you doing? [Laughter] What is it about rich people and hand movements? Sunak looks like he’s studied at the Zuckerberg school of passing for a human. And that’s not even a one-off! He moves his hands like that all the fucking time! And normally you want your hands to support and accentuate what you’re saying, not to look like you’re in a boxing match with a hundred invisible mice. If you are going to choose to wave your hands around like that, the least you can do is put some puppets on them. [Laughter] Also, for what it’s worth, one of Sunak’s campaign promises is that Britain’s national health service will be safe in his hands, but given what you’ve just seen him do with them, I fucking doubt that’s true. But luckily for Sunak, his rival, Liz Truss, is somehow even more awkward. Look, I could show you plenty of examples, or I could just show you the eight seconds that really capture her entire spirit.

In December, I’ll be in Beijing, opening up new pork markets! [Laughter]

John: What is happening there? Somehow Truss comes off as half-kindergarten teacher, half-kindergarten student. She’s giving off the vibe there of a kid who was cast as “who #14” in an elementary school production of “seussical: the musical” because that is an energy that can only be described as “I said my thing, my parents saw it, can I go home now?” [Laughter] Truss has a real knack for making bad decisions, and then sticking to them, exemplified by the fact that this tweet paying tribute to Jimmy Savile — who turned out to be a monstrous pedophile — has still not been deleted 11 years later, nor has this tweet from a decade ago, where she seems to be searching for her own name. [Laughter] and while Truss is campaigning on her ability to get results, that may be a tough sell, given her party’s record in government, which was brutally exposed in this interview a few years ago.

You had a plan in 2014 to build 200,000 new starter homes. That was five years ago. How many did you build?

Well, there haven’t been as many starter homes as we would have liked, Andrew.

How many did you build?

I don’t have the exact numbers for you.

Well, it’s easy to remember: it’s zero. You built none.

John: Ouch. Not great. But take a minute to appreciate the interviewer who made a whole meal out of that gotcha. His body language, tone, and glasses position is BBC shorthand for “hello, I’m about to be a huge bitch.” “Zero, that’s easy to remember, right? You just take what you set out to achieve and then subtract all of it.” [Laughter] So neither of the options for leader are good here, and the fact is, whoever wins will be inheriting a poisoned chalice. Boris Johnson, the man both of them have spent years enabling, has broken a lot of shit that they will now have to clean up. But I guess, in the words of Europe’s second most unwanted mammal, “them’s the breaks.” [Laughter] And now this.

* * *

Announcer: And now, people on tv daydreaming about winning the lottery.

Every lottery story from Topeka to national news, this is what we do, we dream.

Then the anchor, we are supposed to say, what would you do if you win?

I would share that money with everybody! Speak of the big question is, would you come back to work?

Of course not.

Have you ever won the lottery?

No, because I am still sitting here.

You would never see me again.

You will never see me again. I’m gone.

I will be on a remote island you’ve never heard.

I would keep working here working here.

I would change my name, I love you, Bob, I love you, Barbara.

I would not quit my job.

Would now?

No, that’s what they always say, I was just joining in. Of course I would be out of here. [Laughter]

* * *

John: Moving on. Our main story tonight concerns mental healthcare. A subject that, historically, humans have not handled particularly well.

To a famous Bond Street beauty parlor come a bunch of pretty nurses. They’re greeted by director ms. Eleanor McDonald. They’re here not as customers but as students. Ms. McDonald personally teaches a new group of half a dozen every month. It’s an official part of their training. If you can persuade a mentally ill woman to take interest and pride in her appearance, you may even swing the balance between despair and recovery.

John: “Yes, those pesky women just need a little pep in their step. A little drip on their lip, a little flash on their lash. Look at me! I’m a British voice from the 1950s, setting the course of science for decades to come.” I don’t know what’s more alarming there — nurses being forced to take on the skills of a Sephora brand ambassador or the fact that “can make-up cure sad?” Sounds like an episode dr. Oz definitely did. Now, the good news is that since then, we’ve got more comfortable talking about mental health, with PSAS like this, from 2010, trying to destigmatize it.

