One of the questions I have seen bantered back and forth through the vitriol on the Internet is: “If Jared Lee Loughner was obviously schizophrenic and full of disorganized and confused thought, as many people who interacted with him reported, why did he not get help?”

Some thoughts on why:

1. Schizophrenia appears in young men around the end of puberty, between 18-25.

2. By time it starting showing obvious, overt signs of disorganized thought, he was unlikely to still be on his parent’s health insurance. It was only this year that a child could be on the parent’s health insurance until age 26.

3. According to reports, his father didn’t work and his mother had an hourly job with the city. Who knows if they even had health insurance, or if the city health insurance plan covered mental illness, which it probably did not.

4. He couldn’t hold a job and didn’t have any health insurance himself. The few jobs he had were big box stores and sandwich shops.

Getting into a psychiatrist, getting evaluated, getting seen meant seeing a doctor. That meant having coverage because the family was unlikely to have the cash on hand for psychiatrist visits. Even being involuntarily committed to a hospital for emergency treatment meant the uninsured going to a hospital where there would be incurred in-patient costs, doctor costs, medication costs. The costs for medications alone to help curb the effects of schizophrenia would be incredibly prohibitive for parents making little money and, of course, he would be totally uninsurable going forward because had he seen a doctor he would then have a “pre-existing condition.” And he would have that for the rest of his life. Those medications meant constant ongoing, expensive costs.

If he had gotten diagnosed — which was a very expensive and probibitive hill to climb to begin with — maybe he could have eventually gone on Medicaid, but at what toll? To live in poverty so he could get medications to control the hallucinations?  That’s an option, but he would have had to get there, first.

The stark reality is that this country has terrible support for childhood and late adolescence mental illness but the seriously mentally ill can stroll casually into a Sportsman’s Warehouse and buy a gun with an extended clip. This says more about our priorities as a society than anything else that has been said the last five days about what happened in Tuscon. The system failed.

We stand at an ugly intersection of where health care for the mentally ill is prohibitive but gun access is trivial. We cannot have one and have the other and expect to live in in safety. We either put up with “nuts with guns” who kill little girls or this changes. If anything comes out of this tragedy, I hope we at least begin to talk about how difficult it is to get people like Jared Lee Loughner help long before it is too late.