Tuesday, April 23, 2013

Medicare for All? It's Not That Simple

Every Tuesday afternoon for the past two years, I've met with a trauma therapist. Pursuing a course of more specialized treatment was a option suggested to me by another psychologist, one who knew she had done all that she could with me. Before I began the process of finding a new provider, I felt that the search wouldn't be nearly as challenging as it turned out to be. My number one problem at the outset was finding a qualified specialist who took insurance, any insurance. Increasingly these days, specialists in certain fields have been insisting that all fees ought to paid out of pocket.

It does bother me immensely that some psychotherapists in the Washington, DC, area are charging as much per hour as lawyers. One thing I have learned about this city is that there is an overabundance of vocations present, psychologist and attorney being only two of them. This practice is highly exclusionary, even though I recognize that competition for business is heavy. The problems I've observed are not felt across the board, but the fact that they are present anywhere gives reason for concern.

There was a time, you may recall, where several of us unapologetic progressives wanted a single-payer health care system, or Medicare for everyone. From discussions with doctors and specialists, I've learned that Medicare as currently configured has some substantial problems. Psychologists and psychiatrists usually don't take Medicare because the rates of reimbursement are too low for them to stay in business. The amount of paperwork required is extensive and regularly too complicated to justify the time spent. Medicare is highly profitable for surgeons, however, because the surgeons' lobby is strong.

In examining the itemized statements that arrive one-by-one in my mailbox, the amount of money paid out to doctors is at times somewhere between incredible and obscene. My psychiatrist might charge $150 an hour, but a relatively simplistic surgical procedure to remove a pilonidal cyst costs $11,000 from start to finish. The surgeon must be paid, the anesthesiologist compensated, the drugs given to put me under covered in full, and more, even down to the IV put into my arm prior to surgery.

When we are still debating and coming to grips with the vast amount of avoidable violence that comes from mental illness + a firearm, we would do well to provide mental health providers their fair share of payment. Our tax dollars compensate their hard work. It is they who are on the front lines, providing an extremely necessary service to the community and to each of us. If we valued them more, we might not have to worry about a Congress too constipated to pass even basic safety and protection for every American.  

The Patient Protection and Affordable Care Act will not be fully in effect until January 1 of next year. Because I'll still have chronic illnesses in need of treatment, I know I'll be able to observe firsthand the new changes. Some doctors I've talked to are privately nervous about any change whatsoever, not sure exactly what to expect. If I've learned anything about politics, it's that one never knows quite what one will receive until it is in force. Political promises are a dime a dozen. I support health care reform, for myself and for others. But I foresee some bumps and jostling along the way that will require periodic legislative overhaul.

Lest my meaning be misconstrued, the quality of care I have received has been excellent, most of the time. When partnered with hospital systems or other large self-contained systems, Medicare and Medicaid provide a sufficient means of treatment. Small practices, however, rarely take either of them.

Collective mindset can be another hurdle. Mental health providers are often too focused on saving the world than to partner together to lobby for competitive rates of pay. Legislation might seek to be the great leveler, but in the end, the politically well-connected will always be in first place. As much as I may distrust the profession and find lobbying distasteful, it might be worth every American getting one of his or her own.   

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