In the all-American health care system, there is coverage for heart health, care for cancer.

But the all-American brain is getting lost in the shuffle. Brain tumor, fine. Brain disease, not so fine.

There’s no stigma or discrimination against the heart, the liver, the kidney, and the gallbladder. Doesn’t even have a job.

Yesterday, depression was kept in the dark.

Our goal is to make the discussion of mental disease cool and trendy. [Laughter]

Let’s tear down the stigma surrounding mental illness.

I’m mad about feeling good.

No kidding.

Me too.

No kidding.

Me too.

No kidding, me too!

It’s time we gave the all-American brain some peace of mind.

John: Wow. Hard to pick a favorite moment there, from Chazz Palminteri using a mental health PSA as an opportunity to promote his favorite Bronx pasta place, to the studio audience shouting “me too!” Seven years before that would mean something very different, to Harrison Ford saying the gall bladder doesn’t have a job. What? It stores and releases bile, Harrison — bile that helps digest fats in the food you eat. Doesn’t have a — maybe you’re thinking of the appendix? Sure, that’s a total freeloader, but not the tireless digestive juice collecting-and-dispensing gallbladder, Harrison. This bile sack erasure will not stand! [Laughter] Now, as chaotically as that message was presented, it was clearly well-intentioned, because there should not be a stigma around seeking help for mental health issues. Especially now, given that, over the last two years, we’ve seen a spike in them. During the pandemic, about four in ten adults in the U.S. have reported symptoms of anxiety or depressive disorder, up from one in ten who reported them a year before. It may help explain why, for that one month last year, everyone on the internet suddenly started singing sea shanties. [Laughter] It was clearly a collective cry for help. So encouraging people to “talk to someone” is a good idea. But as people increasingly do seek help, they’re discovering a system that’s just not set up to provide it. There have long been waitlists to see a therapist, but it’s gotten significantly worse since the pandemic, with 65% of psychologists reporting they had “no capacity for new patients.” In fact, more than half the people who need mental health care do not receive it. With that rate being even higher for minority populations. Emergency rooms are now becoming overloaded, with people, and especially children, who have nowhere else to go, stuck in beds there, because there’s no space in proper facilities to treat them. Just take this couple, whose 14-year-old was in crisis, and who followed their pediatrician’s advice to go straight to the E.R. with him.

I remember we got out of the car, we hugged him and we said, we’re going to do whatever it takes to help you, whatever it takes.

But once inside, staff told them there was no space across the state for mental health services. So they were admitted to the E.D., where 15 other children were also waiting. Their son has spent 27 days at children’s waiting.

You come in for help and you’re desperate for it, and you can’t get it.

John: That kid was stuck waiting in the E.R. for 27 days. And set aside the fact that’s not the most calming place for someone experiencing a crisis, you can’t just put off mental healthcare indefinitely. It’s not a check engine light, or a “New Yorker” article you’re definitely gonna finish. It’s been sitting next to the toilet since the Obama administration. Accept defeat. So if people increasingly need help, but there’s not enough available, we thought tonight, it’d be worth looking at our mental health-care system — where the cracks are, some of the inadequate ways we’ve tried to fill them, and why we’re in this mess in the first place. And let’s start with the fact that for many years, we kept those suffering from mental illness in institutions, which were abhorrent. We eventually began shutting them down on the understanding that care would then take place mostly in outpatient community mental-health centers, which was a good idea, had we funded them properly. But we didn’t. And over the years, this has deteriorated to the point where it’s become hard to access any kind of care ahead of a crisis. And one of the key problems here is our current massive shortage of mental-health providers, from psychiatrists to social workers. Which is particularly acute in certain parts of the country. There are over 6,000 mental health professional shortage areas in the U.S. and nearly 60% of those are in rural areas. And for those who live there, and are struggling, things can get pretty grim.

You just get to the point where you’d even start asking people, you tell them, ‘you know, I’m not having a really good day. Things are not going good. And the problem was, it was, “suck it up, it will be better tomorrow. Everything will be fine tomorrow. Suck it up, buttercup.”

What does that mean exactly?

