Sunday, May 1, 2011

Provider, Employer, Consumer, I

I want to talk with you about Single Payer Healthcare from the perspectives and concerns of an allied health care, non-medical, private practitioner and public health provider/manager. I’m a Jungian psychotherapist with a Marriage and Family Thearpist license. A short list of my career of over 30 years includes mental health, substance abuse, HIV/AIDS, supportive housing, in home care, non-profit service and executive management, public policy development and advocacy. All these are tremendously impacted by the reimbursement system—private and public.

I’ve been practicing so long that I remember billing insurance companies $120 a session. And you know what they paid me? $120! And that was when $120 was real money. Now-a-days insurance reimburses about $60 a session and severely limits the number of sessions.

Along the way I’ve experienced an unending cascade of catastrophic attempts to control costs of services. Another way of saying that is though services were inadequate to begin with we were asked to to do more and more with less and less and what actually happens is less. Another way of saying that is the less we got the more profit the insurance companies got to keep.

I’ve seen that fee for service “full reimbursement” I mentioned . I’ve also seen and worked with, in no particular order--community rating, experience rating, capitation, case rate, DRGs, HSAs, HMOs, IPAs, FSAs, EMRs, Provider Groups, Consumer Driven, Consolidation, Co-pay, Co-insurance, Deductible, Out of Pocket, Carve Outs, Carve Ins, Authorization, Assertive Community , Targeted Populations, Best Practice… and though the list is far from complete, let me just finish with everyone’s favorite—-PRE EXISTING CONDITION EXCLUSION.

You know what? YES, you KNOW! NONE of them work. None of them deliver adequate services and none of them contain overall cost. This is greed over service. It is, frankly, cruel. As the current GOP/ Ryan Budget has finally exposed.

SO THE QUESTION IS how do we change all this and what do we change it to ?.

SINGLE PAYER is the proven approach used by much of the quote/unquote “developed” world. WHY? Because it works and because they have had the fortitude to focus on solving problems not on , for example, where their head of state was born. It is this kind of diversion tactics that has left us as at #1 in health spending and 37th in health outcomes.

There is so much to say about the superiority of single payer. The one point I want to underscore here is that with single payer you get a system that takes responsibility for overall care including future costs. Unlike the current patchwork system, single payer recognizes that it has to bear the costs now and later. It is incentivized to provide adequate treatment to reduce future costs. Private insurers know that if they deny service now, probably someone else will be faced with the bigger bill later. They are incentivized to kick the can-sumer down the road.

The importance of our work surely stands on its own. But, this bears on us as allied health professionals because it is certainly demonstrable that our services now are important drivers for reduced costs later.

As allied health professionals—mental health, chiropractic, substance abuse, etc. we are included in the single payer coverage. As consumers, we are, of course, covered. And if we are employers we will also be impacted by it.

I am looking forward as a knowledgeable activist consumer to a more complete, humane health care system. However it works out, exactly, it is clear to me that we will get more predictable, less expensive, understandable, comprehensive services . Imagine if you didn’t have to worry about your health care costs, your families, or see your neighbor lose their house because of some catastrophic illness. Over half of the bankruptcies in the US are related to medical costs.

I know as a provider we have a lot of questions as to how this will affect our practices, fees, reimbursement, paper work, etc. Will services be on demand or will they need prior authorizations? Are we looking at a fee-for –service? Will the program essentially be a “consumer-voucher” for service ? Will there be ways to aggregate funds into programming ? Will the regulations and billing processes be as onerous as they currently are for MediCare Mental Health? Will it recognize the need for and efficacy of long-term , depth work? What providers will be included/excluded? Will it be allowed to truly be a “behavioral health” approach and dispense with substance abuse morality issues? Will it help promote service delivery to lower socio-economic groups and efforts against stigma?

Will universal coverage force us to participate in an insurance system that is underpayed and over administered at the same time it dries up our high paying private client pool?

How will it impact us as employers? Probably payroll tax and employee tax will be revenue sources— how will these be structured so that they are more affordable than the current system ?

It won’t come for free—but it will be less expensive and provide better care. How its finances and delivery systems are structured will be best determined by those involved in its creation and maintenance. These issues need to be being addressed in all our policy and advocacy discussions.

I'll be exploring and discussing this as we go along. For now, it is true that I can not give you clear answers on all these questions. Many of them are "in process," depending on how legislation and regulation is developed. That is to say, that the current answer seems to amount to “it will all come out in the wash.” It is imperative that we are involved in this particular laundry.

The current legislative process develops regional councils to design answers to these and other questions. Will this be adequate/will allied health have enough political will and presence to sufficiently address our concerns?

So while you/we are dealing with the usual cascade of crises that seem to make up our lives and work , we really need to attend to this tipping point before we are tipped without being part of the tipping. (To keep up to date and to get involved check out PNHP CA)


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