{"id":131,"date":"2009-07-31T17:45:07","date_gmt":"2009-08-01T00:45:07","guid":{"rendered":"http:\/\/blog.stevenreidbordmd.com\/?p=131"},"modified":"2009-08-01T17:46:16","modified_gmt":"2009-08-02T00:46:16","slug":"healthcare-reform-psychiatry","status":"publish","type":"post","link":"http:\/\/blog.stevenreidbordmd.com\/?p=131","title":{"rendered":"Healthcare reform & psychiatry"},"content":{"rendered":"

\"forestThe recent debates over U.S. healthcare reform are long overdue, yet still sadly inadequate. \u00a0(The discussion is about health insurance<\/em>, actually, not the care itself. \u00a0But I titled this post “healthcare reform” since that is what everyone is calling it.) \u00a0There is no need to rehash the plentiful evidence that the current system is broken: millions of uninsured, job lock<\/a> to maintain health coverage, unwarranted claim delays and denials, whole industries devoted to medical paperwork and reimbursement, and the near impossibility, given a pre-existing condition, of purchasing non-employment based insurance at any price. \u00a0Hardly anyone across the political spectrum argues for the status quo.<\/p>\n

The national debate centers on how to provide universal, or universally available, coverage to all Americans. \u00a0Some argue that with proper incentives, private insurers could cover everyone. \u00a0Similar to health coverage in the Netherlands, this proposal aims to preserve the private insurance industry and competition in the marketplace. \u00a0Others argue that health care does not follow classic supply-demand principles, and that competition among private insurers has not controlled costs. \u00a0A publicly funded, government-sponsored option is preferred to remove the profit motive and gain efficiency through standardization.<\/p>\n

Universal health coverage is the norm in virtually all developed countries. \u00a0I believe Turkey and the U.S. are the only remaining exceptions. \u00a0Some nations, Britain for example, have nationalized health care<\/a> \u2014 doctors are government employees. \u00a0Others, like Canada<\/a>, use public funds to pay doctors in private practice, much as Medicare currently operates in the U.S. \u00a0These systems are not perfect. \u00a0In particular, there are longer waiting times for elective procedures, sometimes on the order of months. \u00a0But surveys<\/a> repeatedly<\/a> show that citizens (and doctors<\/a>) of these countries are happier with their health services than Americans are with ours. \u00a0And studies also show their health outcomes are the same or better than ours, for far less<\/a> money<\/a>.<\/p>\n

There are many places to read about health insurance reform that do a better job than I can (e.g., here<\/a>). \u00a0From my reading, I believe a single-payer plan such as those in \u00a0Australia, Canada<\/a>, and Taiwan would greatly improve health care in the U.S., while preserving patients’ ability to choose their own doctors, and also doctors’ ability to work in the private sector. \u00a0It’s a pity this option, so popular across the globe, is a political third-rail here. \u00a0In my view, publicly funded health insurance (think Medicare) is no more “socialist” than the public funding of highways, police departments, and firefighters.<\/p>\n

In a nutshell, that’s my view of publicly funded health insurance in general medicine and surgery. \u00a0But what about psychiatry in particular?<\/p>\n

Universal coverage would be a boon for the seriously mentally ill. \u00a0Schizophrenia and severe chronic mood disorders render many sufferers unemployable and ineligible for private insurance. \u00a0Some eventually qualify for Medicare and\/or Medicaid, the limited forms of public health insurance that already exist. \u00a0The additional stigma attached to using public programs due to severe disability would abate if public health insurance became a mainstream reality. \u00a0Others with debilitating but less severe forms of mental illness do not qualify for Medicare or Medicaid, but cannot maintain private insurance due to frequent job loss, chaotic lives, depression, and so forth. \u00a0The affordability of care and treatment is a constant stress atop an already stressful existence.<\/p>\n

Universal health coverage would change all that (see this report<\/a> from the California Endowment). \u00a0Canadians talk about their comfort in knowing their friends, acquaintances, coworkers \u2014 fellow citizens \u2014 have access to health care regardless of circumstance. \u00a0Healthy Americans might feel this way, too, when the chronically mentally ill among us<\/a> are assured access to care.<\/p>\n

At the other end of the psychiatric spectrum are relatively healthy individuals who seek psychotherapy for help in living a life that is basically stable, but is unfulfilling, frustrating, anxiety-laden, or sad. \u00a0In the U.S., most health insurance, private or public, limits coverage for this type of treatment. \u00a0Many private plans cap the number of treatment sessions to 20 or fewer per year; Kaiser Permanente additionally requires that a mental health professional “believes the condition will significantly improve with relatively short-term therapy.” \u00a0Medicare does not cap the number of visits, but covers only half its “allowed fee” \u2014 the patient or supplemental insurance pays the other half.<\/p>\n

It should be noted that traditional dynamic psychotherapy, the kind I do, considers it beneficial when the patient pays for therapy himself. \u00a0Directly paying for therapy focuses the dynamics between patient and therapist by excluding distracting intermediaries. \u00a0It matters more (to both parties) that the patient gets what he or she is paying for. \u00a0Sometimes patients express unstated feelings toward their therapist in how they pay their bill; this can be interpreted as transference<\/a>, moving the treatment forward. \u00a0Moreover, dynamic psychotherapy is an intensely private undertaking: \u00a0Many patients choose to forgo insurance coverage even if they have it, to avoid a public record of the treatment, or the need to document it with third parties.<\/p>\n

All that said, many more people can benefit by psychotherapy than can afford to pay for it directly. \u00a0A universal health plan that covered therapy in a substantial way (say, as Medicare does now) would make this service available to many who could not receive it before. \u00a0Third-party payment issues are handled all the time in dynamic therapy even now. \u00a0And not all therapy is psychodynamic; I know of no concerns regarding CBT (cognitive behavioral therapy), for example, being paid by third parties.<\/p>\n

In short, U.S. healthcare \u2014 more accurately, health insurance \u2014 reform that universally covered mental health treatment would revolutionize care of the mentally ill in this country. \u00a0Benefits could be as visible as fewer homeless on the streets and in the jails, as subtle and pervasive as a comforting sense that Americans care about each other both in body and spirit. \u00a0I hope we have the will and the wisdom to make it happen.<\/p>\n","protected":false},"excerpt":{"rendered":"

The recent debates over U.S. healthcare reform are long overdue, yet still sadly inadequate. (The discussion is about health insurance, actually, not the care itself. But I titled this post “healthcare reform” since that is what everyone is calling it.) There is no need to rehash the plentiful evidence that the current system is broken: […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[4,8],"tags":[70,14,24],"class_list":["post-131","post","type-post","status-publish","format-standard","hentry","category-current-events","category-psychotherapy","tag-current-events","tag-fees","tag-transference","odd"],"aioseo_notices":[],"_links":{"self":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/131","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=131"}],"version-history":[{"count":13,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/131\/revisions"}],"predecessor-version":[{"id":146,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/131\/revisions\/146"}],"wp:attachment":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=131"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=131"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=131"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}