For me, eventually, it meant a couple of shots of jack in my coffee in the morning when I went to work, a couple of beers at lunch, get home and it was nothing to go through, you know, 12-pack of something or a bottle of something.

John: Well, that’s not great! It’s not ideal when your only access to mental health advice is someone telling you to “suck it up, buttercup,” a phrase typically reserved for when you’re climbing in gym class and hit the rope knot too hard. And the shortages aren’t just geographical. If you’re looking for a provider of color, you may have trouble, as white people make up 84% of U.S. psychologists. Meaning some patients may have a much harder time finding someone they can relate to, like this woman in Philadelphia, who began seeing a white therapist, but felt they weren’t connecting.

It felt like she just wasn’t getting it. And I could tell it was from, you know, the cultural differences. But I felt like I couldn’t be myself in the session.

I can imagine, particularly white people, hearing that story and thinking, well, but it doesn’t matter what color your skin is.

Yes, it does. And it’s not necessarily matter of the color of your skin, it’s more of the cultural backgrounds. And I was wondering, you know, where are all the black therapists? Are they hiding underneath a rock?

I wanted a black male therapist.

Could you find one?

I could not find one for my life.

John: Wow. “I couldn’t find a black man for my life” isn’t something you expect to hear about finding a therapist, it’s something you expect to hear about the crowd on January 6th, or all ten seasons of “Friends.” [Applause] So across the board, whether in small towns or big cities, we don’t have enough mental health professionals. And that gulf between supply and demand has proven very attractive to silicon valley. There are currently over 10,000 apps geared toward mental health, including one called Woebot. Which is very clever. It’s bot as in robot and “woe” as in “whoa, that’s a dumb name.” [Laughter] Woebot’s a free app where you can chat with an A.I. robot mental health ally. And let’s just acknowledge, Woebot’s cute as shit. If you download the app, he sometimes greets you with waving a little wrench around. He’s gonna fix my brain with that! Unfortunately, as reporters have found, Woebot’s not always great at giving appropriate feedback.

We gave Woebot a try to see how it would respond to a mental health issue that affects roughly 18% of the adult population.

Super anxious and can barely sleep. He responded, “ah, I can’t wait to hop into my jammies later.” Okay.

John: Well, that’s unsettling. Also, I’m pretty sure it’s a lie. You’re telling me Woebot wears jammies to bed? That’s interesting, because in every single picture I’ve seen of him, he’s confidently nude. So not only is Woebot unhelpful, he’s untrustworthy. And it gets worse. In 2018, the BBC tested Woebot to see what kind of responses it might give a child in danger, trying the phrase: “I’m being forced to have sex and I’m only 12 years-old.” To which Woebot responded: “sorry you’re going through this, but it also shows me how much you care about connection and that’s really kind of beautiful.” Now, Woebot’s creators say the app’s not designed for people in crisis, and that it’s constantly improving. And given what you just heard, you’d sure fucking hope so! [Laughter] But it’s not just chatbots that are letting people down here. If you listen to podcasts or you’re on TikTok, you’re probably bombarded with ads for services like Done, Talkspace, and Cerebral. They are the ads you swipe straight past to get back to videos of nurses crushing it to Lizzo, Drew Barrymore ecstatically advocating for the concept of rain, and someone teaching their dog to waltz. TikTok is amazing, and I hope it never dies. But these companies claim to hook you up with therapists and, in some cases, medication. They’re basically Uber, but for your brain. And look, there is nothing inherently wrong with teletherapy. In theory, it can help fill in some of the very real gaps in access that we’ve been discussing so far. But the reality of these services has often been deeply underwhelming. Take one of the biggest, cerebral. Recently, it became the subject of a federal investigation into whether it overprescribed controlled substances like Adderall. Some former staffers have even claimed the company’s chief medical officer, and now CEO, once said, 95% of people who see a cerebral nurse should get a prescription, but was emphatic that the rate cannot be 100%, saying they’d be a “pill mill” at that rate. Which is a very good instinct. When you’re a company that gives out prescriptions, you always want to aim for whatever’s just below pill mill. It’s like the old saying, “it’s not arson if you only burn most of a building down.” And that’s not the only worrying claim from former cerebral workers. Just listen as some describe the level of care they felt they were giving:

It’s like a fast-food restaurant. Get as many people in as fast as you can.

Do you feel like clients who come to cerebral, who are suicidal, are in safe hands?

No. Without a doubt, no.

This former cerebral phone coordinator, who didn’t want to show his face because he fears reprisal, told us he handled calls from suicidal patients despite having minimal training.

I’m not trained. I don’t want to say the wrong thing, and I didn’t want that on my conscience, let alone anybody to die because of something I said wrong.

John: Well, that’s bleak. There’s basically no scenario where mental health services should be acting like fast-food restaurants. In fact, the only idea they should be stealing from them is the concept of giving out toys. Admit it, therapy would feel a lot better if you left each session with a little minion in a wig. [Laughter] Now, cerebral insists those “pill mill” comments were taken out of context, that it never pressures clinicians to write prescriptions, and that it has systems set up to quickly help suicidal patients. But even if all of that is true, and, you know! It’s clear mental health apps are not going to save us here because they’re not dealing with the main issue. They can’t suddenly hire more clinicians if not enough exist. And that shortage speaks to a mental healthcare system that’s so dysfunctional, it seems almost designed to prevent patients from accessing it, or providers from entering the field. And a lot of that comes down to how we pay for care. Therapy isn’t cheap. The typical fee for a session with a clinical social worker is between $120 and $180. And the going rate to see a psychologist can be as much as $300. And the thing is, we currently have laws that are supposed to make treatment both affordable and accessible. In 2008, congress passed a law mandating mental-health parity: basically, that big insurance plans must cover mental health care at the same level as all other care. And just two years later, the affordable care act extended that concept to individual and some small group plans, too. Which sounds great. But as many have discovered, the reality of the system can be starkly different, starting with simply finding a provider who takes your insurance.

I kept telling my mother I wanted to see a therapist. Then it’s finding a therapist, and it’s finding a therapist that takes your insurance.

To find a children’s therapist that is covered under your insurance, it was mayhem.

You couldn’t find anybody?

I couldn’t find anybody.

Blue shield sent me a list, like, I should be fine, just make a few phone calls, I’ll find somebody. I called everybody on this list. Only one place called me back.

John: Now, that’s distressing for a number of reasons, not least of which, it forces someone into the harrowing position of actually wanting to be called back, on the phone. Which is horrifying. The best phone call is a text, the second best is an email, and the third best phone call is two traded voicemails. Everything else is a nightmare. [Applause] Some seeking care have even run up against what are known as “ghost networks,” lists from insurance providers that are padded with clinicians who either don’t take new patients or are no longer in-network. In one 2015 study, researchers posing as patients called three 360 psychiatrists from a list of in-network blue cross blue shield providers. But only 40% of those calls were answered, and 16% of the numbers were wrong, including numbers for a McDonald’s, a boutique, and a jewelry store. Although, to be fair, if you’re a woman in the 1950s, a boutique and a jewelry store is apparently the only mental healthcare you need. [Laughter] “Buck up, dolly! You’ll be happier if you’re prettier!” And there are times where the inadequacy of these lists feels pretty deliberate. Take Melissa Davies, a psychologist in Ohio, who was part of anthem’s network for years when she worked for a large medical group. But when she started a solo practice, anthem refused to contract with her, saying the area was saturated, even though she was one of only three psychologists in the county, and when she examined their directory, she found a great number of their providers were no longer practicing or were dead. Look, it’s not that retirees and the dead don’t have their place in society. They absolutely do, it’s right in front of a tv set blasting fox news, but they’re not what you want to find when looking for healthcare. And because mental health is often seen as subjective and hard to measure, even when patients do find a provider, insurance companies can deny appropriate treatment. And even when they approve it, in some cases, they’ve intervened to put an early stop to it. Take this family, whose son dealt with suicidal ideation and had a horrible experience with their insurance.

After years of issues, this time his doctor prescribed residential treatment. Such facilities are not cheap but the good news is that Leah’s insurance, anthem, covers residential treatment.

They sent me an email saying he’s approved.

But, after checking him in, anthem came back and decided the treatment was not medically necessary. With insurance refusing to pay, Leah made the financially crushing decision to let her son stay and finish treatment, 85 days in all and $88,000 of her own money.

John: That’s obviously infuriating. And while the company did eventually agree to pay some of that bill, just imagine an insurance company reversing their decision in the middle of any other serious treatment. “Hey, we love how this heart surgery is going, just popping in to say, it’s done. Yeah, it’s done now. Hit the showers, everyone, great job. Don’t bother closing anything up, that’s not medically necessary.” [Laughter] And debates over coverage between insurance and health-care providers can get incredibly adversarial. A reviewer for anthem at one point had an average denial rate of 92% when it came to doctors’ requests for coverage. And yet, according to one of anthem’s medical directors at the time, there was a good reason their system operated that way.

Doctors will spin the clinical information. They will make things appear more serious than, perhaps, they are because they feel strongly the patient needs this level of care for a little longer. So you do have a somewhat adversarial relationship between the reviewer and the attending physician.

Was that best for the patient?

Well, it’s like our legal system. If you — each side, does a good job in presenting their case and asking the right questions, you ultimately arrive at the truth.

John: Oh, yeah. Because if there’s one thing we know about the American legal system, it’s that it always arrives at the truth. It’s why the innocence project is mostly just two guys in an empty office getting really good at ping pong. There’s simply nothing else for them to do. Now, I know treating critical health care as something doctors have to “win” may seem dangerous, but that man will have you know: it isn’t!

I cannot, offhand, think of a situation where a decision was made to discharge a patient from a hospital and some terrible consequence occurred soon thereafter. I’m sure it happens, but —

We found quite a few. [Laughter]

I’d have to look at them to see. There’s one that occurs to me that I was involved with where the child left the hospital with his parents, escaped from his parents, drove cross country to another state, and days later, committed suicide. Keeping that individual in the hospital longer is not likely to have made any difference.

I would have to imagine that the parents would say, if you’d kept him in the hospital, he wouldn’t have been in another state killing himself.

John: Holy shit. Do you think that guy went into that interview knowing he was about to be absolutely murdered by Scott Pelley on Network TV? Do you think he was getting ready in the morning, and thought “I’ve got that interview with CBS News’s Scott Pelley Tonight, I wonder if he’s going to take my stupidest soundbite and feed it back to me right through my fucking teeth?” [Laughter] Was he driving to the interview thinking “I wonder if any of the camera crew will step in as beloved, Peabody-award-winning newsman Scott Pelley runs me across the floor like a Swiffer mop, or will they just stand by as my lifeless body is deservedly whipped back and forth?” [Laughter] And if you’re wondering how insurers can get away with that sort of thinking, it’s partly because the government has, to this point, done shockingly little when it comes to enforcing parity laws. Multiple federal and state agencies have responsibility for this, but the truth is, they rarely penalize plans. The labor department, which oversees most workplace plans, closed just 74 investigations last year, finding violations in only 12. As for state-level enforcement, a study found they’ve levied fines just 13 times since 2017, which is absolutely pathetic. And it’s not just private insurers that are a nightmare. Community mental health clinics, which often serve low-income patients, are suffering as well, because the reimbursement rates for public insurance, like Medicare and Medicaid, are also woefully insufficient. Basically, from top to bottom, we significantly underpay mental health professionals, many of whom do difficult, high-burnout work. It’s no wonder so many opt out of the system. One study found patients are more than five times as likely to have to use out of network providers for behavioral care, than for other medical services. Just listen to these two counselors who spoke anonymously to local news about their concerns over what all this might mean.

The counselors say insurers take 90 days to pay them and the payments are so low, fewer mental health providers are taking insurance.

We will face a crisis where people are only able to get services if they can pay out of pocket.

Both therapists wanted us to conceal their identities out of concern for patient privacy and because they still have to work with insurance companies.

So as providers when people think, oh, you know, we’re just for the money, or we don’t care. Oh, no, we care. We care a lot. But these companies are also driving us into the ground and we can’t — this is not sustainable.

John: Yeah, of course it isn’t. Therapists are in a no-win situation here. And for what it’s worth, it’s not a great sign that insurance companies are now so powerful that mental health providers feel they have to go on the news like they’re in witness protection after seeing someone get whacked. [Laughter] And the thing is, some out-of-network therapists can make a lot of money, if they live in an area with patients that can afford to pay out of pocket. But for the many who don’t, they’re stuck taking whatever insurance companies are willing to pay, which explains why psychiatry was ranked one of the lowest in compensation among 29 medical specialties. And it’s not just doctors. Counselors and social workers with masters degrees earn 33% to 45% less than other health professionals with a comparable education. And as bad as our situation is right now, it’s getting worse. One survey in Massachusetts said that for every ten clinicians entering work in mental health clinics there, 13 leave. And if we continue at that rate, one day, we’re going to wind up with negative therapists, which I’m pretty sure is what you call anyone who responds to your serious mental health issues with “interesting, I can’t wait to get into my jammies later.” [Laughter] And the costs of leaving mental health untreated can be massive, not just for those needing it, but for all of us. Mental health problems are a big driver of homelessness, and also force people into contact with the criminal justice system. In fact, it’s often said that correctional facilities have become the largest providers of mental health care services in our country. Basically, we’ve gone from warehousing people with mental illness in buildings that felt like prisons, to warehousing them in actual prisons instead. It’s very much the “new look, same great taste” of America’s failures. [Laughter] So how do we fix all this? Well, first, this is clearly an absurd way to operate a health care system. And for the umpteenth time, I’d argue single-payer health care is the way to go. [Applause] Unfortunately, we can’t get that, because it’s very high up on a shelf. [Laughter] I don’t know who left it there, but they must’ve been tall because it is way too high to reach. And if you’re thinking, why not use a ladder? The ladder’s also on the shelf. [Laughter] It’s a really frustrating situation. But in the absence of that, we need to both recruit more mental healthcare professionals, and make sure that insurers cover them properly. Now, on the first point, the Biden administration, to its credit, announced a plan back in march that’d provide $100 billion in mandatory funding over ten years to transform our current system, which includes investing $700 million in programs to cover everything from training to scholarships and loan repayments for those committed to working in underserved areas. But obviously, that’s only half the battle. On the insurance company side, we badly need to be strengthening and enforcing those mental-health parity laws, at both the state and federal level. California has actually put in one of the most comprehensive parity laws in the country. Among many, many other things, it requires that insurers must base medical necessity determinations on current, generally accepted standards of mental health care, instead of just making up the criteria for themselves. That is a very big deal, and more states should follow California’s lead. In the past, so much of the problem was that people wouldn’t ask for help, and thankfully that’s now less of an issue now, thanks to, among other things, the tireless gland shaming of mr. Harrison Ford. [Laughter] But now, when people do reach out for help, we’re just not in a position to give it to them. If we want to be a society that truly respects and values mental health, we have to respect and value mental health care. And that means supporting the people who deliver it. Look, it’s going to take a lot of investment and continued resolve to fix things, but it’s also worth it. Because it can’t be the case that, when people ask for help, our only option is to tell them to “suck it up, buttercup.” And now, this.

* * *

Announcer: And now, the world’s horniest televangelist. Speaker everywhere I go I tell people to stroke their bible, rub it over your face.

I really like that. I look at a woman’s ankles, her toenails, her fingernails.

I don’t know why cutoffs are sexy, but they are. I don’t like long shorts come I want to see everything I can, I am a man.

You think when I think of marriage I am thinking of black-eyed peas, corn, glass of iced tea? That is married? Are you kidding me? I want a sex pot stripping on stage in front of me in the bedroom. ♪ ♪

Cover those up, but she wants you to see the mountains because men see mountains and they start thinking.

31 Secrets of an unforgettable woman. Unbelievable book, I started crying when I started reading this book that I was writing. [Laughter] [applause]

John: That’s our show, thanks so much for watching. To see you next week, good night.

In December, I’ll be in Beijing, opening up new pork


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